Nutritional therapy and caloric achievement within the first week of PICU admission
Abstract: Nutritional therapy
is an important aspect in managing PICU patients. Careful decisions should be
made regarding initiation, route of administration, and achievement based on
caloric requirements. Many conditions could affect the application of
nutritional therapy.
Objective To investigate the implementation of nutritional therapy during
the 1st week after PICU admission.
Methods We conducted a retrospective study involving 156 children aged 1
month-18 years who were hospitalized for at least 4 days in the PICU during the
period of January 1st, 2015 to December 31st, 2015. Subjects were divided
into three groups according to initiation time of caloric administration, which
were: category I (within the first 24 hours of PICU admission), category II
(within the first 25-48 hours of PICU admission), and category III: (more than
48 hours after PICU admission). Caloric requirement was calculated using the
Caldwell or Schofield formula, whilst caloric achievement was figured up from
PICU daily monitoring sheets containing nutritional therapy given to the
subjects.
Results Of 131 subjects, 72 (55%) had good nutritional status and 59
(45%) children had malnutrition. Caloric administration was initiated within 24
hours of admission in 101 (77.1%) patients, of whom 90 (89.1%) patients
received enteral feeding. Nineteen (14.5%) patients received their initial
calories within 25-48 hours of admission, with 16 (84.2%) using the enteral
route. At the 4th and 7th days of hospitalization, 93 (71%) and 107 (81.7%)
patients achieved >70% of their caloric requirements. Delays in feeding
initiation were due to shock, gastrointestinal bleeding, inotropic support, and
feeding intolerance, which reduced caloric achievement.
Conclusion Most patients receive nutritional therapy in the first 48
hours after PICU admission and achieve >70% of their caloric requirements at
the 4th day of hospitalization. The enteral route is preferred. Delayed
initiation of nutritional therapy reduce caloric achievement.
Keywords: nutrition therapy;
malnutrition; PICU; caloric achievement
Author: Melia Yunita, Desy
Rusmawatiningtyas, Titis Widowati
Journal Code: jpkedokterangg180014
