Enteral nutrition in critically ill children: are prescription and delivery according to their energy requirements?
BACKGROUND
The purpose of this study was to compare the differences between prescribed and delivered energy among critically ill children and to identify the factors that impede the optimal delivery of enteral nutrition in the first 5 days of nutrition support.


METHODS
In a prospective cohort study, we evaluated 55 critically ill children aged 8.2 +/- 11.4 months (0-162.3 months), who were fed for > or =2 days through a gastric or postpyloric tube. The patients were followed from admission until day 10 of enteral nutrition. Prescribed and delivered energy were recorded daily and compared with each other and with the estimated basal metabolic rate (BMR). The Paediatric Index of Mortality 2 (PIM 2) was used to estimate illness severity.


RESULTS
The ratio of delivered:required energy was <90% in 55.7% of the enteral nutrition days. Low prescription was the main reason for not achieving the energy goal in the first 5 days of enteral nutrition. Discrepancies between prescribed and delivered: energy were attributable to interruptions in feeding caused by clinical instability, airway management, radiologic and surgical procedures, and accidental feeding tube removal. The other factors associated with the delivery of less than required energy were PIM 2 > or =15%, gastrointestinal complications, dialysis, and use of alpha-adrenergic vasoactive drugs. The latter was the only variable in multivariate analysis that was associated with not ultimately achieving energy goal.


CONCLUSIONS
The prescription and delivery of energy were not adequate in >50% of enteral nutrition days. The gap between the effective administration and energy requirements can be explained by both underprescription and underdelivery. Administration of vasoactive drugs was the only variable independently associated with a low energy supply.
de Oliveira Iglesias
Simone Brasil
SB
Pediatric Intensive Care Unit, Department of Pediatrics, Federal University of São Paulo, Rua Loefgreen 1647, 04040-032, São Paulo SP, Brazil.
Leite
Heitor Pons
HP
Santana e Meneses
Juliana Fernandez
JF
de Carvalho
Werther Brunow
WB
D001481:Basal Metabolism / Q000502:physiology; D015331:Cohort Studies; D016638:Critical Illness / Q000628:therapy*; D004734:Energy Metabolism / Q000502:physiology*; D004750:Enteral Nutrition; D005260:Female; D006801:Humans; D007223:Infant; D007227:Infant Nutritional Physiological Phenomena; D008297:Male; D015999:Multivariate Analysis; D009751:Nutritional Requirements; D011446:Prospective Studies; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome