Intended versus delivered parenteral nutrition in the pediatric intensive care units: A multi-center survey

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.