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Journal of Pediatric Gastroenterology & Nutrition:
doi: 10.1097/MPG.0b013e31824a0149
Original Articles: Hepatology and Nutrition

Factors Associated With Peptide-based Formula Prescription in a Pediatric Intensive Care Unit

Vidigal, Maria V.M.*; Leite, Heitor P.; Nogueira, Paulo C.K.

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Objectives: There is no evidence-based consensus on the use of peptide-based formulas for critically ill children. The present study aimed to identify the factors associated with the choice of peptide-based formulas in the first enteral nutrition prescription for critically ill children and to compare the direct costs of the enteral formulas used in a pediatric intensive care unit.

Methods: In a prospective study, children admitted to the intensive care unit and receiving tube feeding for ≥48 hours were evaluated. The potential exposure variables for the use of peptide-based formulas as the first nutrition prescription were age, sex, malnutrition, sepsis/septic shock, fasting period >2 days, use of α-adrenergic drugs before initiating first diet, and the revised Pediatric Index of Mortality score. A direct cost comparison of prescribed formulas was performed.

Results: Of 291 patients included, 85 (29.2%) were given peptide-based formulas in the first nutrition prescription. This choice was independently associated with malnutrition (odds ratio [OR] 2.94; 95% confidence interval [CI] 1.60%–5.39%; P < 0.01), fasting period >2 days (OR 3.46; 95% CI 1.93%–6.20%; P < 0.01), and use of α-adrenergic drugs (OR 2.32; 95% CI 1.24%–4.31%; P < 0.01). Peptide-based formula costs were up to 10 times higher than standard polymeric formula costs.

Conclusions: The choice of peptide-based formula as the first enteral nutrition prescription is associated with the greater severity of patients’ clinical status—patients receiving α-adrenergic drugs, those who are malnourished, and those with longer fasting periods. These prescriptions engender costs higher than those associated with standard polymeric formula.

Copyright 2012 by ESPGHAN and NASPGHAN


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