Relationship between acute nutritional goal achievement and outcomes in critically ill pediatric patients: A single-center retrospective cohort study
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Published on: September 20, 2019
Satoshi Nakano1, Takehiro Niitsu1, Ikuya Ueta1
1Department of Emergency and Critical Care Medicine, Saitama Children's Medical Center, Saitama, Japan.
Insights
Achieving nutritional goals in critically ill children via enteral nutrition (EN) within a week significantly shortens hospital stays and reduces complications. Early EN optimization improves outcomes for these vulnerable patients.
Area of Science:
- Pediatric Intensive Care
- Clinical Nutrition
- Critical Care Medicine
Background:
- Malnutrition is common in critically ill children, impacting outcomes.
- Guideline-recommended nutritional targets are crucial but their impact is unclear.
- This study investigates the link between achieving nutritional goals and outcomes in a Japanese pediatric intensive care unit (PICU).
Purpose of the Study:
- To examine the association between achieving American Society for Parenteral and Enteral Nutrition (ASPEN) goals via enteral nutrition (EN) and clinical outcomes.
- To determine if meeting nutritional targets within 7 days impacts length of stay (LOS) and other complications.
- To support the optimization of early EN in critically ill children.
Main Methods:
- Retrospective cohort study of 110 children (<16 years) in a PICU requiring mechanical ventilation and ≥7 days stay.
- Comparison of patients achieving ASPEN goals (≥2/3 energy, ≥1.5g/kg/day protein via EN within 7 days) versus those who did not.
- Multivariable Cox proportional hazards models used to assess the association with total LOS.
Main Results:
- 72.7% of patients achieved nutritional goals.
- The achievement group had significantly shorter LOS (12 vs 20 days).
- Meeting nutritional targets was independently associated with a higher likelihood of discharge (aHR 2.41) and fewer new-onset infections (8.8% vs 40%).
Conclusions:
- Achieving ASPEN-recommended nutritional targets via EN within the first week is strongly associated with shorter LOS and reduced complications.
- Early EN achievement may serve as a marker of better prognosis in critically ill children.
- Optimization of early EN is supported for this vulnerable population.
Background:
Although malnutrition in critically ill children is linked to poor outcomes, the impact of achieving guideline-recommended nutritional goals remains unclear. We examined the association between achievement of American Society for Parenteral and Enteral Nutrition (ASPEN) goals via enteral nutrition (EN) and clinical outcomes in a Japanese pediatric intensive care unit (PICU).
Methods:
This single-center, retrospective cohort study included patients aged <16 years admitted between July 2022 and December 2024 who required mechanical ventilation and had a PICU/high care unit (HCU) stay of ≥7 days. We compared patients who achieved the ASPEN goal (≥2/3 of resting energy expenditure and ≥1.5 g/kg/day protein via EN) within 7 days with those who did not. Multivariable Cox proportional hazards models were used to evaluate the association between nutritional goal achievement and the primary outcome of total length of stay (LOS).
Results:
Of the 110 patients, 80 (72.7%) achieved their nutritional goals. The achievement group had a significantly shorter total LOS (median 12 vs 20 days; P < 0.001). After multivariable adjustment, meeting the nutritional target was independently associated with a higher likelihood of discharge (adjusted hazard ratio: 2.41; 95% confidence interval: 1.45-4.02; P < 0.001). The achievement group also had fewer new-onset infections (8.8% vs 40%) and more ventilator-free days.
Conclusion:
Achievement of ASPEN-recommended nutritional targets through EN within the first week is strongly associated with short LOS and reduced complications in critically ill children. Although early EN is a potential marker of better prognosis, our findings support its optimization in this vulnerable population.
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