The Prevalence of Nutritional Depletion and Nutritional Support of the Pediatric Intensive Care Unit Patient

Abstract Objective: The prevelence of nutritional depletion utilizing anthropometric measurements has been reported to be 20% in hospitalized pediatric patients upon admission. It has also been reported that the majority of pediatric patients in the intensive care unit (ICU) remain NPO by day 3 in the ICU. We hypothesize that there is a high incidence of nutritional depletion in our ICU pediatric patients upon admission as indicated by weight less than fifth percentile and that patients who have extended stays (> 5 days) in the ICU receive calories below our calorie recommendations. Methods: A prospective, observational study was conducted to investigate these hypotheses. Pediatric patients who remained in the ICU for greater than 5 days were evaluated for: weight, type of nutrition ordered, calories ordered, calories received, and calories recommended by the Parenteral and Enteral Nutrition (PEN) team. Results: Twenty-seven patients enrolled in the study between October and December, 1994. The study group consisted of 15 males and 12 females with ages ranging from 1 month to 19 years of age (X = 7.5 years). The majority of patients were admitted either to the pediatric medical service (n=9) or the pediatric surgical service (n=8). The average length of stay was 14.6 days (range 5–43 days). Eight patients (30%) were admitted with a weight less than the fifth percentile for age. An analysis of calories ordered and received was completed for each of the 18 patients receiving parenteral nutrition (TPN; n=7), tube feeding (TF; n=5) or a combination of TPN and TF (n=6). Physicians ordered calories equal to or greater than those recommended by the PEN team in 6 (33%) of the 18 patients. Physicians ordered an average of 87%± 33% of recommended calories (range 25–163%). The percent of ordered calories received by patients was 76% ± 14% (range 47–102%). Patients received 67% +28% of calories recommended by the PEN team (range 14–104%). Conclusion: Pediatric patients who remain in our ICU for greater than 5 days have a higher prevalence of nutritional depletion than reported in the literature (30% vs 20%). This study indicates that calories received by these patients are less than those recommended by the PEN team due to a combination of inadequate calorie ordering by physicians and frequent interruption of caloric delivery. This study suggests that physicians should be educated regarding ordering recommended calories for pediatric ICU patients.