Implementing a physician-driven feeding protocol is not sufficient to achieve adequate caloric and protein delivery in a paediatric intensive care unit: A retrospective cohort study

Clin Nutr ESPEN. 2023 Jun:55:384-391. doi: 10.1016/j.clnesp.2023.04.010. Epub 2023 Apr 15.

Abstract

Background and aims: Daily caloric and protein intake is crucial for the management of critically ill children. The benefit of feeding protocols in improving daily nutritional intake in children remains controversial. This study aimed to assess whether the introduction of an enteral feeding protocol in a paediatric intensive care unit (PICU) improves daily caloric and protein delivery on day 5 after admission and the accuracy of the medical prescription.

Methods: Children admitted to our PICU for a minimum of 5 days who received enteral feeding were included. Daily caloric and protein intake were recorded and retrospectively compared before and after the introduction of the feeding protocol.

Results: Caloric and protein intake was similar before and after introduction of the feeding protocol. The prescribed caloric target was significantly lower than the theoretical target. The children who received less than 50% of the caloric and protein targets were significantly heavier and taller than those who received more than 50%; the patients who received more than 100% of the caloric and protein aims on day 5 after admission had a decreased PICU length of stay and decreased duration of invasive ventilation.

Conclusion: The introduction of a physician-driven feeding protocol was not associated with an increase in the daily caloric or protein intake in our cohort. Other methods of improving nutritional delivery and patient outcomes need to be explored.

Keywords: Critical care; Enteral nutrition; Feeding protocol.

MeSH terms

  • Child
  • Energy Intake*
  • Enteral Nutrition / methods
  • Humans
  • Intensive Care Units, Pediatric
  • Physicians*
  • Retrospective Studies