title: Survey of contemporary feeding practices in critically ill children in the Asia-Pacific and the Middle East.
abstract: OBJECTIVE
  Nutrition is a fundamental component of care of critically ill children. Determining variation in nutritional practices within paediatric intensive care units (PICUs) allows for review and improvement of nutrition practices.
  
  
  METHODS
  The aim was to survey the nutrition practices and perspectives of paediatric intensivists and dieticians in Asia-Pacific and the Middle East. A questionnaire was developed to collect data on (1) the respondent's and institution's characteristics, (2) nutritional assessments and nutrient delivery practices, and (3) the perceived importance and barriers to optimal enteral feeding in the PICU.
  
  
  RESULTS
  We analysed 47 responses from 35 centres in 18 different countries. Dedicated dietetic services were only present in 13 (37%) centres and regular nutrition assessments were conducted in only 12 (34%) centres. In centres with dedicated dieticians, we found greater use of carbohydrate, fat additives and special formulas. Two thirds [31 (66%)] of respondents used total fluids to estimate energy requirements. Only 11 (31%) centres utilized feeding protocols. These centres had higher use of small bowel feeding, acid suppressants, laxatives and gastric residual volume thresholds. When dealing with feed intolerance, they were also more likely to start a motility agent. There was also a lack of consensus on when feeding should start and the use of adjuncts.
  
  
  CONCLUSIONS
  Nutrition practices and barriers are unique in Asia-Pacific and the Middle East and strongly reflect a lack of dietetic services. Future effort should focus on developing a uniform approach on nutrition practices to drive paediatric critical care nutrition research in these regions.
authors.affiliation: Department of Paediatric Medicine, KK Women's and Children's Hospital, Singapore.
authors.forename: Judith J M
authors.initials: JJ
authors.lastname: Wong
authors.affiliation: Department of Dietetics and Nutrition, KK Women's and Children's Hospital, Singapore.
authors.forename: Chengsi
authors.initials: C
authors.lastname: Ong
authors.affiliation: Department of Dietetics and Nutrition, KK Women's and Children's Hospital, Singapore.
authors.forename: Wee Meng
authors.initials: WM
authors.lastname: Han
authors.affiliation: Critical Care Medicine, Boston Children's Hospital, Boston, United States of America.
authors.forename: Nilesh M
authors.initials: NM
authors.lastname: Mehta
authors.affiliation: Children's Intensive Care Unit, Department of Paediatric Subspecialties, KK Women's and Children's Hospital, Singapore. Email: lee.jan.hau@kkh.com.sg.|Office of Clinical Sciences, Duke-NUS School of Medicine, Singapore.
authors.forename: Jan Hau
authors.initials: JH
authors.lastname: Lee
mesh_terms: D001208:Asia; D002648:Child; D015362:Child Nutrition Disorders; D016638:Critical Illness / Q000628:therapy*; D004046:Dietetics; D004750:Enteral Nutrition / Q000379:methods; D005248:Feeding Methods; D006801:Humans; D015278:Intensive Care Units, Pediatric; D008877:Middle East; D015596:Nutrition Assessment; D009749:Nutrition Surveys; D009751:Nutritional Requirements; D009752:Nutritional Status; D010288:Parenteral Nutrition / Q000379:methods; D010372:Pediatrics / Q000379:methods*