Protein intake deficiency in critically ill children with respiratory insufficiency: A call to action?

Abstract

Adequate energy-protein intake is associated with improved clinical outcomes in critically ill children. The aim of this study was to evaluate the time of enteral nutrition (EN) onset and the energy-protein intake in critically ill pediatric patients admitted with respiratory insufficiency. A single-center prospective cohort study, including children and adolescents, aged from 1 month to 14 years. All patients had been diagnosed with respiratory insufficiency and were exclusively enterally fed and had been admitted to a Pediatric Intensive Care Unit (PICU) of a public quaternary hospital in southeastern Brazil. Demographic, clinical, and nutritional therapy characteristics were recorded. Early EN (EEN) was considered when EN was initiated within the first 48h of PICU admission. Seventy-one patients were included in this study, 64.79% were male with a median age of 6 months (2; 13) and a median PICU length of stay of 13.00 days (6.75; 23.00). PICU mortality was 4.23% and 78.87% of patients were under mechanical ventilation within the first 48h of PICU admission with a median time of mechanical ventilation of 10 days (6.00; 16.50). The median energy adequacy was 74.97% (50.29; 93.94) and the median protein adequacy was 56.12% (40.72; 69.81). Only 7.25% of the patients achieved protein adequacy. Nutritional variables were compared between groups: EEN and late EN (LEN). EEN was utilized in 69.01% of patients who had increased energy (41.80 [34.07; 51.17] versus 23.60 [11.22; 35.17] kcal/kg/day; p<0.0001) and protein intake (0.94 [0.78, 1.16] versus 0.53 [0.30, 0.79] g/kg/day, p<0.0001) and better nutritional adequacies (p<0.0001). Patients who received EEN had increased energy-protein delivery and adequacies. However, protein inadequacy occurred throughout in all patients within this sample, regardless the onset of EN.