Nutritional support of critically ill children

Guidelines for the administration of nutrition to critically ill children have recently been published 1. The purpose of this study was to assess the adequacy of nutritional support administered to children admitted to a tertiary care pediatric intensive care unit (PICU). We performed a retrospective analysis of the medical records of children admitted to the PICU for >3 days after April 1, 1993. A descriptive analysis was performed. The median (range) age and weight of the 83 subjects was 18 mo (0 - 229) and 11 kg (2.2 -61.7), respectively. The median number of days in the PICU was 7 (3 - 33). Forty-three percent of the children had evidence of shock (I.e., need for 2 volume expander boluses and/or inotropic support). Thirty-six percent of the children received some form of nutrition during the first 24 hours In the PICU. Enteral nutrition comprised 71% of the type of nutrition started. Fifty-four percent were fed enteral nutrition through a transpyloric tube. Complications were infrequent (emesis, 1%; gastric residuals greater than hourly enteral Infusion rate, 7%). Despite 88% of the children receiving some form of enteral nutrition in the first 72 hours, approximately half received ≤50% of their recommended daily allowances (RDA) for calories by the end of their third PICU day. Fifty-eight percent were taking nutrition by mouth by their last PICU day. By the last day in the PICU, 55% received ≥75% of their RDA. Children admitted to the PICU for >3 days receive early enteral nutrition. Complications of enteral nutrition are negligible. Despite early nutritional support, children fed in the PICU receive inadequate calories for an extended period of time. A nutritional survey should be used to assess and improve the quality of nutritional support provided to critically ill children.