title: A stepwise enteral nutrition algorithm for critically ill children helps achieve nutrient delivery goals*.
abstract: OBJECTIVE
  To evaluate the impact of implementing an enteral nutrition algorithm on achieving optimal enteral nutrition delivery in the PICU.
  
  
  METHODS
  Prospective pre/post implementation audit of enteral nutrition practices.
  
  
  METHODS
  One 29-bed medical/surgical PICU in a freestanding, university-affiliated children's hospital.
  
  
  METHODS
  Consecutive patients admitted to the PICU over two 4-week periods pre and post implementation, with a stay of more than 24 hours who received enteral nutrition.
  
  
  METHODS
  Based on the results of our previous study, we developed and systematically implemented a stepwise, evidence and consensus-based algorithm for initiating, advancing, and maintaining enteral nutrition in critically ill children. Three months after implementation, we prospectively recorded clinical characteristics, nutrient delivery, enteral nutrition interruptions, parenteral nutrition use, and ability to reach energy goal in eligible children over a 4-week period. Clinical and nutritional variables were compared between the pre and postintervention cohorts. Time to achieving energy goal was analyzed using Kaplan-Meier statistical analysis.
  
  
  RESULTS
  Eighty patients were eligible for this study and were compared to a cohort of 80 patients in the preimplementation audit. There were no significant differences in median age, gender, need for mechanical ventilation, time to initiating enteral nutrition, or use of postpyloric feeding between the two cohorts. We recorded a significant decrease in the number of avoidable episodes of enteral nutrition interruption (3 vs 51, p < 0.0001) and the prevalence and duration of parenteral nutrition dependence in patients with avoidable enteral nutrition interruptions in the postintervention cohort. Median time to reach energy goal decreased from 4 days to 1 day (p < 0.0001), with a higher proportion of patients reaching this goal (99% vs 61%, p = 0.01).
  
  
  CONCLUSIONS
  The implementation of an enteral nutrition algorithm significantly improved enteral nutrition delivery and decreased reliance on parenteral nutrition in critically ill children. Energy intake goal was reached earlier in a higher proportion of patients.
authors.affiliation: 1Department of Cardiovascular/Critical Care Nursing, Boston Children's Hospital, Boston, MA. 2Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, MA. 3Critical Care Medicine, Department of Anesthesiology, Pain and Perioperative Medicine, Boston Children's Hospital, Boston, MA.
authors.forename: Susan
authors.initials: S
authors.lastname: Hamilton
authors.forename: Diane M
authors.initials: DM
authors.lastname: McAleer
authors.forename: Katelyn
authors.initials: K
authors.lastname: Ariagno
authors.forename: Megan
authors.initials: M
authors.lastname: Barrett
authors.forename: Nicole
authors.initials: N
authors.lastname: Stenquist
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Duggan
authors.forename: Nilesh M
authors.initials: NM
authors.lastname: Mehta
mesh_terms: D000293:Adolescent; D000465:Algorithms; D002648:Child; D002675:Child, Preschool; D003422:Critical Care; D003663:Decision Trees; D002149:Energy Intake; D004750:Enteral Nutrition; D005260:Female; D006801:Humans; D007223:Infant; D007902:Length of Stay; D008297:Male; D011446:Prospective Studies