Multiprofessional Critical Care Review: Pediatric 2024 (MCCRCP24ON)-Nutritional Support

Nutritional Support

Pdf Summary

The document "Nutritional Therapy in the Pediatric Critical Care Setting" by Dr. Katri Typpo focuses on various aspects of nutrition management for critically ill children. It begins with the discussion of metabolic stress response and its impact, highlighting the importance of estimating energy expenditure and protein balance. The metabolic stress response alters energy expenditure and organ function, unlike starvation, which preserves counter-regulatory hormone capacity.<br /><br />Indirect calorimetry is emphasized for measuring resting energy expenditure (REE), as traditional estimation methods are often inaccurate. The role of RQ (Respiratory Quotient) in assessing feeding adequacy is discussed, where an RQ of 0.7 indicates underfeeding, and an RQ of 1.0 suggests carbohydrate overfeeding.<br /><br />The document stresses the significance of maintaining a positive protein balance to preserve lean body mass. Key factors influencing optimal protein delivery include early initiation of enteral nutrition (EN), method of EN delivery (post-pyloric vs. gastric), minimizing EN interruptions, and the presence of a dedicated dietitian. An intake of protein greater than 1.5 g/kg/day and energy of at least 57 cal/kg/day is recommended.<br /><br />Micronutrient management is also discussed, with current guidelines advising provision based on dietary reference intakes for age rather than pharmacologic doses. The importance of individualized nutrition plans, particularly post-operative nutritional strategies to avoid prolonged fasting, is also highlighted.<br /><br />The document touches on enteral versus parenteral nutrition, suggesting that early initiation of EN is crucial, while delaying parenteral nutrition (PN) can reduce infection rates and PICU stay duration. Complications and strategies related to PN, including infection control and managing PN-associated liver disease, are covered.<br /><br />Finally, the document advocates for a structured approach to nutritional therapy in pediatric critical care, involving early EN initiation, careful monitoring, and individualized care plans, with the ultimate goal of improving clinical outcomes and minimizing hospital-acquired malnutrition. Consistent practice and involvement of a dedicated dietitian are key components of effective nutritional management in this setting.

Keywords

Pediatric Critical Care

Nutritional Therapy

Metabolic Stress Response

Energy Expenditure

Indirect Calorimetry

Protein Balance

Enteral Nutrition

Parenteral Nutrition

Micronutrient Management

Individualized Nutrition Plans

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