(345) Nutrition Adequacy in Critically Ill Children With Organ Dysfunction Admitted to PICU

Introduction: Pediatric intensive care unit (PICU) nutrition support is influenced by disease, nutritional status, and interventions. Achieving 60% adequacy of calories and protein in the first week of admission is associated with improved survival. We aim to evaluate the nutritional support of critically ill children during the first week of admission to the PICU. We hypothesize that children with organ dysfunction (OD) in the first 3 days of admission to the PICU are less likely to achieve 60% caloric and protein adequacy.

Methods: Retrospective cohort study of children admitted (index) to Texas Children’s Hospital PICU between 01-16 to 12-17. Inclusion criteria included mechanical ventilation (MV) >48 hrs., PICU length of stay (LOS) >7 days, and >2 yrs. of age. Nutritional status was evaluated by CDC growth charts (Body Mass Index z-scores). Nutrition support included enteral and parenteral nutrition, adequacy as (intake/prescription x 100). All calculations used dietitians' prescriptions. Optimal adequacy was defined as ≥60%. The Pediatric Sequential Organ Failure Assessment (pSOFA) score was calculated on days 1 and 3 and defined as high if the pSOFA was ≥ 5. On day 3, children were classified according to whether their pSOFA score had increased, decreased, or unchanged. Comparison by Mann-Whitney, and Kruskal-Wallis test as appropriate.

Results: Out of 4199 patient admissions, 164 children (55% male) met inclusion criteria. The median (25th-75th IQR) for age 11.7 (8–15) yrs., weight 36.8 (23–55) kg, MV 223 (157–391) hrs., PICU LOS 12 (9–20) days, hospital LOS 30 (19–53) days, PIMS2 ROM 3.71 (2.8–6.4)%, and 12.2% hospital mortality. By day 3 for children with OD, optimal adequacy was reached in 34% for calories and 18% for protein, compared to 29% for calories and 3% for protein in children without OD (p=0.53 and p=0.262; respectively). The caloric adequacy from days1-3 for pSOFA categories down, uptrending, and unchanged was 11 (0–39)%, 2.61 (0–25)%, and 38 (4.05–75)% (p=0.022), respectively; and protein adequacy of 13 (0–42)%, 1.45 (0–28)%, and 49 (3–87)% (p=0.015), respectively.

Conclusions: Children with OD reached higher adequacies than children without OD. On day 3, children with an uptrending pSOFA score have lower nutrition adequacy than those with an unchanged or downtrending score.