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Implementation of Nutrition Support Guidelines May Affect Energy and Protein Intake in the Pediatric Intensive Care Unit

      Abstract

      Background

      Critically ill children are at risk of developing malnutrition, and undernutrition is a risk factor for morbidity and mortality.

      Objective

      The study evaluated changes in the energy and protein intake before and after implementation of nutrition support (NS) guidelines for a pediatric critical care unit (PICU).

      Design

      This retrospective study documented energy and protein intake for the first 8 days of PICU stay. Basal metabolic rate and protein needs were estimated by Schofield and American Society for Parenteral and Enteral Nutrition Guidelines, respectively.

      Participants/setting

      Three hundred thirty-five children from August to December 2012 (pre-implementation) and 185 from October to December 2013 (post-implementation).

      Intervention

      Implementation of NS Guidelines.

      Main outcome measures

      Changes in actual energy and protein intake in the post- compared with the pre-Implementation period.

      Statistical analysis performed

      Unpaired t tests, Pearson’s χ2 (unadjusted analysis) were used. Logistic regressions were used to estimate odds ratios and 95% confidence intervals for protein and energy intake, adjusted for age, sex, and Pediatric Risk of Mortality score.

      Results

      After the implementation of guidelines, significant improvements were seen during days 5 through 8 in energy intake among children 2 years of age and older, and in protein intake in both age groups (P<0.05). For the 8-day period, statistically or clinically significant improvements occurred in the cumulative protein deficit/kg/day, as follows: younger than 2-year-olds, −1.5±0.7 g/kg/day vs −1.3±0.8 g/kg/day, P=0.02; 2-year-olds or older, −1.0±0.6 g/kg/day vs −0.7±0.8 g/kg/day, P=0.01; and for the energy deficit/kg/d in 2-year-olds and older, −17.2±13.6 kcal/kg/day vs −13.3±18.1 kcal/kg/day, unpaired t test, P=0.07, in the pre- vs post-implementation period, respectively.

      Conclusions

      The implementation of NS guidelines was associated with improvements in total energy in 2-year-olds and older and protein in younger than 2 and 2 years and older children by days 5 through 8, and protein deficits were significantly lower in the post- vs the pre-implementation period. The implementation of NS guidelines may have had a positive effect on improving NS in critically ill children.

      Keywords

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      Biography

      U. G. Kyle is an instructor, Section of Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine/Texas Children's Hospital, Houston.

      Biography

      G. Mackey is a research assistant, Section of Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine/Texas Children's Hospital, Houston.

      Biography

      J. C. Silva is a research assistant, Section of Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine/Texas Children's Hospital, Houston.

      Biography

      J. Lusk is a nurse practitioner, Section of Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine/Texas Children's Hospital, Houston.

      Biography

      R. Orellana is an associate professor, Section of Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine/Texas Children's Hospital, Houston.

      Biography

      L. S. Shekerdemian is a professor, Section of Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine/Texas Children's Hospital, Houston.

      Biography

      J. A. Coss-Bu is an associate professor and director of research, Section of Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine/Texas Children's Hospital, Houston.

      Biography

      L. A. Lucas is a registered dietitian, Clinical Nutrition Services, Texas Children’s Hospital, Houston.