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Worldwide Survey of Nutritional Practices in PICUs*

Kerklaan, Dorian MD1; Fivez, Tom MD2; Mehta, Nilesh M. MD3; Mesotten, Dieter MD, PhD2; van Rosmalen, Joost PhD4; Hulst, Jessie M. MD, PhD5; Van den Berghe, Greet MD, PhD2; Joosten, Koen F. M. MD, PhD1; Verbruggen, Sascha C. A. T. MD, PhD1

Pediatric Critical Care Medicine: January 2016 - Volume 17 - Issue 1 - p 10–18
doi: 10.1097/PCC.0000000000000542
Feature Articles

Objective: To assess current nutritional practices in critically ill children worldwide.

Design: A two-part online, international survey. The first part, “the survey”, was composed of 59 questions regarding nutritional strategies and protocols (July–November 2013). The second part surveyed the “point prevalence” of nutritional data of patients present in a subgroup of the responding PICUs (May–September 2014).

Setting: Members of the World Federation of Pediatric Intensive and Critical Care Societies were asked to complete the survey.

Subjects: Pediatric critical care providers.

Interventions: Survey.

Measurements and Main Results: We analyzed 189 responses from 156 PICUs in 52 countries (survey). We received nutritional data on 295 patients from 41 of these 156 responding PICUs in 27 countries (point prevalence). According to the “survey”, nutritional protocols and support teams were available in 52% and 57% of the PICUs, respectively. Various equations were in use to estimate energy requirements; only in 14% of PICUs, indirect calorimetry was used. Nutritional targets for macronutrients, corrected for age/weight, varied widely. Enteral nutrition would be started early (within 24 hr of admission) in 60% of PICUs, preferably by the gastric route (88%). In patients intolerant to enteral nutrition, parenteral nutrition would be started within 48 hours in 55% of PICUs. Overall, in 72% of PICUs supplemental parenteral nutrition would be used if enteral nutrition failed to meet at least 50% of energy delivery goal. Several differences between the intended (survey) and the actual (point prevalence) nutritional practices were found in the responding PICUs, predominantly overestimating the ability to adequately feed patients.

Conclusion: Nutritional practices vary widely between PICUs worldwide. There are significant differences in macronutrient goals, estimating energy requirements, timing of nutrient delivery, and threshold for supplemental parenteral nutrition. Uniform consensus-based nutrition practices, preferably guided by evidence, are desirable in the PICU.

Supplemental Digital Content is available in the text.

1Intensive Care Unit, Department of Paediatrics and Pediatric Surgery, Erasmus Medical Centre, Sophia Children’s Hospital, Rotterdam, The Netherlands.

2Clinical Division and Laboratory of Intensive Care Medicine, Department Cellular and Molecular Medicine, KU Leuven University, Leuven, Belgium.

3Critical Care Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, and Center for Nutrition, Division of Gastroenterology, Hepatology and Nutrition, Boston Children’s Hospital, Harvard Medical School, Boston, MA.

4Department of Biostatistics, Erasmus MC, Rotterdam, The Netherlands.

5Department of Pediatric Gastroenterology, Erasmus MC-Sophia Children’s Hospital, Rotterdam, The Netherlands.

*See also p. 85.

Drs. Kerklaan and Fivez contributed equally.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (

Supported, in part, by grant IWT-TBM 110685, Fonds NutsOhra, and the Erasmus–Trustfonds.

Dr. Mesotten holds a senior clinical investigator fellowship from the FWO Research Foundation Flanders Belgium. Dr. Mesotten’s institution received grant support from IWT-TBM grant for PEPaNIC clinical trial (governmental funding). Dr. Mehta received royalties related to textbook sales by McGraw Hill Publications. Dr. Van den Berghe’s institution received grant support from IWT-TBM grant for PEPaNIC clinical trial (governmental funding). Dr. Verbruggen received grant support from Fonds NutsOhra and Erasmus MC Trustfonds. The remaining authors have disclosed that they do not have any potential conflicts of interest.

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©2016The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies