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.
*Department of Pediatrics, Pediatric Intensive Care Unit
†Department of Pediatrics, Discipline of Nutrition and Metabolism
‡Department of Pediatrics, Section of Pediatric Nephrology, Federal University of São Paulo, São Paulo, Brazil.
Address correspondence and reprint requests to Heitor P. Leite, Rua Loefgreen, 1647 zip code 04040-032, São Paulo, SP, Brazil (e-mail: firstname.lastname@example.org).
Received 10 September, 2011
Accepted 6 January, 2012
The authors report no conflicts of interest.