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Pediatr Crit Care Med. 2018 Nov 1. doi: 10.1097/PCC.0000000000001761. [Epub ahead of print]

The Latin American and Spanish Survey on Nutrition in Pediatric Intensive Care (ELAN-CIP2).

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Pediatric Intensive Care Unit, Hospital Metropolitano, Facultad de Medicina, Pontificia Universidad Católica del Ecuador, Quito, Ecuador.
Department of Pediatric Intensive Care, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid, Red de Salud Maternoinfantil y del Desarrollo (Red SAMID) ISCIII, Madrid, Spain.
Pediatric Intensive Care of Instituto da Criança do Hospital das Clinicas da Faculdade de Medicina - Sao Paulo University, San Paulo, Brazil.
Clínica Las Condes, Hospital Luis Calvo Mackenna, Santiago, Chile.
Section of Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, TX.



To characterize the practices of nutritional support in Latin American and Spanish PICUs.


Survey with a questionnaire sent to Latin American Society of Pediatric Intensive Care members.


PICUs of participant hospitals.


Critically ill children between 1 month and 18 years old.




Forty-seven surveys from 17 countries were analyzed. Sixty-seven percent of PICUs were from university-affiliated hospitals, with a median of 380 admissions/yr. Sixty-eight percent and 48.9% had a nutritional support team and nutritional support protocol, respectively. Seventy-five percent completed nutritional evaluations, with 34.2% at admission. PICUs with high-volume admissions were likely to have a nutritional support team (p < 0.005), and university-affiliated hospitals showed a trend of having a nutritional support team (p = 0.056). Measured, estimated, and ideal weights were used in 75%, 14.6%, and 10.4%, respectively. Energy requirements were calculated using Holliday & Segar and Schofield equations in 90% of the PICUs; 43% used correction factors. Only three PICUs had indirect calorimetry. At day 3 of initiation of nutritional support, 57.3% of PICUs provided at least 50% of the calculated energy requirement, and 91.5% at day 5. Protein needs were estimated according to American Society for Parenteral and Enteral Nutrition and European Society for Clinical Nutrition and Metabolism/European Society for Paediatric Gastroenterology Hepatology and Nutrition guidelines in 55.3% and 40.4%, respectively. Enteral nutrition was the preferred feeding method, initiated in 97.7% at 48 hours. The feeding route was gastric (82.9%), by bolus (42.5%) or continuous (57.4%). Monitoring methods included gastric residual measurement in 55.3%. Enteral nutrition was discontinued in 82.8% when gastric residual was 50% of the volume. Prokinetics were used in 68%. More than half of PICUs used parenteral nutrition, with 95.8% of them within 72 hours. Parenteral nutrition was administered by central vein in 93.6%. Undernourished children received parenteral nutrition sooner, whether or not enteral nutrition intolerance was present. When enteral nutrition was not tolerated beyond 72 hours, parenteral nutrition was started in 57.4%. Parenteral nutrition was initiated when enteral nutrition delivered less than 50% in 97%.


Nutritional practices are heterogeneous in Latin American PICUs, but the majority use nutritional support strategies consistent with international guidelines.

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