Proefschrift Kerklaan

Chapter 4

None identified

None identified

Younger children, Malnourishment Multivariate analysis: being overfed not associated with change in no. of days until discharged alive, no. of days on the ventilator, no. of days on antibiotics, no. of new infections or site of infection

Age < 1 year

Parenteral nutrition

Outcome

26.5% patient days None identified 30% (n=344) patient days

60.5% (n=63)

patient days

74% of children on PN and EN

combined (n=240) 43% of children

only on EN (n=140)

28% patient days Parenteral nutrition 83% (n=24) children

% overfeeding Risk factors for overfeeding 18% (n=135) patient days 69% patient days None identified

Table 1. Overview of clinical studies concerning overfeeding in critically ill children Study Design, Patients Applied definition overfeeding Taylor et al., Clin Nutr. 2003 Nutritional support in critically ill children Retrospective study in 95 children in PICU ≥3 days Median age 7.7 (range 1-18.6) years Ratio caloric intake/ pREE (Schofield- weight) >110% Hulst et al., Nutrition. 2005 Adequate feeding and the usefulness of the respiratory quotient in critically ill children Prospective study in 98 mechanically ventilated children, median age 14.6 days (range 0-15.2 y) Ratio caloric intake/ mREE >120% Oosterveld et al., Pediatr Crit Care Med. 2006 Energy expenditure and balance following pediatric intensive care unit admission: a longitudinal study of critically ill children Observational study in 46 children, median age 4 (IQR 0-18) years Ratio caloric intake/ mREE >110% Ratio caloric intake/ pREE (WHO)>110% Ratio caloric intake/ mREE >120%

Ratio caloric intake/ pREE (Schofield- weight) >110%

Ratio caloric intake/ mREE >120%

Ratio caloric intake/ pREE (Schofield- weight) >120%

Retrospective study in 240 children in PICU >2 days

Prospective study in 30 mechanically ventilated children, median age 15.5 (range 3-168) months

Prospective study in 325 children at day 4 after admission, median age 0.14 (range 0-18) years

Prospective study in 84 mechanically ventilated children in PICU ≥3 days,

median age 4.7 (IQR 0.9-18.9) months Prospective study in 33 mechanically ventilated children,

median age 2 (range 0.1-25.8) years

Kyle et al., J Acad Nutr Diet. 2012 Nutrition support in critically ill children: underdelivery of energy and protein

compared with current recommendations Dokken et al., JPEN J Parenter Enteral Nutr. 2015 Indirect calorimetry reveals that better monitoring of nutrition therapy in pediatric intensive care is needed de Betue et al. Clin Nutr. 2015 Achieving energy goals at day 4 after

admission in critically ill children; predictive for outcome?

De Neef et al., Clin Nutr. 2008 Nutritional goals, prescription and delivery in a pediatric intensive care unit

Mehta et al., Pediatr Crit Care Med. 2011 Energy imbalance and the risk of overfeeding in critically ill children

IQR = Interquartile Range, PICU = Pediatric Intensive Care Unit, mREE = measured Resting Energy Expenditure, pREE = predicted Resting Energy Expenditure, WHO =World Health Organization, EN = Enteral Nutrition, PN = Parenteral Nutrition

72