title: Indirect calorimetry reveals that better monitoring of nutrition therapy in pediatric intensive care is needed.
abstract: BACKGROUND
  Monitoring nutrition therapy is essential in the care of critically ill children, but the risk of nutrition failure seems to remain. The aims of the present study were to examine the prevalence of underfeeding, adequate feeding, and overfeeding in mechanically ventilated children and to identify barriers to the delivery of nutrition support.
  
  
  METHODS
  Children aged 0-14 years who fulfilled the criteria for indirect calorimetry were enrolled in this prospective, observational study and were studied for up to 5 consecutive days. Actual energy intake was recorded and compared with the required energy intake (measured energy expenditure plus 10%); energy intake was classified as underfeeding (<90% of required energy intake), adequate feeding (90%-110%), or overfeeding (>110%). The reasons for interruptions to enteral and parenteral nutrition were recorded.
  
  
  RESULTS
  In total, 104 calorimetric measurements for 140 total days were recorded for 30 mechanically ventilated children. Underfeeding, adequate feeding, and overfeeding occurred on 21.2%, 18.3%, and 60.5% of the 104 measurement days, respectively. There was considerable variability in the measured energy expenditure between children (median, 37.2 kcal/kg/d; range, 16.81-66.38 kcal/kg/d), but the variation within each child was small. Respiratory quotient had low sensitivity of 21% and 27% for detecting underfeeding and overfeeding, respectively. Fasting for procedures was the most frequent barrier that led to interrupted nutrition support.
  
  
  CONCLUSIONS
  The high percentage of children (~61%) who were overfed emphasizes the need to measure energy needs by using indirect calorimetry.
authors.affiliation: Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway mdokken@ous-hf.no.
authors.forename: Mette
authors.initials: M
authors.lastname: Dokken
authors.affiliation: Division of Emergencies and Critical Care, Department of Research and Development, Ullevål, Oslo University Hospital, Oslo, Norway Unit of Nursing Science, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway.
authors.forename: Tone
authors.initials: T
authors.lastname: Rustøen
authors.affiliation: Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway Faculty of Medicine, University of Oslo, Oslo, Norway.
authors.forename: Audun
authors.initials: A
authors.lastname: Stubhaug
mesh_terms: D000293:Adolescent; D002153:Calorimetry, Indirect; D002648:Child; D002675:Child, Preschool; D003422:Critical Care / Q000592:standards; D016638:Critical Illness / Q000628:therapy*; D002149:Energy Intake; D004734:Energy Metabolism; D005260:Female; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric; D008297:Male; D044342:Malnutrition / Q000453:epidemiology / Q000209:etiology; D044623:Nutrition Therapy; D009751:Nutritional Requirements; D018529:Nutritional Support; D044343:Overnutrition / Q000453:epidemiology / Q000209:etiology; D015995:Prevalence; D011446:Prospective Studies; D012121:Respiration, Artificial
keywords: barriers; energy expenditure; enteral nutrition; indirect calorimetry; malnutrition; parenteral nutrition; pediatric intensive care unit