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

Abstract

BackgroundCritically ill children are at risk of developing malnutrition, and undernutrition is a risk factor for morbidity and mortality. ObjectiveThe 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). DesignThis 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/settingThree hundred thirty-five children from August to December 2012 (pre-implementation) and 185 from October to December 2013 (post-implementation). InterventionImplementation of NS Guidelines. Main outcome measuresChanges in actual energy and protein intake in the post- compared with the pre-Implementation period. Statistical analysis performedUnpaired 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. ResultsAfter 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. ConclusionsThe 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.