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An In-Depth Look at Nutrition Support and Adequacy for Critically Ill Children with Organ Dysfunction
Nicole Knebusch1,2, Paola Hong-Zhu3, Marwa Mansour1,2
1Division of Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, USA.
Insights
Critically ill children in the pediatric intensive care unit (PICU) with organ dysfunction (OD) received higher caloric and protein intake when their condition improved or stabilized. Nutritional support varied significantly based on organ dysfunction severity.
Area of Science:
- Pediatric Intensive Care
- Critical Care Medicine
- Clinical Nutrition
Background:
- Individualized nutrition support is crucial for pediatric intensive care unit (PICU) patients.
- Organ dysfunction (OD) is common in critically ill children, necessitating tailored nutritional strategies.
- Understanding nutrient delivery in the early phase of critical illness is essential for optimizing outcomes.
Purpose of the Study:
- To evaluate caloric and protein provision in the first seven days of hospitalization for critically ill children with organ dysfunction (OD).
- To assess the relationship between nutrient intake and the severity of organ dysfunction, as measured by the Pediatric Sequential Organ Failure Assessment (pSOFA) score.
Main Methods:
- Retrospective cohort study of 164 children (aged 2-18 years) admitted to a PICU between 2016-2017.
- Inclusion criteria: mechanical ventilation > 48 hours, PICU stay > 7 days.
- Organ dysfunction (OD) defined as a Pediatric Sequential Organ Failure Assessment (pSOFA) score > 5 on days 1 or 3; nutrition assessed via enteral and parenteral routes.
Main Results:
- Organ dysfunction (OD) prevalence was high (79.3% on day 1, 78.7% on day 3).
- On day 3, median caloric intake was significantly lower when pSOFA scores trended upward (0 kcal/kg/day) compared to decreased (9.2 kcal/kg/day) or unchanged (22 kcal/kg/day) scores (p=0.0032).
- Similarly, protein intake was lower with upward trending pSOFA scores (0 g/kg/day) versus decreased (0.44 g/kg/day) or unchanged (0.66 g/kg/day) scores (p=0.0023).
Conclusions:
- Organ dysfunction is prevalent in the initial 72 hours of PICU admission.
- Caloric and protein delivery was higher in patients whose organ dysfunction scores decreased or remained stable compared to those with worsening dysfunction.
- Nutritional support requires careful adjustment based on the dynamic changes in organ dysfunction severity in critically ill children.
Abstract:
Patients admitted to a pediatric intensive care unit (PICU) need individualized nutrition support that is tailored to their particular disease severity, nutritional status, and therapeutic interventions. We aim to evaluate how calories and proteins are provided during the first seven days of hospitalization for children in critical condition with organ dysfunction (OD). A single-center retrospective cohort study of children aged 2-18 years, mechanically ventilated > 48 h, and admitted > 7 days to a PICU from 2016 to 2017 was carried out. Nutrition support included enteral and parenteral nutrition. We calculated scores for the Pediatric Sequential Organ Failure Assessment (pSOFA) on days 1 and 3 of admission, with OD defined as a score > 5. Of 4199 patient admissions, 164 children were included. The prevalence of OD for days 1 and 3 was 79.3% and 78.7%, respectively. On day 3, when pSOFA scores trended upward, decreased, or remained unchanged, median (IQR) caloric intake was 0 (0-15), 9.2 (0-25), and 22 (1-43) kcal/kg/day, respectively (p = 0.0032); when pSOFA scores trended upward, decreased, or remained unchanged, protein intake was 0 (0-0.64), 0.44 (0-1.25), and 0.66 (0.04-1.67) g/kg/day, respectively (p = 0.0023). Organ dysfunction was prevalent through the first 72 h of a PICU stay. When the pSOFA scores trended downward or remained unchanged, caloric and protein intakes were higher than those that trended upward.
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