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Meah S, Kidd C, Rothman B, Marino VL. Exploring paediatric dietetic resources available for critically ill children in the UK and Ireland: A multicentre survey. J Hum Nutr Diet 2024; 37:459-463. [PMID: 38009404 DOI: 10.1111/jhn.13267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 11/10/2023] [Indexed: 11/28/2023]
Abstract
BACKGROUND A dedicated intensive care dietitian, as part of the intensive care unit (ICU) multidisciplinary team, contributes to improved delivery of nutrition support. The Paediatric Critical Care Society recommends a minimum dietetic staffing to critical-care bed ratio of 1:10, led by an Agenda for Change (AfC) Band 7. METHODS A cross-sectional study was conducted using an electronic survey that was available for 12 weeks. The Paediatric Intensive Care Audit Network database was used to identify all hospitals with paediatric intensive care unit (PICU) beds (n = 28). RESULTS Only 14% (n = 4/28) of trusts met the recommended 1:10 dietitian to bed ratio. PICU dietetic whole time equivalent was 0.7 ± 0.4, with a staff to bed ratio of 1:23.7 ± 10.7, compared to adult staff to bed ratio of 1:24.7. Some 92.8% (n = 26/28) had a AfC Band 7 Lead and only 7% (n = 2/28) had an AfC Band 8a Lead compared to adult services where 12.5% (n = 15/122) had an AfC Band 8a (p < 0.05). CONCLUSIONS There is a significant disparity between adult versus paediatric services with regard to seniority of dietitians. Dietitians in well-resourced centres were more likely to review patients without the need for a referral, which may improve nutrition outcomes.
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Affiliation(s)
| | - Catherine Kidd
- Great Ormond Street Hospital for Children Foundation Trust, London, UK
| | - Brittany Rothman
- Great Ormond Street Hospital for Children Foundation Trust, London, UK
| | - V Luise Marino
- Southampton Children's Hospital, University Hospital Southampton NHS Foundation Trust, Southampton, UK
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Winderlich J, Little B, Oberender F, Bollard T, Farrell T, Jenkins S, Landorf E, McCall A, Menzies J, O'Brien K, Rowe C, Sim K, van der Wilk M, Woodgate J, Paul E, Udy AA, Ridley EJ. Nutrition provision in Australian and New Zealand PICUs: A prospective observational cohort study (ePICUre). Nutrition 2024; 118:112261. [PMID: 37984244 DOI: 10.1016/j.nut.2023.112261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 10/01/2023] [Accepted: 10/05/2023] [Indexed: 11/22/2023]
Abstract
OBJECTIVES The main aim of this study was to describe nutrition provision in Australian and New Zealand (ANZ) pediatric intensive care units (PICUs), including mode of nutrition and adequacy of enteral nutrition (EN) to PICU day 28. Secondary aims were to determine the proportion of children undergoing dietetics assessment, the average time to this intervention, and the methods for estimation of energy and protein requirements. METHODS This observational study was conducted in all ANZ tertiary-affiliated specialist PICUs. All children ≤18 y of age admitted to the PICU over a 2-wk period and remaining for ≥48 h were included. Data were collected on days 1 to 7, 14, 21, and 28 (unless discharged prior). Data points included oral intake, EN and parenteral nutrition support, estimated energy and protein adequacy, and dietetics assessment details. RESULTS We enrolled 141 children, of which 79 were boys (56%) and 84 were <2 y of age (60%). Thirty children (73%) received solely EN on day 7 with documented energy and protein targets for 22 (73%). Of these children, 14 (64%) received <75% of their estimated requirements. A dietetics assessment was provided to 80 children (57%), and was significantly higher in those remaining in the PICU beyond the median length of stay (41% in patients staying ≤4.6 d versus 72% in those staying >4.6 d; P < 0.001). CONCLUSIONS This prospective study of nutrition provision across ANZ PICUs identified important areas for improvement, particularly in EN adequacy and nutrition assessment. Further research to optimize nutrition provision in this setting is urgently needed.
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Affiliation(s)
- Jacinta Winderlich
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; Nutrition and Dietetics, Monash Children's Hospital, Melbourne, Australia; Paediatric Intensive Care Unit, Monash Children's Hospital, Melbourne, Australia.
| | - Bridget Little
- Starship Child Health, Auckland City Hospital, Auckland, New Zealand
| | - Felix Oberender
- Paediatric Intensive Care Unit, Monash Children's Hospital, Melbourne, Australia; Department of Paediatrics, School of Clinical Sciences, Monash University, Melbourne, Australia
| | - Tessa Bollard
- Nutrition and Dietetics, Sydney Children's Hospital, Randwick, Australia
| | - Tamara Farrell
- Nutrition & Dietetics Department, Perth Children's Hospital, Perth, Australia
| | - Samantha Jenkins
- Nutrition and Dietetics, John Hunter Children's Hospital, New Lambton Heights, Australia
| | - Emma Landorf
- Nutrition Department, Women's & Children's Hospital, Adelaide, Australia
| | - Andrea McCall
- Nutrition Department, Women's & Children's Hospital, Adelaide, Australia
| | - Jessica Menzies
- Nutrition and Dietetics, Sydney Children's Hospital, Randwick, Australia
| | - Katie O'Brien
- Department of Nutrition & Food Services, The Royal Children's Hospital, Melbourne, Australia
| | - Carla Rowe
- Nutrition & Dietetics, The Children's Hospital at Westmead, Westmead, Australia
| | - Kirsten Sim
- Nutrition & Dietetics, The Children's Hospital at Westmead, Westmead, Australia
| | | | - Jemma Woodgate
- Department of Dietetics & Foodservices, Queensland Children's Hospital, Brisbane, Australia
| | - Eldho Paul
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Andrew A Udy
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; Department of Intensive Care and Hyperbaric Medicine, The Alfred, Melbourne, Australia
| | - Emma J Ridley
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; Dietetics and Nutrition, Alfred Health, Melbourne, Australia
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Continuous versus Intermittent Enteral Feeding in Critically Ill Children: A Systematic Review. Nutrients 2023; 15:nu15020288. [PMID: 36678158 PMCID: PMC9867148 DOI: 10.3390/nu15020288] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 12/28/2022] [Accepted: 12/31/2022] [Indexed: 01/08/2023] Open
Abstract
Administration of enteral nutrition (EN) in critically ill pediatric patients admitted to the pediatric intensive care unit (PICU) constitutes a major challenge due to the increased risk of complications, as well as the lack of well-trained healthcare professionals. EN is usually delivered via cyclic, continuous, or intermittent feeding; however, a number of potential barriers have been reported in the literature regarding different feeding regimens. The purpose of this review was to assess the effectiveness of continuous and intermittent bolus feeding on critically ill children. A systematic search was conducted in PubMed, Scopus Cochrane Central Register of Controlled Trials (CENTRAL) and a clinical trial registry up to September 2022, including randomized controlled trials (RCTs) published in the English language. Four studies met the inclusion criteria with a total population of 288 patients admitted to the PICU. Three studies were rated with a high risk of bias and one with some concerns. There was high heterogeneity between the studies in regard to the reporting of outcomes. Three studies measured the total time needed to reach prescribed caloric intake with conflicting results, while two studies evaluated the length of stay (LOS) in PICU with no difference between the two arms. One study assessed the time weaning from mechanical ventilation, favoring the bolus group. No data were provided for gastric residual volume (GRV), anthropometric measurements, and biochemical markers. Additional randomized trials with better methodology are needed to assess the efficacy of the two enteral feeding regimens in critically ill PICU patients.
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Martinez EE, Bechard LJ, Brown AM, Coss-Bu JA, Kudchadkar SR, Mikhailov TA, Srinivasan V, Staffa SJ, Verbruggen SSCAT, Zurakowski D, Mehta NM. Intermittent versus continuous enteral nutrition in critically ill children: A pre-planned secondary analysis of an international prospective cohort study. Clin Nutr 2022; 41:2621-2627. [PMID: 36306567 PMCID: PMC9722589 DOI: 10.1016/j.clnu.2022.09.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 09/14/2022] [Accepted: 09/30/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND & AIMS Intermittent enteral nutrition (EN) may have physiologic benefits over continuous feeding in critical illness. We aimed to compare nutrition and infection outcomes in critically ill children receiving intermittent or continuous EN. METHODS International, multi-center prospective observational study of mechanically ventilated children, 1 month to 18 years of age, receiving EN. Percent energy or protein adequacy (energy or protein delivered/prescribed × 100) and acquired infection rates were compared between intermittent and continuous EN groups using adjusted-multivariable and 4:1 propensity-score matched (PSM) analyses. Sensitivity analyses were performed after excluding patients who crossed over between intermittent and continuous EN. RESULTS 1375 eligible patients from 66 PICUs were included. Patients receiving continuous EN (N = 1093) had a higher prevalence of respiratory illness and obesity, and lower prevalence of neurologic illness and underweight status on admission, compared to those on intermittent EN (N = 282). Percent energy or protein adequacy, proportion of patients who achieved 60% of energy or protein adequacy in the first 7 days of admission, and rates of acquired infection were not different between the 2 groups in adjusted-multivariable and propensity score matching analyses (P > 0.05). CONCLUSION Intermittent versus continuous EN strategy is not associated with differences in energy or protein adequacy, or acquired infections, in mechanically ventilated, critically ill children. Until further evidence is available, an individualized feeding strategy rather than a universal approach may be appropriate.
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Affiliation(s)
- Enid E Martinez
- Division of Critical Care Medicine, Department of Anesthesiology, Critical Care & Pain Medicine, Boston Children's Hospital, USA; Harvard Medical School, Boston, MA, USA; Perioperative and Critical Care - Center for Outcomes Research (PC-CORE), Department of Anesthesiology, Critical Care & Pain Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Lori J Bechard
- Division of Critical Care Medicine, Department of Anesthesiology, Critical Care & Pain Medicine, Boston Children's Hospital, USA; Harvard Medical School, Boston, MA, USA; Perioperative and Critical Care - Center for Outcomes Research (PC-CORE), Department of Anesthesiology, Critical Care & Pain Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Ann-Marie Brown
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
| | - Jorge A Coss-Bu
- Division of Critical Care Medicine, Baylor College of Medicine, Texas Children's Hospital, Austin, TX, USA
| | - Sapna R Kudchadkar
- Johns Hopkins Children's Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Theresa A Mikhailov
- Medical College of Wisconsin, Children's Hospital of Wisconsin, Milwaukee, WI, USA
| | - Vijay Srinivasan
- Critical Care Medicine, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Steven J Staffa
- Harvard Medical School, Boston, MA, USA; Department of Anesthesiology, Critical Care & Pain Medicine, Boston Children's Hospital, USA
| | - S Sascha C A T Verbruggen
- Pediatric Intensive Care Unit, Sophia Children's Hospital, Erasmus University Medical Center, Rotterdam, NL, USA
| | - David Zurakowski
- Harvard Medical School, Boston, MA, USA; Department of Anesthesiology, Critical Care & Pain Medicine, Boston Children's Hospital, USA
| | - Nilesh M Mehta
- Division of Critical Care Medicine, Department of Anesthesiology, Critical Care & Pain Medicine, Boston Children's Hospital, USA; Harvard Medical School, Boston, MA, USA; Perioperative and Critical Care - Center for Outcomes Research (PC-CORE), Department of Anesthesiology, Critical Care & Pain Medicine, Boston Children's Hospital, Boston, MA, USA.
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