The Latin American and Spanish Survey on Nutrition in Pediatric Intensive Care (ELAN-CIP2)*

Abstract

Objective: To characterize the practices of nutritional support in Latin American and Spanish PICUs. Design: Survey with a questionnaire sent to Latin American Society of Pediatric Intensive Care members. Setting: PICUs of participant hospitals. Patients: Critically ill children between 1 month and 18 years old. Interventions: None. Measurements and Main Results: Forty-seven surveys from 17 countries were analyzed. Sixty-seven percent of PICUs were from university-affiliated hospitals, with a median of 380 admissions/yr. Sixty-eight percent and 48.9% had a nutritional support team and nutritional support protocol, respectively. Seventy-five percent completed nutritional evaluations, with 34.2% at admission. PICUs with high-volume admissions were likely to have a nutritional support team (p < 0.005), and university-affiliated hospitals showed a trend of having a nutritional support team (p = 0.056). Measured, estimated, and ideal weights were used in 75%, 14.6%, and 10.4%, respectively. Energy requirements were calculated using Holliday & Segar and Schofield equations in 90% of the PICUs; 43% used correction factors. Only three PICUs had indirect calorimetry. At day 3 of initiation of nutritional support, 57.3% of PICUs provided at least 50% of the calculated energy requirement, and 91.5% at day 5. Protein needs were estimated according to American Society for Parenteral and Enteral Nutrition and European Society for Clinical Nutrition and Metabolism/European Society for Paediatric Gastroenterology Hepatology and Nutrition guidelines in 55.3% and 40.4%, respectively. Enteral nutrition was the preferred feeding method, initiated in 97.7% at 48 hours. The feeding route was gastric (82.9%), by bolus (42.5%) or continuous (57.4%). Monitoring methods included gastric residual measurement in 55.3%. Enteral nutrition was discontinued in 82.8% when gastric residual was 50% of the volume. Prokinetics were used in 68%. More than half of PICUs used parenteral nutrition, with 95.8% of them within 72 hours. Parenteral nutrition was administered by central vein in 93.6%. Undernourished children received parenteral nutrition sooner, whether or not enteral nutrition intolerance was present. When enteral nutrition was not tolerated beyond 72 hours, parenteral nutrition was started in 57.4%. Parenteral nutrition was initiated when enteral nutrition delivered less than 50% in 97%. Conclusions: Nutritional practices are heterogeneous in Latin American PICUs, but the majority use nutritional support strategies consistent with international guidelines.

The Effects of Protein Intake on Clinical Outcome in Pediatric Intensive Care Units

“…In previously conducted studies, many PICUs use only formulas for energy calculation. 33 We calculated the energy needs of the patients according to the Schofield equation. Healthcare professionals and intensivists sometimes overlook nutrition issues because they are concentrating on the primary problem of the patients.…”

Bolus gastric feeds improve nutrition delivery to mechanically ventilated pediatric medical patients: Results of the COntinuous vs BOlus multicenter trial

“…We acknowledge limitations to this study. Given the timing of study design and implementation, we were unable to include input from more recent international nutrition guidelines, which should inform future studies 15,17 . It was not possible to blind the study arm assignment.…”

“…Given the timing of study design and implementation, we were unable to include input from more recent international nutrition guidelines, which should inform future studies. 15,17 It was not possible to blind the study arm assignment. However, random assignment, feeding protocols that included specific site-based intolerance management, and audits to assure protocol compliance helped minimize study bias.…”

“…Recent guidelines in various populations of critically ill children recommend EN as the preferred route, including but not limited to those jointly published in 2017 by the Society of Critical Care Medicine (SCCM) and the American Society for Parenteral and Enteral Nutrition (ASPEN). [14][15][16][17] However, there is a paucity of evidence to recommend a bolus/intermittent approach vs a continuous approach to gastric EN delivery. 18 Continuous delivery may be efficient from a staffing/resource perspective given the reduced nursing workload to manage continuous rather than intermittent feeding procedures.…”

Barriers to Delivery of Enteral Nutrition in Pediatric Intensive Care: A World Survey

“…Nutritional support teams (including a dietitian) have been shown to be beneficial in optimising nutrition in PICUs (24). This has been shown in a Latin American and Spanish survey on nutrition in paediatric intensive care where 68% of the participant PICUs had a nutritional support team (NST) and the availability of a NST was associated with better nutritional practices (24). A perceived lack of education around nutrition (and the optimal feeding of critically ill patients) is concerning.…”