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Feasibility of Achieving Nutritional Adequacy in Critically Ill Children with Critical Neurological Illnesses
Marwa Mansour1, Nicole Knebusch1, Jennifer Daughtry2
1Division of Critical Care Medicine, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, TX 77030, USA.
Insights
Critically ill children with neurological conditions can achieve 60% of their nutritional needs in the pediatric intensive care unit (PICU). Early dietician evaluation improves nutrition adequacy for these vulnerable pediatric patients.
Area of Science:
- Pediatric critical care nutrition
- Neurological critical illness
- Clinical nutrition research
Background:
- Literature on nutritional needs of critically ill children, especially those with critical neurological illnesses (CNIs), is limited.
- Achieving two-thirds of nutritional needs in the first week of pediatric intensive care unit (PICU) admission is linked to lower mortality.
- The feasibility of meeting 60% of recommended dietary intake in the first week for pediatric CNI patients is uncertain.
Purpose of the Study:
- To determine the feasibility of achieving 60% of recommended caloric and protein intake within the first week of PICU admission for children with CNIs.
- To identify factors influencing nutrition goal adequacy in this pediatric population.
- To assess the impact of early clinical dietician evaluation on nutrition outcomes.
Main Methods:
- Observational retrospective cohort study of children (1 month to 18 years) with CNIs admitted to the PICU from January 2018 to June 2021.
- Collection of demographic data, anthropometric measures, and enteral/parenteral caloric and protein intake during the first PICU week.
- Definition of goal adequacy as achieving ≥60% of recommended dietary intake for calories and protein.
Main Results:
- Of 1112 patients assessed, 12% were underweight. By day 3, 50% of patients <2 years and 25% of patients >2 years achieved goal adequacy (p<0.0005).
- Underweight patients showed higher goal adequacy by day 3 (60%) compared to non-underweight patients (30%) (p<0.003).
- Over half the cohort achieved 60% intake by days 5 and 7; early dietician evaluation (within 48h) correlated with higher nutrition adequacy.
Conclusions:
- Achieving 60% of recommended nutrition within the first week is feasible for a significant portion of pediatric CNI patients in the PICU.
- Younger age and underweight status were associated with better early nutrition goal achievement.
- Early intervention by clinical dieticians is crucial for optimizing nutrition support and improving outcomes in critically ill children with neurological conditions.
Abstract:
The literature on the nutritional needs and outcomes of critically ill children is scarce, especially on those with critical neurological illnesses (CNIs). Current evidence shows a lower mortality in patients who achieve two-thirds of their nutritional needs during the first week of pediatric intensive care unit (PICU) admission. We hypothesized that achieving 60% of the recommended dietary intake during the first week of a PICU stay is not feasible in patients with CNI. We designed an observational retrospective cohort study where we included all index admissions to the PICU in our institution of children (1 month to 18 years) with CNI from January 2018 to June 2021. We collected patient demographics, anthropometric measures, and caloric and protein intake (enteral and parenteral) information during the first week of PICU admission. Goal adequacy for calories and protein was defined as [(intake/recommended) × 100] ≥ 60%. A total of 1112 patients were included in the nutrition assessment, 12% of whom were underweight (weight for age z score < -2). Of this group, 180 met the criteria for nutrition support evaluation. On the third day of admission, 50% of the patients < 2 years achieved caloric and protein goal adequacy, compared to 25% of patients > 2 years, with p-values of 0.0003 and 0.0004, respectively. Among the underweight patients, 60% achieved both caloric and protein goal adequacy by day 3 vs. 30% of non-underweight patients with p-values of 0.0006 and 0.002, respectively. The results show that achieving 60% of the recommended dietary intake by days 5 and 7 of admission was feasible in more than half of the patients in this cohort. Additionally, children who were evaluated by a clinical dietician during the first 48 h of PICU admission reached higher nutrition adequacy.
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