title: An evaluation of enteral nutrition practices and nutritional provision in children during the entire length of stay in critical care.
abstract: BACKGROUND
  Provision of optimal nutrition in children in critical care is often challenging. This study evaluated exclusive enteral nutrition (EN) provision practices and explored predictors of energy intake and delay of EN advancement in critically ill children.
  
  
  METHODS
  Data on intake and EN practices were collected on a daily basis and compared against predefined targets and dietary reference values in a paediatric intensive care unit. Factors associated with intake and advancement of EN were explored.
  
  
  RESULTS
  Data were collected from 130 patients and 887 nutritional support days (NSDs). Delay to initiate EN was longer in patients from both the General Surgical and congenital heart defect (CHD) Surgical groups [Median (IQR); CHD Surgical group: 20.3 (16.4) vs General Surgical group: 11.4 (53.5) vs Medical group: 6.5 (10.9) hours; p ≤ 0.001]. Daily fasting time per patient was significantly longer in patients from the General Surgical and CHD Surgical groups than those from the Medical group [% of 24 h, Median (IQR); CHD Surgical group: 24.0 (29.2) vs General Surgical group: 41.7 (66.7) vs Medical group: 9.4 (21.9); p ≤ 0.001]. A lower proportion of fluids was delivered as EN per patient (45% vs 73%) or per NSD (56% vs 73%) in those from the CHD Surgical group compared with those with medical conditions. Protein and energy requirements were achieved in 38% and 33% of the NSDs. In a substantial proportion of NSDs, minimum micronutrient recommendations were not met particularly in those patients from the CHD Surgical group. A higher delivery of fluid requirements (p < 0.05) and a greater proportion of these delivered as EN (p < 0.001) were associated with median energy intake during stay and delay of EN advancement. Fasting (31%), fluid restriction (39%) for clinical reasons, procedures requiring feed cessation and establishing EN (22%) were the most common reasons why target energy requirements were not met.
  
  
  CONCLUSIONS
  Provision of optimal EN support remains challenging and varies during hospitalisation and among patients. Delivery of EN should be prioritized over other "non-nutritional" fluids whenever this is possible.
authors.forename: Jackie
authors.initials: J
authors.lastname: Mara
authors.affiliation: Paediatric Intensive Care Unit, Royal Hospital for Sick Children, NHS Greater Glasgow and Clyde, Glasgow G3 8SJ, UK. Emma@kehoes.com.
authors.forename: Emma
authors.initials: E
authors.lastname: Gentles
authors.forename: Hani A
authors.initials: HA
authors.lastname: Alfheeaid
authors.forename: Krystalia
authors.initials: K
authors.lastname: Diamantidi
authors.forename: Neil
authors.initials: N
authors.lastname: Spenceley
authors.forename: Mark
authors.initials: M
authors.lastname: Davidson
authors.forename: David
authors.initials: D
authors.lastname: Young
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Gerasimidis
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003422:Critical Care / Q000379:methods* / Q000706:statistics & numerical data; D004044:Dietary Proteins; D002149:Energy Intake; D004750:Enteral Nutrition / Q000379:methods* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric / Q000706:statistics & numerical data*; D007902:Length of Stay; D008297:Male; D018977:Micronutrients; D009751:Nutritional Requirements; D009752:Nutritional Status; D010043:Outcome and Process Assessment, Health Care; D016016:Proportional Hazards Models; D006113:United Kingdom
chemical_list: D004044:Dietary Proteins; D018977:Micronutrients