Key Pediatric Clinical Practice Guidelines in 2017

John Anello; Brian Feinberg; John Heinegg; Yonah Korngold; Richard Lindsey; Cristina Wojdylo; Olivia Wong, DO

Disclosures

January 10, 2018

In This Article

Nutritional Support in Critically Ill Pediatric Patients

Society of Critical Care Medicine and the American Society for Parenteral and Enteral Nutrition

Recommend that patients in the PICU undergo detailed nutritional assessment within 48 hr of admission.

As patients are at risk of nutritional deterioration during hospitalization, which can adversely affect clinical outcomes, it is suggested that the nutritional status of patients be reevaluated at least weekly throughout hospitalization.

Recommend that weight and height/length be measured at admission to the PICU and that z scores for body mass index (BMI) for age (weight for length, <2 yr) or weight for age (if accurate height is not available) be used to screen for patients at extremes of these values. For children <36 mo, head circumference must be documented.

On the basis of observational cohort studies, it is suggested that measured energy expenditure by indirect calorimetry (IC) be used to determine energy requirements and guide prescription of the daily energy goal. If IC measurement of resting energy expenditure is not feasible, it is suggested that the Schofield or Food Agriculture Organization / World Health Organization (WHO) / United Nations University equations may be used without the addition of stress factors to estimate energy expenditure.

Achieve delivery of at least two thirds of the prescribed daily energy requirement by the end of the first week in the PICU.

On the basis of evidence from RCTs and support from observational cohort studies, a minimum protein intake of 1.5 g/kg/day is recommended.

Recommend enteral nutrition as the preferred mode of nutrient delivery to the critically ill child.

Do not recommend the initiation of parenteral nutrition within 24 hr of PICU admission.

References

  • 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 Jul;41(5):706-42. http://journals.sagepub.com/doi/full/10.1177/0148607117711387

  • Brown T. Nutritional Guidelines for Critically Ill Children Released. Medscape News & Perspective. July 19, 2017. http://www.medscape.com/viewarticle/883116

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