(754) Nutritional Evaluation and Support in Overweight and Obese Children in the PICU

Introduction: For obese children in the ICU, there are no guidelines for estimating energy and protein requirements. Achieving 60% adequacy of calories and protein within one week can reduce mortality. We hypothesize that nutrient prescription is variable and optimal adequacy will be difficult to achieve in the first week of admission.

Methods: Retrospective cohort study of children admitted (index) to Texas Children’s Hospital PICU between 01-16 to 12-17. Inclusion criteria included mechanical ventilation (MV) >48 hrs., PICU length of stay (LOS) >7d, and overweight and obesity according to WHO growth curves (Body Mass Index [BMI] and weight for length [WFL] z-scores). Nutrition support and adequacy (intake/prescription) included enteral and parenteral nutrition, and propofol if on TPN. Calculations used dietitians' prescriptions and actual body weight. Optimal adequacy was defined as ≥60%. Comparison by paired T-test as appropriate.

Results: 531 children met inclusion criteria and 116 overweight or obese children (22.8%) were enrolled (65% male). The median (IQR) for age 6.5 (1.04 - 11.4) yrs., weight 33.5 (11.7 - 52) kg, BMI/Age or WFL (2.35±1.10 [SD]), MV 354 (168 – 394) hrs., PICU LOS 19 (9.3 - 20) d, hospital LOS 42 (18 - 48) d, PIMS 2 risk of mortality (ROM) 7.1 (1.04 - 8.5) %, and 17.2% hospital mortality. There were 7 methods for calorie prescription and 5 for protein; 77% included stress factors (1.31 ± 0.6). Calorie prescription was 59 ± 31 kcal/kg/d and for protein 1.93 ± 0.58 g/kg/d. For days 1 to 7, caloric intake (kcal/kg/d) and adequacy (%) was 4.9±15, 8±16, 20±24, 31±29, 35±28, 38±27, 38±25; and 9±25, 14±28, 34±36, 53±42, 61±39, 68±39, and 69±42 respectively. Protein intake (g/kg/d) and adequacy (%) was 0.19±0.56, 0.33±0.67, 0.72±0.83, 1.13±1.02, 1.35±1.02, 1.43±1.02, and 1.48±0.97; and 10±29, 18±38, 37±41, 56±47, 68±47, 74±46, and 77±47 respectively. For each patient, the caloric and protein prescription and daily intake differed significantly (for days 1-7; p < 0.0001). Optimal nutrition adequacy for calories and protein was reached on day 5.

Conclusions: Nutritional prescriptions in this population are highly variable. There is a significant difference between prescription and actual intake. Nonetheless, on average 60% of both nutrients adequacy was reached by day 5 of PICU admission.