Proefschrift Kerklaan

Worldwide survey of nutritional practices in PICUs

Of the 295 patients included in the point prevalence , 60%were male patients and 58% younger than 1 year. Median length of stay (LOS) at moment of data collection was 6 days (IQR, 2-15), with a LOS greater than 7 days in 40% of the patients. Median weight was 7 kg (IQR, 4-16), and 46% of the children were mechanically ventilated. Nutritional support According to the first part of the survey , a nutritional protocol was present in 52% of PICUs; protocol characteristics are shown in Table 2. A Nutrition Support Team (NST) was available in 57% of the PICUs and 51% of the teams visited the ICU daily. The composition of an NST differed; it consisted mostly of dieticians (88%) and pediatric intensivists (51%). In the point prevalence part of the study, median caloric intake did not differ in children fed by EN exclusively ( n = 129) between the following four groups ( p = 0.18): 1) PICUs with an NST (76 kcal/kg/d), 2) PICUs with a nutritional protocol (76 kcal/kg/d), 3) PICUs with both an NST and nutritional protocol (64 kcal/kg/d), and 4) PICUs without an NST and protocol (58 kcal/ kg/d). There was also no difference in the proportion of children receiving EN in PICUs with and without an NST and/or protocol.

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Table 2. Characteristics of nutritional protocols Characteristic

No. of PICUs (%) Total 156

Protocol available

82 (52)

Information in protocol

Assessment of energy requirements Protein requirements Management of gastric residual volume Type of EN Amount of EN Composition of PN Amount of PN

72 (89) 65 (81) 57 (71) 72 (89) 75 (94) 71 (88) 72 (89) 6 (7.7) 8 (10) 7 (8.7) 59 (74)

Protocol age/weight differentiated Not

For EN For PN For both EN and PN

EN = Enteral Nutrition, PN = Parenteral Nutrition

Nutritional requirements To predict energy expenditure (EE) different equations were used according to the first part of the survey , mainly those published by Schofield 17 (25%) and the World Health Organization (WHO) 18 (25%), but also the Harris-Benedict equation 19 (17%). Seventy percent used correction factors, as fever (41% of PICUs), diagnosis (54%) and growth (23%) to calculate energy needs. Twenty-four percent of respondents did not know which equation was used to calculate EE in their unit. Indirect calorimetry (IC) to measure EE was used in 14% of the PICUs. The first

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