Proefschrift Kerklaan

Chapter 8

or as a bolus once a day (children >30 kg), until EN provides ≥80% of preset caloric goals, PICU discharge, or up to day 8 of PICU stay, whichever comes first. On the morning of day 8 after admission, if still present in the PICU, children receiving <80% of caloric goals by the enteral route, will be switched to regular PN solutions containing lipids and amino acids with a composition based on the ESPEN/ESPGHAN guidelines 2 . After discharge from the PICU, the nutritional management is at the discretion of the physicians on the regular wards. Table 1. Suggested energy and macronutrient intake during the different phases of critical illness Acute phase Stable phase Recovery phase Enteral nutrition (Preferred route) Energy Start as soon as possible to match REE and gradually increase if tolerated

2xREE and higher if necessary to enable growth

Protein (g/kg/day)

1-2

2-3

3-4

Parenteral nutrition

Energy

1.3-1.5xREE

2xREE

Carbohydrates (mg/kg/min) Newborn 28d-10 kg

2.5-5 2-4 1.5-2.5

5-10 4-6 2-4 1.5-3 1-2

5-10 6-10

11-30 kg 31-45 kg >45 kg

3-6 3-4 2-3 2-3

1-1.5 0.5-1

Protein (g/kg/day) Lipids (g/kg/day)

0 0

1-2

1-1.5

1.5-3

REE= Resting Energy Expenditure From: Nutritional support and the role of the stress response in critically ill children, K. Joosten, D. Kerklaan, S. Verbruggen. Curr Opin Clin Nutr Metab Care 2016 83 . Copyright©. Reprinted with permission.

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