A nutritional support team in the pediatric intensive care unit: changes and factors impeding appropriate nutrition.
OBJECTIVE
The aims of this study were to determine the impact of a nutritional support team (NST) intervention in a pediatric intensive care unit (PICU) and to identify the factors at admission that were associated to a delay to achieve a sustained optimal caloric intake (SOCI).


METHODS
Caloric and protein intake and nutritional parameters were compared in 82 children in 2000 and 2003, respectively before and after the introduction of a NST. Predictive factors of a delay to achieve the SOCI were identified using multivariate analysis.


RESULTS
There was no difference in 2000 and 2003, respectively, regarding cumulative caloric deficits (19+/-15.7 vs. 20.7+/-14.8 kcal/kg day), cumulative protein deficits (0.26+/-0.31 vs. 0.22+/-0.20 g/kg day), time to achieve a SOCI (7 vs. 7 days). Factors at admission associated with a delay to achieve a SOCI were a pediatric risk of mortality (PRISM) score > 10 (hazard ratio 0.58; 95% CI 0.44-0.77), a CRP > 50 mg/L (hazard ratio 0.49; 95% CI 0.35-0.70), a fluid restriction (hazard ratio 0.51; 95% CI 0.37-0.71), and a weight for age > 3rd centile (hazard ratio 0.54; 95% CI 0.41-0.72).


CONCLUSIONS
The intervention of a NST has not modified significantly the nutritional management. In pediatric intensive care, many factors identified at admission are associated with impairing appropriate nutrition.
Lambe
Cecile
C
Réanimation Pédiatrique, Hôpital Necker-Enfants Malades, APHP, Université René Descartes, Paris, France. Cecile.lambe@svp.aphp.fr
Hubert
Philippe
P
Jouvet
Philippe
P
Cosnes
Jacques
J
Colomb
Virginie
V
D016638:Critical Illness / Q000628:therapy; D004044:Dietary Proteins / Q000008:administration & dosage; D002149:Energy Intake / Q000502:physiology; D005260:Female; D006801:Humans; D007223:Infant; D007227:Infant Nutritional Physiological Phenomena; D015278:Intensive Care Units, Pediatric / Q000592:standards*; D008297:Male; D015999:Multivariate Analysis; D018673:Nutrition Policy; D009751:Nutritional Requirements; D009752:Nutritional Status; D018529:Nutritional Support; D010348:Patient Care Team; D012189:Retrospective Studies
D004044:Dietary Proteins