title: Problems With Optimal Energy and Protein Delivery in the Pediatric Intensive Care Unit.
abstract: BACKGROUND
  Optimal nutrition therapy (NT) delivery is associated with improved outcomes in critically ill children. However, avoidable barriers impede delivery of optimal energy and protein in the pediatric intensive care unit (PICU). This study aims to describe the gap between energy and protein prescription and actual intake.
  
  
  METHODS
  Single-center prospective cohort study, including consecutive children (age: 1 month to 15 years) admitted to the PICU in southern Brazil. Demographics, clinical characteristics, and NT details were recorded.
  
  
  RESULTS
  We enrolled 130 patients: 37% female; median (interquartile range) age, 29.43 months (4.03, 100.63); PICU length of stay, 6 days (4, 13). Median predicted energy expenditure by Schofield equation and prescribed and actual energy intake were 47.13 kcal/kg/d (38.60, 55.38), 31.94 kcal/kg/d (13.99, 51.90), and 25.06 kcal/kg/d (10.21, 46.92), respectively. On average, actual energy intake was 47% of the predicted energy expenditure, and 68% of patients were underfed. Actual protein intake was 49% of the estimated requirement. NT was interrupted in 64% of patients.
  
  
  CONCLUSIONS
  There were significant gaps among the predicted requirement, prescription, and actual delivery of energy and protein in the PICU. Suboptimal prescription and multiple feeding interruptions resulted in underfeeding.
authors.affiliation: Graduate Program in Nutrition, Federal University of Santa Catarina, Florianópolis, Brazil yara.moreno@ufsc.br.
authors.forename: Yara M F
authors.initials: YM
authors.lastname: Moreno
authors.affiliation: Graduate Program in Nutrition, Federal University of Santa Catarina, Florianópolis, Brazil.
authors.forename: Daniela B
authors.initials: DB
authors.lastname: Hauschild
authors.affiliation: Joana de Gusmão Children's Hospital, Florianópolis, Brazil.
authors.forename: Eliana
authors.initials: E
authors.lastname: Barbosa
authors.affiliation: Joana de Gusmão Children's Hospital, Florianópolis, Brazil.
authors.forename: Nilzete L
authors.initials: NL
authors.lastname: Bresolin
authors.affiliation: Division of Critical Care Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts, USA Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Nilesh M
authors.initials: NM
authors.lastname: Mehta
mesh_terms: D001938:Brazil; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003422:Critical Care / Q000379:methods* / Q000706:statistics & numerical data; D016638:Critical Illness; D004044:Dietary Proteins / Q000008:administration & dosage*; D002149:Energy Intake / Q000502:physiology*; D004734:Energy Metabolism / Q000502:physiology; D005260:Female; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric; D008297:Male; D009752:Nutritional Status; D018529:Nutritional Support / Q000379:methods* / Q000706:statistics & numerical data; D011446:Prospective Studies; D016896:Treatment Outcome
chemical_list: D004044:Dietary Proteins
keywords: critical care; critical illness; energy; enteral nutrition; intensive care unit; parenteral nutrition; pediatrics; protein