title: Achieving energy goals at day 4 after admission in critically ill children; predictive for outcome?
abstract: OBJECTIVE
  Adequate nutritional intake is essential during pediatric intensive care admission. We investigated whether achievement of energy intake goals at day 4 after admission and route of nutrition were associated with improved outcome.
  
  
  METHODS
  Observational study using prospectively acquired data. Patients receiving enteral and/or parenteral nutrition were included. The energy intake target range at day 4 after admission was 90-110% of resting energy expenditure +10%. Acute malnutrition was defined as weight-for-age <-2 SD. Clinical outcome measures were length of stay, days on ventilator, duration of antibiotics and number of new infections. Data as median (min-max).
  
  
  RESULTS
  Of 325 subjects (age 0.14 (0.0-18.0) year), 19% were acutely malnourished upon admission. Median 86% of energy goals were administered via the enteral route. With enteral energy intake, 7% of patients were fed within the target range, 50% were fed below and 43% were fed above the target range. In a subgroup (n = 223) the acutely malnourished proportion at discharge (26%) was not significantly different from that upon admission (22%). Whether the energy intake was below, within or above the target range did not affect changes in clinical outcome, nor did the route of nutrition.
  
  
  CONCLUSIONS
  Acute malnutrition was highly prevalent upon admission and at discharge. With our nutritional protocol we achieved high rates of (enteral) energy intake. A high percentage of our population received enteral energy above the target energy range. However, there was no association between the amount of energy intake or route of nutrition and clinical outcome.
authors.affiliation: Intensive Care and Department of Pediatric Surgery, Erasmus MC - Sophia Children's Hospital, Rotterdam, The Netherlands. Electronic address: carlijndebetue@gmail.com.
authors.forename: C T I
authors.initials: CT
authors.lastname: de Betue
authors.affiliation: Intensive Care, Erasmus MC - Sophia Children's Hospital, Rotterdam, The Netherlands.
authors.forename: W N
authors.initials: WN
authors.lastname: van Steenselen
authors.affiliation: Department of Pediatric Gastroenterology, Erasmus MC - Sophia Children's Hospital, Rotterdam, The Netherlands.
authors.forename: J M
authors.initials: JM
authors.lastname: Hulst
authors.affiliation: Department of Dietetics, Erasmus MC - Sophia Children's Hospital, Rotterdam, The Netherlands.
authors.forename: J F
authors.initials: JF
authors.lastname: Olieman
authors.affiliation: Intensive Care, Erasmus MC - Sophia Children's Hospital, Rotterdam, The Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: Augustus
authors.affiliation: Department of Biostatistics, Erasmus MC, Rotterdam, The Netherlands.
authors.forename: S H
authors.initials: SH
authors.lastname: Mohd Din
authors.affiliation: Intensive Care, Erasmus MC - Sophia Children's Hospital, Rotterdam, The Netherlands.
authors.forename: S C A T
authors.initials: SC
authors.lastname: Verbruggen
authors.affiliation: Intensive Care, Erasmus MC - Sophia Children's Hospital, Rotterdam, The Netherlands.
authors.forename: D
authors.initials: D
authors.lastname: Tibboel
authors.affiliation: Intensive Care, Erasmus MC - Sophia Children's Hospital, Rotterdam, The Netherlands.
authors.forename: K F M
authors.initials: KF
authors.lastname: Joosten
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D002648:Child; D002675:Child, Preschool; D016638:Critical Illness / Q000628:therapy*; D002149:Energy Intake; D004750:Enteral Nutrition; D006760:Hospitalization; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric; D007902:Length of Stay; D044342:Malnutrition / Q000150:complications / Q000628:therapy*; D009426:Netherlands; D009752:Nutritional Status; D011446:Prospective Studies; D012121:Respiration, Artificial; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents
keywords: Children; Critical care; Energy intake; Infants; Nutritional intake; Nutritional protocol