title: Outcomes in a pediatric intensive care unit before and after the implementation of a nutrition support team.
abstract: BACKGROUND
  We evaluated the effect of parenteral nutrition (PN) and enteral nutrition (EN) on in-pediatric intensive care unit (PICU) mortality before and after a continuous education program in nutrition support that leads to implementation of a nutrition support team (NST).
  
  
  METHODS
  We used a historical cohort study of infants hospitalized for >72 hours at the PICU from 1992 to 2003. Five periods were selected (P1 to P5), considering the modifications incorporated into the program: P1, without intervention; P2, basic themes and original articles discussion; P3, clinical and nursing staff participation; P4, clinical visits; P5, NST. The samples were compared in terms of sex, age, admitting service (ie, medical vs surgical), prognostic index of mortality, length of stay (LOS), duration of mechanical ventilation, in-PICU mortality rate, and percentage of time receiving EN and PN for each patient. Bi- and multivariate analyses were performed. Statistical significance was set at 0.05 level.
  
  
  RESULTS
  Progressive increase was observed in EN use (p = .0001), median values for which were 25% in P1 and rose to 67% by P5 in medical patients; there was no significant difference in surgical patients. A reduction was observed in PN use; in P1 medians were 73% and 69% for medical and surgical patients respectively, and decreased to 0% in P5 for both groups (p = .0001). There was significant reduction in-PICU mortality rate during P4 and P5 among medical patients (p < .001). The risk of death was 83% lower in patients that received EN for >50% of LOS (odds ratio, 0.17; confidence interval, 0.066-0.412; p = .000).
  
  
  CONCLUSIONS
  The program motivated an increase in EN and a decrease in PN use, mainly after implementation of NST and reduced in-PICU mortality rate.
authors.affiliation: Pediatric Intensive Care Unit and the Discipline of Nutrition and Metabolism, Department of Pediatrics, Federal University of São Paulo, São Paulo, Brazil.
authors.forename: Gisele Limongeli
authors.initials: GL
authors.lastname: Gurgueira
authors.forename: Heitor Pons
authors.initials: HP
authors.lastname: Leite
authors.forename: José Augusto de Aguiar Carrazedo
authors.initials: JA
authors.lastname: Taddei
authors.forename: Werther Brunow
authors.initials: WB
authors.lastname: de Carvalho
mesh_terms: D015331:Cohort Studies; D016638:Critical Illness / Q000401:mortality / Q000628:therapy*; D004496:Education, Continuing; D004750:Enteral Nutrition; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric / Q000706:statistics & numerical data*; D007902:Length of Stay; D008297:Male; D015999:Multivariate Analysis; D010288:Parenteral Nutrition; D012720:Severity of Illness Index; D016896:Treatment Outcome