title: The effect of cumulative energy and protein deficiency on anthropometric parameters in a pediatric ICU population.
abstract: OBJECTIVE
  Nutritional support is essential in the care of critically ill children since inadequate feeding increases morbidity and negatively affects growth. We aimed to compare cumulative energy and protein intakes with recommended dietary intakes (RDA) and examine relationships between accumulated balances and anthropometric parameters.
  
  
  METHODS
  Prospective, observational study. Total daily energy and protein intakes were determined during a maximum of 14 days in 261 children admitted to our multidisciplinary tertiary pediatric ICU. Actual intakes were subtracted from RDA and cumulative balances were calculated. Relations between cumulative balances, various clinical factors and changes in anthropometry (weight, arm and calf circumference) were analyzed using regression analysis.
  
  
  RESULTS
  At 14 days after admission children showed significant cumulative nutritional deficits compared to RDA. These deficits were on average 27, 20, 12 kcal/kg and 0.6, 0.3, and 0.2 g protein/kg per day for preterm neonates (n = 103), term neonates (n = 91) and older children (n = 67), respectively. Age at admission, length of ICU-stay and days on mechanical ventilation were negatively related to cumulative balances. Cumulative energy and protein deficits were associated with declines in SD-scores for weight and arm circumference.
  
  
  CONCLUSIONS
  Children admitted to the ICU accumulate substantial energy and protein deficits when compared to RDA. These deficits are related to decreases in anthropometric parameters.
authors.affiliation: Department of Pediatric Surgery, Erasmus MC, Sophia Children's Hospital, Rotterdam, The Netherlands.
authors.forename: Jessie M
authors.initials: JM
authors.lastname: Hulst
authors.forename: Johannes B
authors.initials: JB
authors.lastname: van Goudoever
authors.forename: Luc J I
authors.initials: LJ
authors.lastname: Zimmermann
authors.forename: Wim C J
authors.initials: WC
authors.lastname: Hop
authors.forename: Marcel J I J
authors.initials: MJ
authors.lastname: Albers
authors.forename: Dick
authors.initials: D
authors.lastname: Tibboel
authors.forename: Koen F M
authors.initials: KF
authors.lastname: Joosten
mesh_terms: D000293:Adolescent; D000886:Anthropometry; D002648:Child; D002675:Child, Preschool; D016638:Critical Illness; D002149:Energy Intake; D006760:Hospitalization; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007234:Infant, Premature; D015278:Intensive Care Units, Pediatric; D015931:Intensive Care, Neonatal; D007902:Length of Stay; D009426:Netherlands; D018673:Nutrition Policy; D009751:Nutritional Requirements; D009752:Nutritional Status; D011446:Prospective Studies; D011502:Protein-Energy Malnutrition / Q000453:epidemiology* / Q000503:physiopathology; D012044:Regression Analysis