title: Implementation of Nutrition Support Guidelines May Affect Energy and Protein Intake in the Pediatric Intensive Care Unit.
abstract: Critically ill children are at risk of developing malnutrition, and undernutrition is a risk factor for morbidity and mortality.
  
  
  
  The study evaluated changes in the energy and protein intake before and after implementation of nutrition support (NS) guidelines for a pediatric critical care unit (PICU).
  
  
  
  This retrospective study documented energy and protein intake for the first 8 days of PICU stay. Basal metabolic rate and protein needs were estimated by Schofield and American Society for Parenteral and Enteral Nutrition Guidelines, respectively.
  
  
  
  Three hundred thirty-five children from August to December 2012 (pre-implementation) and 185 from October to December 2013 (post-implementation).
  
  
  
  Implementation of NS Guidelines.
  
  
  
  Changes in actual energy and protein intake in the post- compared with the pre-Implementation period.
  
  
  
  Unpaired t tests, Pearson's χ(2) (unadjusted analysis) were used. Logistic regressions were used to estimate odds ratios and 95% confidence intervals for protein and energy intake, adjusted for age, sex, and Pediatric Risk of Mortality score.
  
  
  
  After the implementation of guidelines, significant improvements were seen during days 5 through 8 in energy intake among children 2 years of age and older, and in protein intake in both age groups (P<0.05). For the 8-day period, statistically or clinically significant improvements occurred in the cumulative protein deficit/kg/day, as follows: younger than 2-year-olds, -1.5±0.7 g/kg/day vs -1.3±0.8 g/kg/day, P=0.02; 2-year-olds or older, -1.0±0.6 g/kg/day vs -0.7±0.8 g/kg/day, P=0.01; and for the energy deficit/kg/d in 2-year-olds and older, -17.2±13.6 kcal/kg/day vs -13.3±18.1 kcal/kg/day, unpaired t test, P=0.07, in the pre- vs post-implementation period, respectively.
  
  
  
  The implementation of NS guidelines was associated with improvements in total energy in 2-year-olds and older and protein in younger than 2 and 2 years and older children by days 5 through 8, and protein deficits were significantly lower in the post- vs the pre-implementation period. The implementation of NS guidelines may have had a positive effect on improving NS in critically ill children.
authors.forename: Ursula G
authors.initials: UG
authors.lastname: Kyle
authors.forename: Laura A
authors.initials: LA
authors.lastname: Lucas
authors.forename: Guisela
authors.initials: G
authors.lastname: Mackey
authors.forename: Jaime C
authors.initials: JC
authors.lastname: Silva
authors.forename: Jennifer
authors.initials: J
authors.lastname: Lusk
authors.forename: Renan
authors.initials: R
authors.lastname: Orellana
authors.forename: Lara S
authors.initials: LS
authors.lastname: Shekerdemian
authors.forename: Jorge A
authors.initials: JA
authors.lastname: Coss-Bu
mesh_terms: D000293:Adolescent; D001481:Basal Metabolism; D002648:Child; D002675:Child, Preschool; D016638:Critical Illness / Q000628:therapy; D004044:Dietary Proteins / Q000008:administration & dosage*; D002149:Energy Intake; D005260:Female; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric / Q000592:standards*; D016015:Logistic Models; D008297:Male; D044342:Malnutrition / Q000628:therapy; D018673:Nutrition Policy; D009751:Nutritional Requirements; D018529:Nutritional Support / Q000379:methods*; D012189:Retrospective Studies
chemical_list: D004044:Dietary Proteins
keywords: Children; Critically ill; Energy needs; Nutrition support; Protein needs