[Nutritional and metabolic support in the pediatric ICU]

Nutritional support has been considered an important part of the treatment of critically ill patients. The information about the current clinical pattern of nutrition support in hospitals may provide a basis for future modification and improvement of its prescription and use.

1) To evaluate patterns of usage and monitoring of nutritional support in critically ill children; 2) To recommend policies aiming at the improvement of the nutritional support quality.

Records of 37 patients receiving nutritional support throughout one year were reviewed.

From a total of 425 days of therapy, the single parenteral route was utilized in 80.50% the digestive route (tube feeding or oral route) in 19.5% of this time. A previous nutritional assessment was performed in 3 children; no patient had the nutrition goals set. The nitrogen to nonprotein calories ratio ranged between 1:80 and 1:250. Only 29.7% of the patients had their estimated caloric needs supplied and this goal was achieved only in those patients who were on enteral tube feeding. Patients did not achieved their goals for vitamins. The supply of oligoelements was adequate except zinc. Nutritional monitoring parameters including weight, serum albumin and serum triglycerides were performed in almost all the patients but without uniformity.

There was a lack in the implementation of nutritional support. Inadequacy of protein and micronutrients supply, irregular nutritional monitoring and infrequent enteral feeding were detected. A minimal standard for nutritional and metabolic monitoring and the organization of a multidisciplinary team in charge of coordinating the providing of nutritional support are suggested.