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Delivery of Enteral Nutrition after the Introduction of Practice Guidelines and Participation of Dietitians in Pediatric Critical Care Clinical Teams

      Abstract

      Provision of optimal nutrition is often difficult to achieve in the critically ill child, but can improve with better nutritional support practices. This study evaluated the joint impact of the introduction of enteral feeding practice guidelines and participation of dietitians in daily ward rounds on enteral nutrition (EN) intake and practices in children in intensive care. Nutritional intake and EN practices were audited before (period A) and after (period B) the introduction of enteral feeding practice guidelines and participation of dietitians in daily ward rounds in a pediatric intensive care unit. Information was collected on a daily basis and nutritional intake was compared with predefined targets and the United Kingdom dietary reference values. There were 65 patients and 477 nutritional support days in period A and 65 patients and 410 nutritional support days in period B. Basal metabolic rate (BMR) energy requirements were achieved in a larger proportion of nutritional support days in period B (BMR achieved [% nutritional support days]; period A: 27% vs period B: 48.9%; P<0.001). In patients admitted for nonsurgical reasons, median energy, protein, and micronutrient intake improved significantly. In the same group, the percentage of daily fluid intake delivered as EN increased post implementation (period A: median=66.8%; interquartile range=40.9 vs period B: median=79.6%; interquartile range=35.2; P<0.001). No significant changes were seen in patients admitted for corrective heart surgery. Implementation of better EN support practice can improve nutritional intake in some patients in critical care, but can have limited benefit for children admitted for corrective heart surgery.

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      References

        • Correia M.I.
        • Waitzberg D.L.
        The impact of malnutrition on morbidity, mortality, length of hospital stay and costs evaluated through a multivariate model analysis.
        Clin Nutr. 2003; 22: 235-239
        • Hulst J.M.
        • Joosten K.F.
        • Tibboel D.
        • van Goudoever J.B.
        Causes and consequences of inadequate substrate supply to pediatric ICU patients.
        Curr Opin Clin Nutr Metab Care. 2006; 9: 297-303
        • Pollack M.M.
        • Wiley J.S.
        • Kanter R.
        • Holbrook P.R.
        Malnutrition in critically ill infants and children.
        JPEN J Parenter Enteral Nutr. 1982; 6: 20-24
        • Hulst J.
        • Joosten K.
        • Zimmermann L.
        • et al.
        Malnutrition in critically ill children: From admission to 6 months after discharge.
        Clin Nutr. 2004; 23: 223-232
        • Mitchell I.M.
        • Logan R.W.
        • Pollock J.C.
        • Jamieson M.P.
        Nutritional status of children with congenital heart disease.
        Br Heart J. 1995; 73: 277-283
        • Mehta N.M.
        • Compher C.
        A.S.P.E.N. clinical guidelines: Nutrition support of the critically ill child.
        JPEN J Parenter Enteral Nutr. 2009; 33: 260-276
        • Cahill N.E.
        • Murch L.
        • Jeejeebhoy K.
        • et al.
        When early enteral feeding is not possible in critically ill patients: Results of a multicenter observational study.
        JPEN J Parenter Enteral Nutr. 2011; 35: 160-168
        • Doig G.S.
        • Simpson F.
        • Finfer S.
        • et al.
        Effect of evidence-based feeding guidelines on mortality of critically ill adults: A cluster randomized controlled trial.
        JAMA. 2008; 300: 2731-2741
        • Doig G.S.
        • Simpson F.
        • Sweetman E.A.
        • et al.
        Early parenteral nutrition in critically ill patients with short-term relative contraindications to early enteral nutrition: A randomized controlled trial.
        JAMA. 2013; 309: 2130-2138
        • Meyer R.
        • Harrison S.
        • Sargent S.
        • Ramnarayan P.
        • Habibi P.
        • Labadarios D.
        The impact of enteral feeding protocols on nutritional support in critically ill children.
        J Hum Nutr Diet. 2009; 22: 428-436
        • Petrillo-Albarano T.
        • Pettignano R.
        • Asfaw M.
        • Easley K.
        Use of a feeding protocol to improve nutritional support through early, aggressive, enteral nutrition in the pediatric intensive care unit.
        Pediatr Crit Care Med. 2006; 7: 340-344
      1. Bird J, Gentles E, Ellis D, et al. Guideline for introducing and establishing enteral nutrition in PICU. http://www.clinicalguidelines.scot.nhs.uk/PICU%20HDU%20guidelines/PICU%20guideline%20for%20introducing%20and%20establishing%20enteral%20nutrition%20in%20PICU%20v1.1.pdf. Accessed April 1, 2014.

        • Briassoulis G.
        • Zavras N.
        • Hatzis T.
        Malnutrition, nutritional indices, and early enteral feeding in critically ill children.
        Nutrition. 2001; 17: 548-557
        • Gurgueira G.L.
        • Leite H.P.
        • Taddei J.A.
        • de Carvalho W.B.
        Outcomes in a pediatric intensive care unit before and after the implementation of a nutrition support team.
        JPEN J Parenter Enteral Nutr. 2005; 29: 176-185
        • Schofield W.N.
        Predicting basal metabolic rate, new standards and review of previous work.
        Hum Nutr Clin Nutr. 1985; 39: 5-41
        • Holliday M.A.
        • Segar W.E.
        The maintenance need for water in parenteral fluid therapy.
        Pediatrics. 1957; 19: 823-832
        • Department of Health
        Dietary Reference Values for Food Energy and Nutrient for the United Kingdom. Report on Health and Social Subjects. No. 41.
        Stationery Office Book, London, UK1991
        • Cole T.J.
        Growth charts for both cross-sectional and longitudinal data.
        Stat Med. 1994; 13: 2477-2492
        • Heyland D.K.
        • Dhaliwal R.
        • Drover J.W.
        • Gramlich L.
        • Dodek P.
        Canadian clinical practice guidelines for nutrition support in mechanically ventilated, critically ill adult patients.
        JPEN J Parenter Enteral Nutr. 2003; 27: 355-373
        • Kreymann K.G.
        • Berger M.M.
        • Deutz N.E.
        • et al.
        ESPEN Guidelines on enteral nutrition: Intensive care.
        Clin Nutr. 2006; 25: 210-223
        • de Oliveira Iglesias S.B.
        • Leite H.P.
        • Santana e Meneses J.F.
        • de Carvalho W.B.
        Enteral nutrition in critically ill children: Are prescription and delivery according to their energy requirements?.
        Nutr Clin Pract. 2007; 22: 233-239
        • de Neef M.
        • Geukers V.G.
        • Dral A.
        • Lindeboom R.
        • Sauerwein H.P.
        • Bos A.P.
        Nutritional goals, prescription and delivery in a pediatric intensive care unit.
        Clin Nutr. 2008; 27: 65-71
        • Hulst J.M.
        • van Goudoever J.B.
        • Zimmermann L.J.
        • et al.
        The effect of cumulative energy and protein deficiency on anthropometric parameters in a pediatric ICU population.
        Clin Nutr. 2004; 23: 1381-1389
        • Lambe C.
        • Hubert P.
        • Jouvet P.
        • Cosnes J.
        • Colomb V.
        A nutritional support team in the pediatric intensive care unit: Changes and factors impeding appropriate nutrition.
        Clin Nutr. 2007; 26: 355-363
        • Briassoulis G.C.
        • Zavras N.J.
        • Hatzis MD T.D.
        Effectiveness and safety of a protocol for promotion of early intragastric feeding in critically ill children.
        Pediatr Crit Care Med. 2001; 2: 113-121

      Biography

      E. Gentles is a highly specialist dietitians in pediatric critical care, Paediatric Intensive Care Unit and Department of Dietetics and Nutrition, Royal Hospital for Sick Children, NHS Greater Glasgow and Clyde, Glasgow, UK.

      Biography

      J. Mara is a highly specialist dietitians in pediatric critical care, Paediatric Intensive Care Unit and Department of Dietetics and Nutrition, Royal Hospital for Sick Children, NHS Greater Glasgow and Clyde, Glasgow, UK.

      Biography

      K. Diamantidi is a registrar in pediatrics, Human Nutrition, School of Medicine, College of Medicine, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK.

      Biography

      H. A. Alfheeaid is a clinical nutritionist, Human Nutrition, School of Medicine, College of Medicine, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK.

      Biography

      K. Gerasimidis is a lecturer in clinical nutrition, Human Nutrition, School of Medicine, College of Medicine, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK.

      Biography

      N. Spenceley is a consultant pediatric intensivists, Paediatric Intensive Care Unit, Royal Hospital for Sick Children, NHS Greater Glasgow and Clyde and Human Nutrition, School of Medicine, College of Medicine, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK.

      Biography

      M. Davidson is a consultant pediatric intensivists, Paediatric Intensive Care Unit, Royal Hospital for Sick Children, NHS Greater Glasgow and Clyde and Human Nutrition, School of Medicine, College of Medicine, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK.