Background

Assessing nutritional status in PICU can be challenging due to the difficulties in obtaining an accurate weight and/or height. There are other methods which have been proposed to aid the nutritional assesement in PICU.

Assessing energy requirements in PICU has been widely researched but there is still no absolutely accurate robust method to do so. Delivery of appropriate nutrition support can prove challenging and there are many methods used to assess the tolerance of this.

Identfiying appropriate outcome measures within nutrition in PICU can be challenging.

Objectives

To review the different methods of assessing nutritional status and requirements in PICU.

To review how to successfully deliver appropritate nutrition to children in PICU.

To review how these can inpact on outcomes

Methods

Review of available literature in the areas of nutritional assessement and feeding in PICU

Results

There are many different means to assess nutritional status and requirements in PICU - none are 100% accurate.

Delivery of enteral feeding can be challenging but can be successfully achieved by questioning current accepted methods in assessing enteral tolerances.

Conclusion

Successfully achieving appropriate nutriton during the PICU stay can have a posistive inpact on outcomes during the PICU stay and beyond.

Background

Over half of the children admitted to a pediatric intensive care unit (ICU) become undernourished because of intolerance and inaccessibility of enteral feeding. Postpyloric feeding increases the total percentage of nutrition delivered when compared to gastric feeding.

Objectives

Comparing CORTRAK Enteral Access System (CEAS), an electromagnetic guidance to standard blind technique in terms of total time and attempts for placing a post-pyloric tube.

Methods

Experienced pediatric nurses trained with CEAS equipment participated in the randomized controlled intention to treat study to place postpyloric feeding tubes. We excluded patients with an open chest wall or an open abdominal wall. Data analyzed with R v3+, using the Fisher’s exact test for categorical variables and the Wilcoxon rank test for continuous variables with data documented as median (IQR).

Results

Fifty two patients were enrolled in the study with split between 28 using CEAS and 24 using the blind approach. Number of attempts and x-rays (median IQR) was significantly higher using the blind approach at 2 (1,2.3) compared to CEAS group at 1 (1.0,1.0) with a p=0.001. A postpyloric feeding tube was placed successfully 96.4% in the CEAS group compared to only 66.7% using the blind approach, p = 0.008. Total time required for postpyloric feeding tube placement was significantly lower using CEAS at 2.5 mins (2, 7.25) compared to blind approach at 19 mins (9.25, 27), p < 0.001.

Conclusion

CORTRAK Enteral Access System is a superior, faster, and safer method of postpyloric feeding tube placement in critically ill.

Background

Childhood obesity is an increasingly significant public health issue, but its burden on paediatric intensive care units (PICUs) is unclear.

Objectives

To identify the burden of obesity and obesity-related conditions on PICUs in England.

Methods

Anonymised admission data were obtained from the Paediatric Intensive Care Audit Network database for school-aged children admitted to English PICUs between 2003 and 2015, with a recorded admission diagnosis or co-morbidity of obesity or a condition known to be associated with obesity. The data were used to identify trends in the incidence of obesity and related conditions, and associated length of stay and mortality rates.

Results

The incidence of obesity and related conditions per 1000 PICU admissions has increased by 333% (11.26 to 37.52) during the study period. Poisson regression modelling shows a 7.7% annual increase (95% CI 6.3% to 9.0%) in obesity-related admissions, even when offset against increasing overall PICU admissions (p value <0.0001). Annual PICU bed day use has substantially increased during the study period, with an increase of 712%. Poisson regression analysis shows a 1.3% annual increase in median length of stay (95% CI 0.6% to 2.0%) when offset against the increase in obesity-related admissions (p value = 0.0003).

Conclusion

Childhood obesity and obesity-related conditions are placing an increasing burden on paediatric intensive care services in England. Our study supports the growing body of evidence that the childhood obesity epidemic is leading to an increased utilisation of health services and highlights the importance of public health initiatives to try to curb the increase in obesity-related admissions.