A nutritional support team in the pediatric intensive care unit: Changes and factors impeding appropriate nutrition

Background & aims The aims of this study were to determine the impact of a nutritional support team (NST) intervention in a pediatric intensive care unit (PICU) and to identify the factors at admission that were associated to a delay to achieve a sustained optimal caloric intake (SOCI). Methods Caloric and protein intake and nutritional parameters were compared in 82 children in 2000 and 2003, respectively before and after the introduction of a NST. Predictive factors of a delay to achieve the SOCI were identified using multivariate analysis. Results There was no difference in 2000 and 2003, respectively, regarding cumulative caloric deficits (19±15.7 vs. 20.7±14.8 kcal/kg day), cumulative protein deficits (0.26±0.31 vs. 0.22±0.20 g/kg day), time to achieve a SOCI (7 vs. 7 days). Factors at admission associated with a delay to achieve a SOCI were a pediatric risk of mortality (PRISM) score > 10 (hazard ratio 0.58; 95% CI 0.44–0.77), a CRP > 50 mg/L (hazard ratio 0.49; 95% CI 0.35–0.70), a fluid restriction (hazard ratio 0.51; 95% CI 0.37–0.71), and a weight for age > 3rd centile (hazard ratio 0.54; 95% CI 0.41–0.72). Conclusions The intervention of a NST has not modified significantly the nutritional management. In pediatric intensive care, many factors identified at admission are associated with impairing appropriate nutrition.