Nutrition Section Position Statement and Clinical Practice Recommendations for Children Admitted to Intensive Care Unit

Abstract

Context: Children admitted to the intensive care unit are at risk of malnutrition, mainly due to chronic diseases they are suffering from. These patients require a different nutritional diet regimen from those in a normal or stable disease state due to change in metabolism under the stress of diseases. Methods: According to the SIGN guideline based on evidence, first, articles matching our criteria were extracted from the literature, and then the strength of evidence was evaluated. Finally, a summary of statements consisting of details regarding the strength of evidence and recommendation level was reviewed by 12 experts, and two-round surveys were accomplished according to the Delphi method to reach a consensus. Results: Twenty-seven statements in 5 categories with strength of evidence, grade of recommendations, and expert opinions are summarized. Conclusions: Rapid nutritional assessment, judging patients with malnutrition or at risk of malnutrition, fast intervention with early enteral nutrition, reaching the protein and energy goals under the supervision of an expert registered dietitian, and persistent monitoring with minimizing the time of fasting are some of the key components of proper nutrition management based on evidence found in the literature.

Evaluation of nutritional status in pediatric intensive care unit patients: the results of a multicenter, prospective study in Turkey

“…There is an increased risk of malnutrition in critically ill patients who have limited calorie intake throughout their stay in the hospital. It is recommended that critically ill patients should receive a minimum of 54-58 kcal/kg/day nutritional support in order to avoid a catabolic state and maintain protein and energy support as required (28). In the present study, the patients had a mean calorie intake of 57.39 ± 32.97 kcal/kg/day as recommended by the guidelines.…”

“…Achieving optimal calorie and protein intake in critically ill patients by early initiating optimal enteral feeding is associated with an improvement in clinical outcomes (27). It is recommended that enteral nutrition be initiated within 24-48 h after admission to the intensive care unit in hemodynamically stable children with a functional gastrointestinal tract if there is no contraindication such as vomiting, abdominal distension and gastrointestinal hemorrhage, and this approach is referred to as early enteral nutrition (28). In our country, 40.6% of critically ill patients initiated on enteral nutrition in the first 24 h after admission and this rate was 72.3% at the end of 48 h. At the end of one week, 91.5% of our patients started on enteral nutrition.…”

“…It was found in the present study that 6.5% of the patients started on parenteral feeding within the first 24 h after admission to the intensive care unit and this rate was 8% at the end of one week. However, available guidelines on nutrition do not recommend initiation of parenteral feeding within 24 h after admission to the intensive care unit (5,28). In the PEPaNIC study, initiation of parenteral feeding within 24 h after admission to the intensive care unit was defined as early parenteral nutrition and initiation of parenteral feeding after seven days was defined as late parenteral nutrition, and the outcomes of early and later parenteral nutrition were compared in critically ill patients.…”

“…In the present study, the patients had a mean calorie intake of 57.39 ± 32.97 kcal/kg/day as recommended by the guidelines. Protein intake must be at least 1.5 gr/kg/day in pediatric intensive care unit patients to avoid negative protein balance (5,28). Our patients received 1.6 gr/kg/day protein support.…”