title: Risk Factors for Delayed Enteral Nutrition in Critically Ill Children.
abstract: OBJECTIVE
  Delayed enteral nutrition, defined as enteral nutrition started 48 hours or more after admission to the PICU, is associated with an inability to achieve full enteral nutrition and worse outcomes in critically ill children. We reviewed nutritional practices in six medical-surgical PICUs and determined risk factors associated with delayed enteral nutrition in critically ill children.
  
  
  METHODS
  Retrospective cross-sectional study using medical records as source of data.
  
  
  METHODS
  Six medical-surgical PICUs in northeastern United States.
  
  
  METHODS
  Children less than 21 years old admitted to the PICU for 72 hours or more excluding those awaiting or recovering from abdominal surgery.
  
  
  RESULTS
  A total of 444 children with a median age of 4.0 years were included in the study. Enteral nutrition was started at a median time of 20 hours after admission to the PICU. There was no significant difference in time to start enteral nutrition among the PICUs. Of those included, 88 children (19.8%) had delayed enteral nutrition. Risk factors associated with delayed enteral nutrition were noninvasive (odds ratio, 3.37; 95% CI, 1.69-6.72) and invasive positive-pressure ventilation (odds ratio, 2.06; 95% CI, 1.15-3.69), severity of illness (odds ratio for every 0.1 increase in pediatric index of mortality 2 score, 1.39; 95% CI, 1.14-1.71), procedures (odds ratio, 3.33; 95% CI, 1.67-6.64), and gastrointestinal disturbances (odds ratio, 2.05; 95% CI, 1.14-3.68) within 48 hours after admission to the PICU. Delayed enteral nutrition was associated with failure to reach full enteral nutrition while in the PICU (odds ratio, 4.09; 95% CI, 1.97-8.53). Nutrition consults were obtained in less than half of the cases, and none of the PICUs used tools to assure the adequacy of energy and protein nutrition.
  
  
  CONCLUSIONS
  Institutions in this study initiated enteral nutrition for a high percentage of patients by 48 hours of admission. Noninvasive positive-pressure ventilation was most strongly associated with delay enteral nutrition. A better understanding of these risk factors and assessments of nutritional requirements should be explored in future prospective studies.
authors.affiliation: 1Department of Pediatrics, Yale University School of Medicine, New Haven, CT. 2Department of Pediatric Critical Care, Nemours/AI duPont Hospital for Children, Wilmington, DE. 3Department of Pediatrics, Connecticut Children's Medical Center, Hartford, CT. 4Department of Pediatrics, Women and Children's Hospital of Buffalo, Buffalo, NY. 5Division of Pediatric Critical Care Medicine, Department of Pediatrics, Maria Fareri Children's Hospital, Valhalla, NY. 6Department of Pediatrics, University of Massachusetts Memorial Medical Center, Worcester, MA. 7Division of Critical Care, Department of Anesthesia, Perioperative and Pain Medicine, Boston Children's Hospital, Boston, MA.
authors.forename: Michael F
authors.initials: MF
authors.lastname: Canarie
authors.forename: Suzanne
authors.initials: S
authors.lastname: Barry
authors.forename: Christopher L
authors.initials: CL
authors.lastname: Carroll
authors.forename: Amanda
authors.initials: A
authors.lastname: Hassinger
authors.forename: Sarah
authors.initials: S
authors.lastname: Kandil
authors.forename: Simon
authors.initials: S
authors.lastname: Li
authors.forename: Matthew
authors.initials: M
authors.lastname: Pinto
authors.forename: Stacey L
authors.initials: SL
authors.lastname: Valentine
authors.forename: E Vincent S
authors.initials: EV
authors.lastname: Faustino
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D016638:Critical Illness; D003430:Cross-Sectional Studies; D004750:Enteral Nutrition / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric / Q000706:statistics & numerical data*; D008297:Male; D009511:New England; D009752:Nutritional Status; D016017:Odds Ratio; D011175:Positive-Pressure Respiration; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D055815:Young Adult