739

Abstract

Introduction: Critically ill children and especially infants in the pediatric intensive care unit (PICU) are at high risk of underfeeding. Methods: Retrospective chart review of patients admitted to PICU for at least >48 h between (10/12-12/12). All intravenous fluids, parenteral and enteral nutrition for the first 8D were analyzed. Resting energy expenditure (REE) and protein needs were estimated by the Schoefield equation (Hum Nutr Clin Nutr 39, 1985) and ASPEN Clinical Guidelines (JPEN 33, 2009), respectively. Results are mean ± SD. Results: There were 156 (sex M/F 79/77) patients identified, with a total length of hospital stay of 12 (8.5-19)(median (interquartile range)) days, with age 1.3 (0.3-4.6) yr; PRISM score 5 (2.5-8.0); and Pediatric Logistic Organ Dysfunction (PELOD) 11 (2-11). Estimated REE by Schoefield for <2 y, n=93; 2-5 y, n=30; >6 y, n=33; was 52.8 ± 9.1, 54.7 ± 7.7, 36 and 33.5 ± 7.4 kcal/kg/d, respectively. Average 8D energy intake was 46.6 ± 22.5, 33.4 ± 13.3, and 18.0 ± 12.3 kcal/kg/d, respectively (paired t-test all p <0.01). Thus only 93, 62 and 53 %, respectively of 8D energy needs were met. Patients met <90% of estimated REE: <2 y: 51%; 2-6 y: 87% and >6y: 91% (Chi2 p <0.001). Average energy deficit was 0.2, 2.3 and 2.0 times the daily energy needs in <2, 2-5 and >6y old children. Estimated protein needs by ASPEN guidelines for <2 y, 2-5 y and >6 y was 2.5 ± 0.1, 1.8 ± 0.1 and 1.6 ± 0.1 g/kg/d; average 8D protein intake was 1.0 ± 0.7, 0.9 ± 0.6 and 0.5 ± 0.5 g/kg/d, respectively (all p <0.001). Thus only 41, 51 and 33 %, respectively of protein needs were met. Patients met <90% of estimated protein needs: <2 y: 94%; 2-6 y: 87% and >6y: 94% (Chi2 p <0.43). Average protein deficit was 3.2, 2.8 and 3.1 times the daily energy need in <2, 2-5 and >6y old children. Conclusions: Only 53 to 93% of energy and 33 to 51 % of protein needs were met during the first 8 days of PICU stay. Critically ill children are at significant risk for underfeeding, especially protein underfeeding. Further efforts should be made to meet energy and protein needs of PICU patients.