Nutrition provision in Australian and New Zealand PICUs: A prospective observational cohort study (ePICUre)
Jacinta Winderlich1, Bridget Little2, Felix Oberender3
1Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; Nutrition and Dietetics, Monash Children's Hospital, Melbourne, Australia; Paediatric Intensive Care Unit, Monash Children's Hospital, Melbourne, Australia.
Insights
Nutrition provision in Australian and New Zealand pediatric intensive care units (PICUs) shows room for improvement. Many children received inadequate enteral nutrition (EN) and timely dietetics assessments were lacking.
Area of Science:
- Pediatric intensive care
- Clinical nutrition
- Dietetics
Background:
- Optimizing nutrition is critical for critically ill children.
- Current nutrition provision practices in Australian and New Zealand (ANZ) pediatric intensive care units (PICUs) are not well-described.
- Understanding current practices is essential for identifying areas for improvement.
Purpose of the Study:
- To describe nutrition provision in ANZ PICUs.
- To assess the adequacy of enteral nutrition (EN) up to day 28 of PICU admission.
- To determine the rate and timing of dietetics assessments and methods for estimating nutritional requirements.
Main Methods:
- Observational study conducted in all ANZ tertiary-affiliated specialist PICUs.
- Included children ≤18 years admitted to the PICU for ≥48 hours.
- Collected data on oral intake, EN, parenteral nutrition, energy/protein adequacy, and dietetics assessment over 28 days.
Main Results:
- 141 children were enrolled; 73% received EN on day 7.
- Of those receiving EN, 64% received <75% of estimated requirements.
- Dietetics assessment was provided to 57% of children, with higher rates in those with longer PICU stays.
Conclusions:
- Significant opportunities exist to enhance EN adequacy in ANZ PICUs.
- Nutrition assessment practices require improvement.
- Further research is needed to optimize nutrition delivery in pediatric critical care settings.
Objectives:
The main aim of this study was to describe nutrition provision in Australian and New Zealand (ANZ) pediatric intensive care units (PICUs), including mode of nutrition and adequacy of enteral nutrition (EN) to PICU day 28. Secondary aims were to determine the proportion of children undergoing dietetics assessment, the average time to this intervention, and the methods for estimation of energy and protein requirements.
Methods:
This observational study was conducted in all ANZ tertiary-affiliated specialist PICUs. All children ≤18 y of age admitted to the PICU over a 2-wk period and remaining for ≥48 h were included. Data were collected on days 1 to 7, 14, 21, and 28 (unless discharged prior). Data points included oral intake, EN and parenteral nutrition support, estimated energy and protein adequacy, and dietetics assessment details.
Results:
We enrolled 141 children, of which 79 were boys (56%) and 84 were <2 y of age (60%). Thirty children (73%) received solely EN on day 7 with documented energy and protein targets for 22 (73%). Of these children, 14 (64%) received <75% of their estimated requirements. A dietetics assessment was provided to 80 children (57%), and was significantly higher in those remaining in the PICU beyond the median length of stay (41% in patients staying ≤4.6 d versus 72% in those staying >4.6 d; P < 0.001).
Conclusions:
This prospective study of nutrition provision across ANZ PICUs identified important areas for improvement, particularly in EN adequacy and nutrition assessment. Further research to optimize nutrition provision in this setting is urgently needed.
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