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Nutrition support in children discharged from the pediatric intensive care unit: A bi-national prospective cohort
Jacinta Winderlich1,2,3, Bridget Little4, Felix Oberender2,5
1Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
Insights
Critically ill children often do not meet nutrition needs after pediatric intensive care unit (PICU) discharge. Many children receiving enteral nutrition (EN) or oral intake alone fail to meet energy and protein requirements during ward recovery.
Area of Science:
- Pediatric critical care medicine
- Clinical nutrition
- Pediatric recovery and rehabilitation
Background:
- Nutrition is crucial for critically ill children's recovery, but post-PICU nutrition support is poorly understood.
- Current practices for nutrition provision in children after pediatric intensive care unit (PICU) discharge require investigation.
Purpose of the Study:
- To describe ward nutrition support in children after PICU discharge.
- To assess energy and protein intake in children during the recovery phase on the ward.
Main Methods:
- A prospective study enrolled 108 children (up to 18 years) from nine PICUs with >48-hour stays.
- Data on oral intake, enteral nutrition (EN), and parenteral nutrition (PN) were collected on the first ward day post-PICU discharge and on days 7, 14, 21, and 28.
- Energy and protein provision from oral and EN routes were analyzed against estimated requirements.
Main Results:
- On the first ward day, 69% received EN, 50% oral intake, and 7% PN.
- Among children on oral nutrition only, 36% received <50% of energy and protein needs.
- Children receiving EN alone frequently failed to meet energy (17%) and protein (15%) targets, with shortfalls increasing by Day 28 (33% and 42%, respectively).
Conclusions:
- Ward-based nutrition support for children post-PICU involves consistent use of EN and PN up to 28 days.
- A significant proportion of children receiving EN or oral intake alone do not meet their estimated energy and protein requirements during ward recovery.
Objectives:
The role of nutrition in the recovery of critically ill children has not been investigated and current nutrition provision in the post-pediatric intensive care unit (PICU) period is unknown. The primary objective of this study was to describe ward nutrition support in children following PICU discharge.
Methods:
Children up to 18 years admitted to one of nine PICUs over a 2-week period with a length of stay >48 h were enrolled. Data were collected on the first full ward day following PICU discharge and on Days 7, 14, 21, and 28 following PICU admission. Data points included oral intake, enteral (EN) and parenteral nutrition (PN) support, and oral and EN energy and protein provision.
Results:
Among the 108 children, on the first full ward day 75/108 (69%) children received EN, 54/108 (50%) oral intake, and 8/108 (7%) PN. Of those receiving oral nutrition only on the first full ward day (25/108; 23%), 9/25 (36%) received <50% of their estimated energy and protein requirements. Of those provided EN only, and where nutrition targets were known, on the first full ward day 8/46 (17%) and 7/46 (15%) met <75% of their estimated energy and protein requirements, respectively. On Day 28, this increased to 4/12 (33%) and 5/12 (42%).
Conclusions:
In this study of ward-based nutrition support, key findings included consistent use of EN and PN up to at least 28 days following PICU admission, and a high proportion of children receiving EN or oral intake only not meeting their estimated energy and protein requirements.
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