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Energy and Protein Intake during the First Week of the Pediatric Cardiac Intensive Care Unit Improves Hospital Outcomes

  • Author / Creator
    Boff, Luana
  • Provision of energy to critically ill children during hospitalization is important. However, too much or not enough energy impacts hospital outcomes. Nutrients can be delivered as enteral nutrition (EN) and/or parenteral nutrition (PN) to promote recovery post-surgery, preserve body weight, and improve hospital outcomes including decreased length of stay, ventilator support days, and infections. This study aimed to evaluate the energy and protein intake through EN or PN during the first week of Pediatric Cardiac Intensive Care Unit (PCICU) admission, and its association to hospital outcomes including hospital length of stay (LOS), PCICU LOS, ventilator support days, and infections. Changes in anthropometric z-scores were measured. All patients admitted to the PCICU between March 1, 2016 and June 30, 2018 with a PCICU stay of seven days were included. Demographics, clinical conditions, anthropometric measurements, total daily energy (kcal/kg/day) and protein (grams/kg/day) intake were collected from patient medical charts. A total of 253 patients were included and categorized as surgical (n=203) or non-surgical patients (n=50), and the analyses were independently performed. Energy requirement were estimated by two-thirds of basal metabolic rate from World Health Organization predictive equation (median 31kcal/kg/d) and compared patients receiving energy below or above the predictive value. For patients who had heart surgery, mean energy intake below 31kcal/kg/d was associated with longer PCICU LOS (11, IQR:6-17), total hospital LOS (27, IQR:15-49), and ventilator days (10, IQR:6-15) compared to those receiving energy greater than 31kcal/kg/d; (PCICU LOS 7, IQR:3-10; Hospital LOS 14, IQR:10-24; ventilator days 4, IQR:2-7; p<0.001, respectively). For non-surgical patients, no differences were observed in hospital outcomes in association with energy and protein intake (p>0.05). Patients receiving PN versus EN had similar hospital and PCICU LOS and infections rate. Patients receiving PN were on ventilation support for longer (7, IQR:5-14) compared to patients receiving EN (5, IQR: 3-10). This study provides supportive evidence suggesting that providing energy, whether through EN or PN in the first seven days of PCICU admission reduces hospital LOS and promotes improved hospital outcomes.

  • Subjects / Keywords
  • Graduation date
    Fall 2019
  • Type of Item
    Thesis
  • Degree
    Master of Science
  • DOI
    https://doi.org/10.7939/r3-6qpw-ep06
  • License
    Permission is hereby granted to the University of Alberta Libraries to reproduce single copies of this thesis and to lend or sell such copies for private, scholarly or scientific research purposes only. Where the thesis is converted to, or otherwise made available in digital form, the University of Alberta will advise potential users of the thesis of these terms. The author reserves all other publication and other rights in association with the copyright in the thesis and, except as herein before provided, neither the thesis nor any substantial portion thereof may be printed or otherwise reproduced in any material form whatsoever without the author's prior written permission.