Assessment of calories prescribed and delivered to critically ill children

Summary Background & aims As critically ill children are at high risk of malnutrition, nutritional status at admission, prescribed and delivered calories and factors confounding the actual intake were assessed in a pediatric intensive care unit (PICU). Methods Mechanically ventilated children with an expected PICU stay ≥72 h were included from May 1 to August 1, 2005. Anthropometric measurements, prescribed and delivered calories and the main reasons for feeding interruptions were prospectively recorded. Main results 10/49 patients (20%) showed moderate or severe malnutrition at admission. Median estimated energy requirements (EER) per patient was 90 kcal/kg/day (95% CI: 82;90), prescribed calories were 75 kcal/kg/day (95% CI: 45;98), and actual delivered calories were 58 kcal/kg/day (95% CI: 35;85). Full EER was prescribed in 50% of the patients within almost 6 days and actually delivered within 9 days. A difference ≥10 kcal/kg/day between prescribed and delivered calories was observed on 165/576 recorded days (29%). The major barriers to the provision of prescribed enteral nutrition were procedural interruptions. Conclusions Despite a high prevalence of malnutrition, EER are not achieved partially due to enteral feeding interruptions for procedures during PICU stay. Physicians are challenged to address the non-delivery of prescribed nutrition.