2017, Silver Spring, MD:
American Society for Parenteral and Enteral
(ASPEN) and the Society of Critical Care Medicine (SCCM) today
for the Provision and Assessment of Nutrition Support Therapy in the Pediatric
Critically Ill Patient: Society of Critical Care Medicine and American Society
for Parenteral and Enteral Nutrition
. These guidelines were based
upon an exhaustive literature review on the importance of nutritional support
therapy in cases involving critically ill patients ages one month to 17 years
The research team, chaired by ASPEN President-elect, Dr. Nilesh
Mehta of Boston Children’s Hospital, analyzed over 2,032 citations for
relevance related to pediatric nutritional support, specifically looking at the
data for critically ill pediatric patients with a length of stay greater than
two or three days in a pediatric intensive care unit (PICU), admitting medical,
surgical, and cardiac patients.
“In 2009, after conducting a comprehensive review, ASPEN issued clinical
guidelines for critically ill pediatric patients. Up until that time, healthcare
providers had no such assistance when providing nutrition support therapy to
their youngest patients,” explained Debra BenAvram, ASPEN’s CEO. “Thanks to Dr.
Mehta and his team, we have now updated that information. The strategic pathway
indicated in the 2017 guidelines will help to deliver optimal nutrition and better
outcomes for this particularly vulnerable population.”
Among the guidelines findings:
There is a
significant gap in proper nutritional interventions, particularly among
malnourished pediatric patients.
This is deeply concerning as malnutrition
is associated with adverse clinical outcomes including longer periods of
ventilation, higher risk of hospital-acquired infection, longer PICU and
hospital stays, and increased mortality.
intervention makes a difference.
Patients who receive a nutritional intervention
in a timely manner may benefit most from the therapy. The new guidelines recommend
that PICU patients undergo a detailed nutritional assessment within 48 hours of
being admitted to the hospital.
and method of nutrient delivery is important.
The new guidelines offer strategies
to optimize enteral nutrition (tube feeding) during critical illness. The
research also points to the benefits of a delayed approach to parenteral
nutrition (intravenous feeding).
nutrition support team is a key differentiator
. One that
includes a dedicated dietitian should be available in the PICU to facilitate
timely nutritional assessment, and optimal nutrient delivery and adjustment to
the patient’s nutrition plan as the clinical situations change.
monitoring is critical to avoid unintended caloric under- or overfeeding.
are at risk of nutritional deterioration during hospitalization, which can
adversely affect clinical outcomes. The new guidelines, therefore, suggest that
the nutritional status of patients be reevaluated at least weekly throughout
how much nutrition is needed is an important factor.
example, optimal protein intake is closely related to positive clinical
outcomes. The new guidelines provide recommendations on the minimum protein
intake. However, it’s important to bear in mind that the use of RDA
(recommended daily allowance) values to guide protein prescription in
critically ill pediatric patients is not advised; these were developed for
healthy children and often underestimate the protein needs during critical
“Children are especially susceptible to malnutrition,” stated
Dr. M. Molly McMahon, President of ASPEN and Professor of Medicine in the
Division of Endocrinology, Diabetes, Metabolism, and Nutrition at the Mayo
Clinic in Rochester, MN. “These guidelines addressing the nutrition of
critically ill children have never been more needed or relevant. Ultimately,
this clinical guidance has the potential to improve medical outcomes and to
decrease health care costs in this group of children.“
Please visit http://journals.sagepub.com/doi/full/10.1177/0148607117711387 to access the full report and complete
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American Society for Parenteral and Enteral Nutrition (ASPEN) is
dedicated to improving patient care by advancing the science and practice of
nutrition support therapy and metabolism. Founded in 1976, ASPEN is an
interdisciplinary organization whose members are involved in the provision of
clinical nutrition therapies, including parenteral and enteral nutrition. With
more than 6,500 members from around the world, ASPEN is a community of
dietitians, nurses, nurse practitioners, pharmacists, physicians, scientists,
students and other health professionals from every facet of nutrition support
clinical practice, research and education. For more information about ASPEN,
please visit www.nutritioncare.org.