Background & aims: Optimizing nutrition remains challenging in pediatric intensive care units (PICUs), particularly for children requiring prolonged mechanical ventilation. In 2020, our PICU adopted a standardized enteral nutrition protocol emphasizing early energy delivery. We evaluated its impact and identified predictors of early enteral feeding shortfalls.
Methods: This retrospective cohort study (2016-2023) included children <18 years, weighing ≥10 kg and intubated ≥48 h in a tertiary PICU. Daily enteral and total (enteral and parenteral) caloric intakes expressed as percentage of Schofield-estimated resting energy expenditure (REE) were compared between pre-protocol period (2016-2019, n = 83) and post-protocol (2020-2023, n = 58) periods. Multivariate linear regression analyses assessed factors linked to suboptimal enteral intake on day 2 and 3.
Results: Of 141 patients (median age 7.4 [3.6-11.3] years; 60 % boys), enteral and total intakes did not differ significantly between periods. By day 2, 60 % received enteral nutrition (median 26 [0-93] % of REE); by day 3, 81 % did (median 75 [31-122] % of REE). Protein targets (1.5 g/kg/day) were met infrequently. On day 2, independent predictors of lower enteral intake included vasoactive agent use, higher body weight, and non-neurological/respiratory admission diagnoses; on day 3, vasoactive support and atypical diagnoses persisted as risk factors.
Conclusion: PICU nutritional practices aligned with international guidelines but struggled to meet targets in critically ill subgroups, underscoring the value of personalized strategies, potentially incorporating indirect calorimetry, for this vulnerable population.
Keywords: Enteral nutrition; Mechanical ventilation; Nutrition protocol; PELOD-2; Pediatric intensive care; Vasoactive support.
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