769 - Nutrition support adequacy in critically ill children admitted to neuro ICU

Studies report challenges in achieving adequate nutrition intake in the first days of admission to the PICU and that delayed achievement of macronutrient targets beyond 7 days in the PICU is associated with greater mortality. 

Objective: The study aims to evaluate nutrition support adequacy in critically ill patients in neuro ICU.

Design/Methods:

Retrospective cohort study of children admitted (index) to Neuro ICU with medical and surgical primary diagnosis from 01-19 to 12-19. We included patients with ICU LOS >7 days who received enteral and/or parental nutrition. Underweight assessed by WHO and CDC weight for age charts (WFA z score < -2). Caloric and protein adequacy defined as (Intake/BMR by Schofield equation) and (Intake/1.5 g/kg as recommended by ASPEN 2017). Optimal adequacy defined as (intake/prescribed ≥ 60%). Analyses by unpaired t-test and Chi-Square.

Results:

Of 515 pts, 67 patients were enrolled (42% females). Three patients were on enteral keto diet. 15 patients were on TPN, with or without enteral feeds. The median (IQR) for age was 4.9 (0.79-11) yrs., weight 16.6 (8.5-35) kg, mechanical ventilation (MV) duration (n= 65) 189 (139-359) hours, PIM3 risk of mortality (ROM) 1.9 (0.78-4) %, ICU Length of stay (LOS) 13.4 (10-24) days, hospital LOS 27 (17-43) days. The prevalence of underweight was 20.9% and mortality was 5.9%. Diagnostic categories included: seizures (33%), infections (26%), neurovascular (17%), brain (12%), spinal cord (4.5%), Neuromuscular (3%), complications (3%), and anomalies (1.5%). The optimal caloric and protein adequacy prevalence at Days 1, 3, 5, and 7 was 7.5%, 51%, 79%, and 79%; and 7.5%, 43%, 70%, and 76%, respectively. By day 3 of admission, caloric adequacy was achieved by 68% of patients < 2 years old (n=25) and 40% patients >2 yrs old (n=42), p=0.03 and protein adequacy was achieved by 64% of patients < 2 yrs vs 30% of patients >2 yrs; p=0.008. Underweight patients (n=14) achieved caloric adequacy at 110±61 % vs 46±53% by non-underweight (n=53); p=0.0002 and protein 132±92% vs 46±60% adequacy by day 3, respectively; p< 0.0001. No statistical difference between macronutrient intake adequacy between medical (n=63) and surgical (n=4) patients was observed in this cohort.

Conclusion(s):

Optimal caloric and protein adequacy were reached by the majority of the patients by day 5 of admission. Younger patients < 2 years old reached faster adequate macronutrient adequacy compared to older patients. Underweight patients were more likely to achieve optimal adequacy compared to patients with normal nutritional status.