title: Avoidable causes of delayed enteral nutrition in critically ill children.
abstract: To evaluate the incidence of delayed enteral nutrition (EN) and identify avoidable causes of delay, we retrospectively reviewed medical records of 200 children (median age [range]; 37.5 [1-216] months) who stayed in the intensive care unit (ICU) for a minimum of 3 days. Among 200 children, 115 received EN following ICU admission with a median time of EN initiation of 5 days after admission. Of these, only 22 patients achieved the estimated energy requirement. A significant decrease in the final z score of weight for age from the initial assessment was observed in the non-EN group only (-1.3±2.17 to -1.57±2.35, P<0.001). More survivors than non-survivors received EN during their ICU stay (61.2% vs 30.0%, P=0.001) and received EN within 72 hr of ICU admission (19.8% vs 3.3%, P=0.033). The most common reason for delayed EN was gastrointestinal (GI) bleeding, followed by altered GI motility and hemodynamic instability. Only eight cases of GI bleeding and one case of altered GI motility were diagnosed as active GI bleeding and ileus, respectively. This study showed that the strategies to reduce avoidable withholding EN are necessary to improve the nutrition status of critically ill children.
authors.affiliation: Department of Nutrition and Dietetics, Severance Hospital, Yonsei University Health System, Seoul, Korea.
authors.forename: Hosun
authors.initials: H
authors.lastname: Lee
authors.forename: Shin Ok
authors.initials: SO
authors.lastname: Koh
authors.forename: Hyungmi
authors.initials: H
authors.lastname: Kim
authors.forename: Myung Hyun
authors.initials: MH
authors.lastname: Sohn
authors.forename: Kyu-Earn
authors.initials: KE
authors.lastname: Kim
authors.forename: Kyung Won
authors.initials: KW
authors.lastname: Kim
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D016638:Critical Illness; D002149:Energy Intake; D004750:Enteral Nutrition / Q000706:statistics & numerical data*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis*; D005769:Gastrointestinal Motility; D006801:Humans; D045823:Ileus / Q000175:diagnosis*; D007223:Infant; D007362:Intensive Care Units; D008297:Male; D009752:Nutritional Status; D012189:Retrospective Studies; D016896:Treatment Outcome; D028761:Withholding Treatment / Q000706:statistics & numerical data*
keywords: Child; Critical Illness; Enteral Nutrition; Parenteral Nutrition