Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; Nutrition and Dietetics, Monash Children's Hospital, Melbourne, Australia; Paediatric Intensive Care Unit, Monash Children's Hospital, Melbourne, Australia.
Starship Child Health, Auckland City Hospital, Auckland, New Zealand.
Nutrition. 2024 Feb;118:112261. doi: 10.1016/j.nut.2023.112261. Epub 2023 Nov 19.
The main aim of this study was to describe nutrition provision in Australian and New Zealand (ANZ) pediatric intensive care units (PICUs), including mode of nutrition and adequacy of enteral nutrition (EN) to PICU day 28. Secondary aims were to determine the proportion of children undergoing dietetics assessment, the average time to this intervention, and the methods for estimation of energy and protein requirements.
This observational study was conducted in all ANZ tertiary-affiliated specialist PICUs. All children ≤18 y of age admitted to the PICU over a 2-wk period and remaining for ≥48 h were included. Data were collected on days 1 to 7, 14, 21, and 28 (unless discharged prior). Data points included oral intake, EN and parenteral nutrition support, estimated energy and protein adequacy, and dietetics assessment details.
We enrolled 141 children, of which 79 were boys (56%) and 84 were <2 y of age (60%). Thirty children (73%) received solely EN on day 7 with documented energy and protein targets for 22 (73%). Of these children, 14 (64%) received <75% of their estimated requirements. A dietetics assessment was provided to 80 children (57%), and was significantly higher in those remaining in the PICU beyond the median length of stay (41% in patients staying ≤4.6 d versus 72% in those staying >4.6 d; P < 0.001).
This prospective study of nutrition provision across ANZ PICUs identified important areas for improvement, particularly in EN adequacy and nutrition assessment. Further research to optimize nutrition provision in this setting is urgently needed.
本研究的主要目的是描述澳大利亚和新西兰（ANZ）儿科重症监护病房（PICU）的营养供给情况，包括营养供给方式以及肠内营养（EN）在 PICU 第 28 天的充足性。次要目的是确定接受营养师评估的儿童比例、进行该干预的平均时间以及估计能量和蛋白质需求的方法。
这是一项在所有 ANZ 三级专科 PICU 进行的观察性研究。纳入在 PICU 住院时间超过 48 小时且入住时间≥2 周的所有≤18 岁的儿童。在第 1 至 7 天、第 14 天、第 21 天和第 28 天（除非在此之前出院）收集数据。数据点包括口服摄入、EN 和肠外营养支持、估计能量和蛋白质充足性以及营养师评估详细信息。
我们共纳入 141 名儿童，其中 79 名（56%）为男性，84 名（60%）<2 岁。30 名儿童（73%）在第 7 天仅接受 EN，且有 22 名儿童（73%）记录了能量和蛋白质目标。在这些儿童中，有 14 名（64%）接受的估计需求量不足 75%。80 名儿童（57%）接受了营养师评估，且在 PICU 住院时间超过中位数的儿童中（住院时间≤4.6 天的患者中为 41%，住院时间>4.6 天的患者中为 72%；P<0.001），接受评估的比例显著更高。
本项对 ANZ PICU 营养供给情况的前瞻性研究确定了需要改进的重要领域，尤其是在 EN 充足性和营养评估方面。迫切需要进一步研究以优化该环境中的营养供给。
