Jacquot Aurélien, Valla Frédéric Victor, Mura Thibault, Tume Lyvonne Nicole, Bertet Héléna, Ford-Chessel Carole, Milesi Christophe, Cambonie Gilles, De Luca Arnaud, Gaillard-Le Roux Bénédicte
Pediatric Intensive Care, Arnaud de Villeneuve University Hospital, 371 avenue du doyen G Giraud, 34295, Montpellier Cedex 5, France.
Pediatric Intensive Care, CarMEN INSERM, UMR 1060 Equipe INFOLIP, Hospices civils de Lyon, Hôpital Femme Mère Enfant, 59 bd Pinel, 69500, Lyon-Bron, France.
Ann Intensive Care. 2019 Jan 22;9(1):15. doi: 10.1186/s13613-019-0493-z.
Impaired nutritional status is adversely associated with suboptimal outcomes in critically ill children. Undernutrition at pediatric intensive care unit (PICU) admission ranges from 15 to 65%. A lack of knowledge of the nutritional status of children in French PICUs prevents us from specifically targeting education. This study aims to describe the nutritional status of children in French PICUs and to assess nutritional practices and physicians' knowledge of nutrition, in order to focus NutriSIP (the French-speaking PICU nutrition group) future education programs. A prospective observational multicenter point prevalence study was conducted in French PICUs, recruiting all children admitted over three different weeks. Anthropometric measurements were taken (weight, height/length, mid-upper arm, and head circumferences), in order to calculate nutritional indices. Nutritional status was defined according to WHO Body Mass Index z-score and dynamic assessment based on growth faltering detection. Concurrently, PICU physicians and PICU nurses from seven French-speaking countries completed a survey to ascertain knowledge about local nutritional care practices and overall nutrition knowledge. PICU physicians' responses were compared to PICU nurses' responses (previously published).
Four hundred and thirty-two children were included in the observational study from 27 French PICUs. Undernutrition was diagnosed in 18.5% of them, young age and underlying chronic condition being the two independent risk factors. Faltering growth was diagnosed in 4.8% and overweight in 7.4%. Subjective nutritional assessment was not accurate. Thirty-eight French-speaking PICUs completed the survey. These showed nutritional practices frequently did not comply with international guidelines, especially regarding nutritional goals, and the reasons for withholding enteral nutrition. Comparison between physicians' and nurses' responses to the survey showed large discrepancies.
Undernutrition is frequent at admission in French PICUs. Nutritional status should be assessed using a holistic approach, because of the potential impact on outcome. French-speaking PICU healthcare professionals need further nutrition education, in order to improve nutritional practices to comply with international recommendations. This study will serve as a baseline to focus NutriSIP teaching programs in the future.
营养状况受损与危重症儿童的不良预后存在负相关。儿科重症监护病房（PICU）入院时的营养不良发生率在15%至65%之间。法国PICU缺乏对儿童营养状况的了解，这使我们无法有针对性地开展教育。本研究旨在描述法国PICU中儿童的营养状况，评估营养实践以及医生的营养知识，以便为法语区PICU营养小组（NutriSIP）未来的教育项目提供重点。在法国的PICU开展了一项前瞻性观察性多中心现患率研究，招募了在三个不同周入院的所有儿童。进行了人体测量（体重、身高/身长、上臂中部和头围），以计算营养指标。营养状况根据世界卫生组织体质指数Z评分以及基于生长迟缓检测的动态评估来定义。同时，来自七个法语国家的PICU医生和PICU护士完成了一项调查，以确定关于当地营养护理实践的知识以及总体营养知识。将PICU医生的回答与PICU护士的回答（此前已发表）进行了比较。
来自27个法国PICU的432名儿童纳入了观察性研究。其中18.5%被诊断为营养不良，年龄小和潜在慢性病是两个独立的危险因素。4.8%被诊断为生长迟缓，7.4%为超重。主观营养评估不准确。38个法语区PICU完成了调查。这些调查显示营养实践经常不符合国际指南，尤其是在营养目标以及停止肠内营养的原因方面。医生和护士对调查的回答比较显示出很大差异。
法国PICU入院时营养不良很常见。由于对预后可能产生影响，应采用整体方法评估营养状况。法语区PICU医护人员需要进一步的营养教育，以改善营养实践，使其符合国际建议。本研究将作为未来聚焦NutriSIP教学项目的基线。
