Abstract
Background
Establishing a caloric requirement or energy target is a recommended part of any nutrition
care plan.
Objective
Our objective was to describe early documentation of a caloric requirement in critically
ill children, and to determine if this would have any effect on daily energy intake
and route of nutrition.
Design
We used a descriptive chart review of a subgroup of patients included as part of a
larger, retrospective multicenter study. Variables of interest included nutritional
intake information, as well as presence/absence and amount of a documented caloric
requirement within 48 hours of admission.
Participants
Five of the original 12 study centers collected the required supplementary data. Enrolled
patients were those who were admitted to our pediatric intensive care unit (PICU)
from January 1, 2007, through December 31, 2008; were between ages 30 days and 18
years; and had a length of stay in the PICU ≥96 hours.
Statistical analysis
Energy intake among patients with and without a documented caloric requirement was
analyzed using Mann-Whitney U tests. The difference of receiving enteral nutrition among patients with and without
a caloric requirement was analyzed using a χ2 test.
Results
We studied 1,349 patients, of whom 644 (47.7%) had a caloric requirement documented
(95.6% of caloric requirements were entered by a registered dietitian) in the medical
record; these patients had higher total daily energy intake and were more likely to
be fed enterally during the first 4 days of PICU admission than those without a documented
caloric requirement (P<0.001 for all comparisons).
Conclusions
Less than half of critically ill children studied had a caloric requirement documented
in the medical record; when a caloric requirement was documented in the medical record
of a critically ill child, a registered dietitian had likely made the note. Having
a caloric requirement documented in the medical record is associated with a higher
energy intake and the use of the enteral route.
Keywords
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Biography
M. Wakeham is an assistant professor of pediatrics, Pediatric Critical Care Unit, Medical College of Wisconsin Children's Hospital of Wisconsin, Milwaukee.
Biography
J. Manzi is an acute care pediatric nurse practitioner, Pediatric Critical Care Unit, Medical College of Wisconsin Children's Hospital of Wisconsin, Milwaukee.
Biography
M. Scanlon is an associate professor of pediatrics, Pediatric Critical Care Unit, Medical College of Wisconsin Children's Hospital of Wisconsin, Milwaukee.
Biography
T. A. Mikhailov is an associate professor of pediatrics, Pediatric Critical Care Unit, Medical College of Wisconsin Children's Hospital of Wisconsin, Milwaukee.
Biography
M. Christensen is a clinical research coordinator, Pediatric Surgery Unit, Medical College of Wisconsin Children's Hospital of Wisconsin, Milwaukee.
Biography
E. M. Kuhn is a senior statistical analyst, National Outcomes Center, Children's Hospital of Wisconsin, Milwaukee.
Biography
P. S. Goday is an associate professor of pediatrics, Division of Pediatric Gastroenterology and Nutrition, Medical College of Wisconsin, Milwaukee.
Article info
Publication history
Published online: July 01, 2013
Accepted:
April 22,
2013
Footnotes
STATEMENT OF POTENTIAL CONFLICT OF INTEREST No potential conflict of interest was reported by the authors.
Supplementary materials: Podcast available at www.andjrnl.org/content/podcast
Identification
Copyright
© 2013 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.
