An evaluation of enteral nutrition practices and nutritional provision in children during the entire length of stay in critical care

BMC Pediatrics

Konstantinos Gerasimidis¹  David Young³  Mark Davidson¹  Neil Spenceley¹  Krystalia Diamantidi¹  Hani A Alfheeaid¹  Emma Gentles²  Jackie Mara² 

[1]Human Nutrition, School of Medicine, College of Medicine, Veterinary and Life Sciences, University of Glasgow, Glasgow G3 8SJ, UK

[2]Department of Dietetics and Nutrition, Royal Hospital for Sick Children, NHS Greater Glasgow and Clyde, Glasgow G3 8SJ, UK

[3]Department of Mathematics and Statistics, University of Strathclyde, Glasgow G1 1XH, UK

关键词: Nutrition support;    Enteral nutrition;    Critical care;    Paediatric intensive care unit;   

Others  :  1138536
DOI  :  10.1186/1471-2431-14-186

 received in 2014-03-31, accepted in 2014-07-17,  发布年份 2014

【 摘 要 】

Background

Provision of optimal nutrition in children in critical care is often challenging. This study evaluated exclusive enteral nutrition (EN) provision practices and explored predictors of energy intake and delay of EN advancement in critically ill children.

Methods

Data on intake and EN practices were collected on a daily basis and compared against predefined targets and dietary reference values in a paediatric intensive care unit. Factors associated with intake and advancement of EN were explored.

Results

Data were collected from 130 patients and 887 nutritional support days (NSDs). Delay to initiate EN was longer in patients from both the General Surgical and congenital heart defect (CHD) Surgical groups [Median (IQR); CHD Surgical group: 20.3 (16.4) vs General Surgical group: 11.4 (53.5) vs Medical group: 6.5 (10.9) hours; p ≤ 0.001]. Daily fasting time per patient was significantly longer in patients from the General Surgical and CHD Surgical groups than those from the Medical group [% of 24 h, Median (IQR); CHD Surgical group: 24.0 (29.2) vs General Surgical group: 41.7 (66.7) vs Medical group: 9.4 (21.9); p ≤ 0.001]. A lower proportion of fluids was delivered as EN per patient (45% vs 73%) or per NSD (56% vs 73%) in those from the CHD Surgical group compared with those with medical conditions. Protein and energy requirements were achieved in 38% and 33% of the NSDs. In a substantial proportion of NSDs, minimum micronutrient recommendations were not met particularly in those patients from the CHD Surgical group. A higher delivery of fluid requirements (p < 0.05) and a greater proportion of these delivered as EN (p < 0.001) were associated with median energy intake during stay and delay of EN advancement. Fasting (31%), fluid restriction (39%) for clinical reasons, procedures requiring feed cessation and establishing EN (22%) were the most common reasons why target energy requirements were not met.

Conclusions

Provision of optimal EN support remains challenging and varies during hospitalisation and among patients. Delivery of EN should be prioritized over other “non-nutritional” fluids whenever this is possible.

【 授权许可】

   
2014 Mara et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

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