title: Epidemiology of interruptions to nutrition support in critically ill children in the pediatric intensive care unit.
abstract: BACKGROUND
  Nutrition support is often delayed or interrupted. The aim of this study is to identify reasons for and quantify time spent without nutrition in a mixed medical-surgical-cardiac pediatric intensive care unit (PICU).
  
  
  METHODS
  Data were prospectively collected to describe the patient cohort (anthropometrics and diagnostic category) and nutrition practices (time to nutrition initiation; frequency, duration, and causes of interruptions; and overall caloric intake). Descriptive statistics were used; comparisons of groups were performed using an independent t test and P < .05 as significance.
  
  
  RESULTS
  The mean (standard deviation) time to nutrition initiation was 22.8 (16.6) hours following admission; 35% of patients were initiated after >24 hours. Nutrition was interrupted 1.2 (2.0) times per patient. Time spent without nutrition due to interruptions was 11.6 (23.0) hours, up to 102 hours. Patients spent 42.4% (28.2%) of their median (range) PICU admission of 2.9 days (0.25-39 days) without any form of nutrition. Patients aged 0-6 months had a significantly higher mean number and duration of interruptions (P = .001 and P < .001, respectively) compared with children >6 months. Interruptions due to surgery and planned extubation lasted significantly longer than all other interruptions (P < .001 and P = .001, respectively). Pediatric Risk of Mortality (PRISM) III scores were not correlated with percentage of length of stay spent without nutrition (r = 0.137).
  
  
  CONCLUSIONS
  Prolonged time to nutrition initiation and interruptions in delivery caused pediatric patients to spend a high proportion of admission without nutrition support, preventing most from meeting energy requirements. Further research addressing specific patient outcomes is required to define optimal initiation times and appropriate procedural-specific fasting times.
authors.affiliation: University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Alysha
authors.initials: A
authors.lastname: Keehn
authors.affiliation: University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Christina
authors.initials: C
authors.lastname: O'Brien
authors.affiliation: University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Vera
authors.initials: V
authors.lastname: Mazurak
authors.affiliation: Stollery Children's Hospital, Edmonton, Alberta, Canada.
authors.forename: Kim
authors.initials: K
authors.lastname: Brunet-Wood
authors.affiliation: University of Alberta, Edmonton, Alberta, Canada Stollery Children's Hospital, Edmonton, Alberta, Canada.
authors.forename: Ari
authors.initials: A
authors.lastname: Joffe
authors.affiliation: University of Alberta, Edmonton, Alberta, Canada Stollery Children's Hospital, Edmonton, Alberta, Canada.
authors.forename: Allan
authors.initials: A
authors.lastname: de Caen
authors.affiliation: Stollery Children's Hospital, Edmonton, Alberta, Canada Alberta Health Services, Edmonton, Alberta, Canada bodil.larsen@albertahealthservices.ca.
authors.forename: Bodil
authors.initials: B
authors.lastname: Larsen
mesh_terms: D002648:Child; D002675:Child, Preschool; D003422:Critical Care / Q000379:methods* / Q000706:statistics & numerical data; D016638:Critical Illness / Q000451:nursing*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric; D007902:Length of Stay; D008297:Male; D009752:Nutritional Status; D018529:Nutritional Support / Q000451:nursing* / Q000706:statistics & numerical data*; D011446:Prospective Studies; D013997:Time Factors
keywords: critical care; enteral nutrition; nutrition support teams; parenteral nutrition; pediatrics