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Abstract

Background and aims: Nutritional support may improve outcome during Pediatric Intensive Care Unit (PICU) stay, but guidelines are limited and based on consensus rather than evidence. Aims: We aimed to study current practice in nutritional management of PICUs worldwide. Methods: An online questionnaire, composed of 59 questions, was distributed to members of the World Federation of Pediatric Intensive and Critical Care Societies (WFPICCS). The IRB waived the need for informed consent. Results: We analysed 189 questionnaires accounting for 89000 admissions in 156 PICUs covering 52 countries. A nutritional protocol and nutrition support team (NST) are present in respectively 52% and 57% of PICUs. Presence of a NST is associated with number of beds and admissions. Energy requirements are based on various equations and few PICUs use indirect calorimetry (14%). Lipid targets range from < 1.5 to > 3.5 g/kg/day, protein targets from 0.9 to 3 g/kg/day. Glucose administration during the first 24 hours varies from <2 to >10 mg/kg/min. Enteral nutrition (EN), preferably by gastric tube (68–88%), is started within 24 hours after admission in 60% of the PICUs. In 55% of the PICUs parenteral nutrition (PN) is started within 48 hours in patients intolerable to EN. Insufficient EN, providing < 50% or < 80% of target calories, is respectively supplemented with PN in 48% and 24% of PICUs. Conclusions: Nutritional practices, in terms of requirements, timing and route, are highly variable in PICUs worldwide. Even the limited available guidelines are not consistently followed. The potential impact on outcome warrants uniform evidence based guidelines with consistent implementation.