Nutrition Considerations in the Pediatric Cardiac Intensive Care Unit Patient

Abstract

Adequate caloric intake plays a vital role in the course of illness and the recovery of critically ill patients. Nutritional status and nutrient delivery during critical illness have been linked to clinical outcomes such as mortality, incidence of infection, and length of stay. However, feeding practices with critically ill pediatric patients after cardiac surgery are variable. The Pediatric Cardiac Intensive Care Society sought to provide an expert review on provision of nutrition to pediatric cardiac intensive care patients, including caloric requirements, practical considerations for providing nutrition, safety of enteral nutrition in controversial populations, feeding considerations with chylothorax, and the benefits of feeding beyond nutrition. This article addresses these areas of concern and controversy.

Malnutrition in Children With Chronic Disease

“…Many aspects of congenital heart disease put children at risk for malnutrition, including increased caloric needs, difficulties with adequate nutrition provision due to limitations secondary to ductal‐dependent disease and/or need for vasopressor support, increased risk of necrotizing enterocolitis, and fluid limitations. In addition, children with congenital heart disease often struggle with vomiting and feeding tolerance and may develop oral aversion . Postoperative risk factors for malnutrition in children with congenital heart disease include frequent interruptions of feeds, vocal cord dysfunction, and chylothorax, and those with single ventricle disease are at risk of developing a protein‐losing enteropathy.…”

Manajemen Perioperatif Operasi Arterial Switch pada Transposition of The Great Arteries with Intact Ventricular Septum

“…Sedangkan target kalori yang dapat Volume 12, Nomor 2, Tahun 2020 dicapai 120-150 kkal/kg/hari, ketika target volume tercapai maka diberikan nutrisi padat kalori. [7][8][9] Antibiotik profilaksis merupakan antibiotik yang diberikan untuk mencegah infeksi yang belum terjadi. Antibiotik profilaksis hanya digunakan pada pasien dengan risiko tinggi infeksi, seperti pada pasien dalam terapi imunosupresi, kanker, dan pada pasien yang menjalani operasi.…”

An international survey of the nutrition management of chylothorax: a time for change

“…17 When fluid chemistries are not measured or evaluated when infants are on full standard or breast milk feeds, there is a potential for both under and over-reporting incidence particularly, resulting in the treatment of non-chylous leaks or overly conservative management of asymptomatic patients. 18 Variation in clinical practice is further compounded by a lack of consensus-based expert guidelines as seen in other clinical conditions such as intestinal failure where consensus guidelines guide the provision of parenteral nutrition, 19 providing an opportunity to benchmark clinical practice against predefined standards. 20 A diet high in medium chain triglycerides was first proposed as the primary treatment for chylothorax in 1964, 21 and further refined in 1987 with recommendations to give no more than 1 g long chain triglyceride per year of life up to a maximum of 4-5 g long chain triglycerides per day for 6 weeks.…”

“…The optimal amount of long chain triglyceride fat restriction and percentage of medium chain triglyceride required has never been prospectively studied in a large cohort, and as such the current standard of care is untested in a randomised controlled trial. 1 This is also true of the duration of treatment, with recommendations in the literature of 2 to 6 weeks 6,12,18 reflected in the regional variation in dietary restriction reported by health-care professionals ranging from 2 to 6 weeks of treatment. Given the difficulty of dietary adherence, absence of evidence and known impact on risk of infection, malnutrition, and prolonging hospital stay, these results suggest that a shorter diet treatment duration may be clinically acceptable.…”