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J Acad Nutr Diet. 2016 May;116(5):844-851.e4. doi: 10.1016/j.jand.2016.01.005.

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 χ(2) (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:

Children; Critically ill; Energy needs; Nutrition support; Protein needs

PMID:
27126156
DOI:
10.1016/j.jand.2016.01.005
[Indexed for MEDLINE]

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