Abstract
BackgroundImpaired nutritional status is adversely associated with suboptimal outcomes in critically ill children. Undernutrition at pediatric intensive care unit (PICU) admission ranges from 15 to 65%. A lack of knowledge of the nutritional status of children in French PICUs prevents us from specifically targeting education. This study aims to describe the nutritional status of children in French PICUs and to assess nutritional practices and physicians’ knowledge of nutrition, in order to focus NutriSIP (the French-speaking PICU nutrition group) future education programs. A prospective observational multicenter point prevalence study was conducted in French PICUs, recruiting all children admitted over three different weeks. Anthropometric measurements were taken (weight, height/length, mid-upper arm, and head circumferences), in order to calculate nutritional indices. Nutritional status was defined according to WHO Body Mass Index z-score and dynamic assessment based on growth faltering detection. Concurrently, PICU physicians and PICU nurses from seven French-speaking countries completed a survey to ascertain knowledge about local nutritional care practices and overall nutrition knowledge. PICU physicians’ responses were compared to PICU nurses’ responses (previously published).ResultsFour hundred and thirty-two children were included in the observational study from 27 French PICUs. Undernutrition was diagnosed in 18.5% of them, young age and underlying chronic condition being the two independent risk factors. Faltering growth was diagnosed in 4.8% and overweight in 7.4%. Subjective nutritional assessment was not accurate. Thirty-eight French-speaking PICUs completed the survey. These showed nutritional practices frequently did not comply with international guidelines, especially regarding nutritional goals, and the reasons for withholding enteral nutrition. Comparison between physicians’ and nurses’ responses to the survey showed large discrepancies.ConclusionUndernutrition is frequent at admission in French PICUs. Nutritional status should be assessed using a holistic approach, because of the potential impact on outcome. French-speaking PICU healthcare professionals need further nutrition education, in order to improve nutritional practices to comply with international recommendations. This study will serve as a baseline to focus NutriSIP teaching programs in the future.
Highlights
Impaired nutritional status is adversely associated with suboptimal outcomes in critically ill children
Providing nutritional requirements can be challenging in this setting, resulting in nutrient deficits over the duration of pediatric intensive care unit (PICU) stay [1], which may induce in hospital malnutrition, and worsen outcomes
This survey was the same as the nursing survey [7], except for seven additional questions regarding energy target prescription, which were added to the physician survey only, as nurses in French-speaking countries are not involved in prescribing nutrition goals (The electronic survey had been sent to the lead nurses of each PICUs who were asked to select one nurse confident enough with the local practices to answer the survey; only one physician and one nurse per center answered the survey)
Summary
Impaired nutritional status is adversely associated with suboptimal outcomes in critically ill children. Nutritional status at pediatric intensive care unit (PICU) admission is known to affect outcome in critically ill children. Recent American guidelines [4] strongly recommend systematic nutritional status assessment within the first 48 h of PICU admission This is recommended using a holistic approach [5], combining both static and dynamic measurements, and describing malnutrition in terms of its etiology, severity, mechanisms, chronicity, and impact on outcomes. Providing nutritional requirements can be challenging in this setting, resulting in nutrient deficits over the duration of PICU stay [1], which may induce in hospital malnutrition, and worsen outcomes Identifying these children at risk is essential, in order to provide individualized nutrition support
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