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Abstract Body

The European Society of Pediatric and Neonatal Intensive Care (ESPNIC) metabolism, endocrine and nutrition (MEN) section published recommendations for nutrition in paediatric intensive care unit (PICU) in March2020. To date, their implementation in PICU is the challenge as many barriers exist such as guideline factors, professional factors, patient factors or organisational factors. To facilitate the implementation of recommendations into practice by clinicians, models or frameworks have been developed. The model Pronovost is adapted for healthcare professionals and proposes a strategy in the form of four steps; summarise the evidence, identifiy local barriers to implementation, measure performance, and ensure all patients receive the interventions.

In parallel, specific tools may help in implementing the ESPNIC MEN section guidelines. Some studies have shown that the introduction of a nutrition protocol improves nutritional management in PICU. The implementation of a protocol including the ESPNIC recommendations would be an interesting tool to integrate them into practice. It has also been observed that physicians in PICU need nutritional education in order to improve their knowledge in this specific field. Nutritional course provided to PICU physicians and healthcare professionals is the opportunity to present new scientific data, guidelines, and local nutrition protocol. Finally, it is essential that all PICU professionals involved in nutrition including physicians, dieticians, nurses and pharmacists take part in these different steps in order to effectively implement these new nutritional recommendations. They all should have clear roles and responsibilities in this implementation process.

Abstract Body

Background: anemia is common in critically ill patients and is associated with adverse outcomes. Intravenous iron may decrease anemia and red blood cells (RBC) transfusions. The objective was to assess the efficacy and safety of intravenous iron in critically ill children.

Methods: a prospective longitudinal observational study was performed in one tertiary PICU. Patients with anemia and iron deficiency (transferrin saturation (TSAT) ≤20%, soluble transferrin receptor (sTfR) ≥4.6 mg/L or low ferritin) treated with intravenous iron from August 2017 to May 2020 were included. Patient demographics mean difference in iron biomarkers and adverse effects were registered.

Results: 38 patients (mean age of 44±54 months) received iron sucrose treatment. 84.2% had cardiac disease, 78% with cardiac failure. 86.8% had TAST alterations, 50% in sTfR and 21% in ferritin. Treatment was initiated after 38±41 days of admission; 6±12 doses were administered per patient. After treatment, Hb increased 1.7±1.7 g/dl (p<0.0001) and 55% did not longer have anemia. Iron increased 38.5±70 µg/dl (p=0.004), ferritin 462±777 µg/L (p=0.002) (median 229µg/L), and TAST 13.5±23% (p=0.002). sTfR (0.12±1.6 mg/L) and transferrin (7.2±49 mg/dl) did not change significantly (p>0.5). 60% previously received RBC transfusions. 70% did not received RBC transfusions afterwards and only 5 patients required RBC during the iron treatment. 57% also received erythropoietin and/or oral iron during admission. No patients experience any side effects.

Conclusions: administration of intravenous iron in critically ill children was safe and effective to improve anemia. Iron, alone or in combination with other treatments, could reduce the use of RBC transfusions.

Abstract Body

Recent studies have shown non-invasive respiratory support (NRS) is a barrier for enteral nutrition^1,2. We aimed to explore enteral feeding practices and energy outcomes in European PICUs.

Methods

A retrospective study of critically ill children receiving NRS in 4 European PICUs, for the first 7 days of acute NRS.

Results

325 children were included (Bristol 104; Lyon 99; Madrid 72; Rotterdam 50). The median (IQR) age and weight were 3 months (1-16) and 5 Kg (4-10) respectively, with 66% having respiratory failure. There were large between-centre variations in practices. Overall, 190/325 (58.5%) received NRS as step up & 41.5% as a step down. Main modes of NRS used were HFNC 43.6%, BLPAP 33.2% and CPAP 21.2% Most children (77.8%) were fed gastrically (48.4% continuously) and the median time to first feed after NRS initiation was 4 hours (IQR 1-9). The median percentage of time NPO whilst on NRS was 4 hours (2-13). Children received a median of 56% (25%-82%) of their energy goals compared to a standardised target. Patients receiving step-up NRS (p=<0.001), those on BLPAP or CPAP (compared to HFNC) (p =<0.001) and those on continuous feeds (p =<0.001) achieved significantly more of their kcal goal. GI complications varied between centre from 4.8 – 20%, with the most common reported being vomiting in 54/325 (16.6%), other complications occurred in 40/325 (12.3%) children and pulmonary aspiration was rare 5/325 (1.5%).

Conclusions

Children on NRS tolerated feeding well, with few complications, but prospective randomised trials are now required to determine the optimal timing and feeding method for children on NRS.