Abstract

Objective: Prevention and management of malnutrition are important in critically ill children. Parenteral nutrition (PN) is considered for patients who cannot tolerate enteral feeding. There are many reasons why PN cannot be delivered in the prescribed amount. We aimed to evaluate whether PN is delivered as prescribed in the pediatric intensive care units and to reveal the reasons for failure.

Method: Demographics, pediatric risk of mortality (PRISM) III scores, predicted death rates (PDR), indications for PN, duration of PN, vascular access site, daily amount of prescribed and delivered PN, reasons for not receiving PN as prescribed, and whether renal replacement therapy (RRT) was received were noted. The delivered/prescribed PN volume ratio was compared by gender, age, PRISM III score, PDR, indications for PN, duration of PN, and vascular access site.

Results: The most common indication for PN was failing to meet the targeted energy enterally (n=51, 69.9%). The duration of PN was ≤ 7 days in 40 (54.8%) patients and the type of vascular access was jugular venous catheter in 46 (63%) patients. 16 (21.9%) patients received RRT. PN was administered for 906 PN-days and the patients received the prescribed volume on 698 PN-days (77%). The most common reasons for not receiving the PN volume as prescribed were volume restrictions (n= 29, 39.7%) and electrolyte imbalance (n=13, 17.8%). Age, gender, weight, duration of PN, vascular access site, receiving RRT, PRISM III score, and PDR were not associated with receiving more than 0.8 of the prescribed PN volume. All gastrointestinal surgery patients received more than 0.8 of the prescribed amount.

Conclusion: In about a quarter of PN-days, the prescribed volume could not be delivered, often due to volume restrictions in the pediatric intensive care units. Setting the correct nutritional targets, individualizing nutritional support, and preventing and overcoming obstacles on the way to the targets may improve outcomes.

Keywords: Critically ill, malnutrition, outcomes, parenteral nutrition, pediatric intensive care

Copyright and license

Copyright © 2023 The author(s). This is an open-access article published by Aydın Pediatric Society under the terms of the Creative Commons Attribution License (CC BY) which permits unrestricted use, distribution, and reproduction in any medium or format, provided the original work is properly cited.

How to cite

1.
Öztürk Z, Topal S, Kaçmaz E, Yıldızdaş D, Kanğın M, Çolak M, et al. Intended versus delivered parenteral nutrition in the pediatric intensive care units: A multi-center survey. Trends in Pediatrics. 2023;4(3):180-185. https://doi.org/10.59213/TP.2023.63825

References

  1. Mehta NM, Skillman HE, Irving SY, et al. Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Pediatric Critically Ill Patient: Society of Critical Care Medicine and American Society for Parenteral and Enteral Nutrition. JPEN J Parenter Enteral Nutr. 2017;41:706-42. https://doi.org/10.1177/0148607117711387
  2. Mehta NM, Bechard LJ, Cahill N, et al. Nutritional practices and their relationship to clinical outcomes in critically ill children-an international multicenter cohort study. Crit Care Med. 2012;40:2204-11. https://doi.org/10.1097/CCM.0b013e31824e18a8
  3. Cahill NE, Dhaliwal R, Day AG, Jiang X, Heyland DK. Nutrition therapy in the critical care setting: what is "best achievable" practice? An international multicenter observational study. Crit Care Med. 2010;38:395-401. https://doi.org/10.1097/CCM.0b013e3181c0263d
  4. Jacobs A, Verlinden I, Vanhorebeek I, Van den Berghe G. Early supplemental parenteral nutrition in critically ill children: an update. J Clin Med. 2019;8:830. https://doi.org/10.3390/jcm8060830
  5. Heidegger CP, Berger MM, Graf S, et al. Optimisation of energy provision with supplemental parenteral nutrition in critically ill patients: a randomised controlled clinical trial. Lancet. 2013;381:385-93. https://doi.org/10.1016/S0140-6736(12)61351-8
  6. van Puffelen E, Hulst JM, Vanhorebeek I, et al. Effect of late versus early initiation of parenteral nutrition on weight deterioration during PICU stay: secondary analysis of the PEPaNIC randomised controlled trial. Clin Nutr. 2020;39:104-9. https://doi.org/10.1016/j.clnu.2019.02.014
  7. Fivez T, Kerklaan D, Mesotten D, et al. Early versus late parenteral nutrition in critically ill children. N Engl J Med. 2016;374:1111-22. https://doi.org/10.1056/NEJMoa1514762
  8. Goday PS, Kuhn EM, Mikhailov TA. Early parenteral nutrition in critically ill children not receiving early enteral nutrition is associated with significantly higher mortality. JPEN J Parenter Enteral Nutr. 2020;44:1096-103. https://doi.org/10.1002/jpen.1731
  9. Srinivasan V, Hasbani NR, Mehta NM, et al. Early enteral nutrition is associated with improved clinical outcomes in critically ill children: a secondary analysis of nutrition support in the heart and lung failure-pediatric insulin titration trial. Pediatr Crit Care Med. 2020;21:213-21. https://doi.org/10.1097/PCC.0000000000002135
  10. van Puffelen E, Hulst JM, Vanhorebeek I, et al. Outcomes of delaying parenteral nutrition for 1 week vs initiation within 24 hours among undernourished children in pediatric intensive care: a subanalysis of the PEPaNIC randomized clinical trial. JAMA Netw Open. 2018;1:e182668. https://doi.org/10.1001/jamanetworkopen.2018.2668
  11. Mikhailov TA, Gertz SJ, Kuhn EM, Scanlon MC, Rice TB, Goday PS. Early enteral nutrition is associated with significantly lower hospital charges in critically ill children. JPEN J Parenter Enteral Nutr. 2018;42:920-5. https://doi.org/10.1002/jpen.1025
  12. de Oliveira Iglesias SB, Leite HP, Santana e Meneses JF, de Carvalho WB. Enteral nutrition in critically ill children: are prescription and delivery according to their energy requirements? Nutr Clin Pract. 2007;22:233-9. https://doi.org/10.1177/0115426507022002233
  13. Bockenkamp B, Jouvet P, Arsenault V, Beauséjour M, Pelletier VA. Assessment of calories prescribed and delivered to critically ill children. e-SPEN, the European e-Journal of Clinical Nutrition and Metabolism. 2009;4:e172-5. https://doi.org/10.1016/j.eclnm.2009.04.001
  14. De Jonghe B, Appere-De-Vechi C, Fournier M, et al. A prospective survey of nutritional support practices in intensive care unit patients: what is prescribed? What is delivered? Crit Care Med. 2001;29:8-12. https://doi.org/10.1097/00003246-200101000-00002