Dietetics and Food Services, National Heart Institute, 145, Jalan Tun Razak, 50400 Kuala Lumpur, Malaysia.
Clin Nutr ESPEN. 2021 Jun;43:353-359. doi: 10.1016/j.clnesp.2021.03.024. Epub 2021 Apr 25.
BACKGROUND & AIMS: Inadequate nutrition delivery in critically ill children has shown associated with poor clinical outcomes. Therefore, identifying barriers to deliver adequate nutrition is vital. The aim of this study was to identify factors influencing adequate protein and energy delivery among critically ill children with heart disease in pediatric intensive care unit (PICU).
This single-centre prospective study, involved children aged from birth to 3 years old, admitted to PICU longer than 72 hours. They received either enteral nutrition (EN) or combination of EN and partial parenteral nutrition (PPN). Clinical and nutrition delivery characteristics were recorded from admission until transferred out of PICU. Multiple regression analysis at significant level p < 0.05 were used to identify independent risk factors for lower protein and energy intake.
One hundred and thirty-nine patients were included in this study with median age 6.5 (1.8-20.6) months and median PICU length of stay of 6 (4-7) days. The median energy and protein adequacy were 83.2% and 46.7%, respectively. In multivariable analysis, children who underwent surgery (AOR 0.97; 95% CI 0.27-0.75; p = 0.041), with fluid restriction (AOR 0.97; 95% CI 0.25-0.73; p = 0.041), longer length of PICU stay (AOR 0.35; 95% CI 0.18-0.64; p = 0.001) and longer feeding interruptions (AOR 3.57; 95% CI 1.39-9.15; p = 0.008) were more likely to have lower energy intake. Children at risk of malnutrition (weight-for-age Z score of < -2 SD) (AOR 2.54; 95% CI 1.12 to 5.77; p = 0.026) and longer duration of mechanical ventilation (AOR 0.73; 95% CI 0.53 to 0.98; p = 0.041) were more likely to have lower protein intake.
This study highlighted the factors influencing adequate protein and energy delivery in critically ill children with heart disease in PICU. Strategies to improve the nutrition delivery in this group of patients should be outlined and implemented by the dietitians along with multidisciplinary team.
危重症患儿营养供给不足与临床结局不良有关。因此，明确影响营养供给的因素至关重要。本研究旨在确定儿科重症监护病房（PICU）中患有心脏病的危重症患儿蛋白质和能量供给不足的相关因素。
本单中心前瞻性研究纳入了年龄在出生至 3 岁之间、在 PICU 住院时间超过 72 小时的患儿。他们接受肠内营养（EN）或肠内营养联合部分肠外营养（PPN）。从入院到转出 PICU 期间，记录患儿的临床和营养供给特征。采用具有统计学意义的 p 值<0.05 的多变量回归分析，确定蛋白质和能量摄入较低的独立危险因素。
本研究共纳入 139 例患儿，中位年龄为 6.5（1.8-20.6）个月，PICU 中位住院时间为 6（4-7）天。能量和蛋白质供给的中位数分别为 83.2%和 46.7%。多变量分析显示，接受手术的患儿（OR 0.97；95%CI 0.27-0.75；p=0.041）、液体限制（OR 0.97；95%CI 0.25-0.73；p=0.041）、PICU 住院时间较长（OR 0.35；95%CI 0.18-0.64；p=0.001）和喂养中断时间较长（OR 3.57；95%CI 1.39-9.15；p=0.008）的患儿，能量摄入较低的可能性更大。有营养不良风险的患儿（体重-年龄 Z 评分<-2 SD）（OR 2.54；95%CI 1.12-5.77；p=0.026）和机械通气时间较长的患儿（OR 0.73；95%CI 0.53-0.98；p=0.041），蛋白质摄入较低的可能性更大。
本研究强调了影响 PICU 中患有心脏病的危重症患儿蛋白质和能量供给的因素。营养师和多学科团队应制定并实施改善该类患儿营养供给的策略。
