Factors associated with not meeting the recommendations for micronutrient intake in critically ill children.
OBJECTIVE
Children admitted to the intensive care unit (ICU) are at risk of not meeting their nutritional requirements. This study aimed to identify factors associated with failure to meet the dietary recommended intake (DRI) of zinc, selenium, cholecalciferol, and thiamine in critically ill children receiving enteral tube feeding during their stay in the ICU.


METHODS
We analyzed prospectively 260 cases, corresponding to 206 patients who received enteral tube feeding for a minimum of 3 days up to 10 days during the first 10 d of ICU stay. Individual intake was compared to estimated average requirement (EAR) and adequate intake (AI) values during the first 10 d of ICU stay. The outcome variable was defined as not meeting the recommended intake of the micronutrients studied. Potential explanatory variables for the outcome were age <1 year, malnutrition (WHO), clinical severity scores, heart disease, severe sepsis or septic shock, use of alpha-adrenergic drugs, and renal replacement therapy (RRT). The effect of the explanatory variables on the outcome was analyzed by logistic regression analysis.


RESULTS
The majority of patients did not meet the recommendations for micronutrients. After adjusting for covariates, age <1 year, malnutrition, heart disease, use of alpha-adrenergic drugs, and renal replacement therapy were associated with failure to meet the recommendations for at least one of the micronutrients studied.


CONCLUSIONS
Factors associated with failure to meet the recommendations for micronutrient intake in children receiving enteral tube feeding during their ICU stay are linked to patients' low weight, restriction in fluid intake, and clinical severity of the disease.
Discipline of Nutrition and Metabolism, Department of Pediatrics, Federal University of São Paulo, São Paulo, Brazil.
Marcella
M
Dos Reis Santos
Discipline of Nutrition and Metabolism, Department of Pediatrics, Federal University of São Paulo, São Paulo, Brazil. Electronic address: heitorpons@gmail.com.
Heitor Pons
HP
Leite
Department of Pediatrics, Federal University of São Paulo, São Paulo, Brazil.
Aline Maria
AM
Luiz Pereira
Department of Surgery, Federal University of São Paulo, São Paulo, Brazil.
Bruna
B
Dell'Acqua Cassão
Pediatric Intensive Care Unit, Department of Pediatrics, Federal University of São Paulo, São Paulo, Brazil.
Simone Brasil
SB
de Oliveira Iglesias
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D002762:Cholecalciferol / Q000008:administration & dosage; D015331:Cohort Studies; D003422:Critical Care / Q000379:methods*; D016638:Critical Illness; D004750:Enteral Nutrition; D005260:Female; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric; D008297:Male; D018977:Micronutrients / Q000008:administration & dosage*; D044623:Nutrition Therapy / Q000379:methods*; D009751:Nutritional Requirements; D010289:Parenteral Nutrition, Total; D011446:Prospective Studies; D012643:Selenium / Q000008:administration & dosage; D013831:Thiamine / Q000008:administration & dosage; D015032:Zinc / Q000008:administration & dosage
D018977:Micronutrients; D002762:Cholecalciferol; D012643:Selenium; D015032:Zinc; D013831:Thiamine
Dietary reference intakes; Enteral nutrition; Intensive care unit; Micronutrients; Nutrition support; Pediatric