(1018) Nutrition Support Adequacy in Children With Critical Neurologic Illness

Introduction: Delayed achievement of macronutrient adequacy by day 7 of ICU admission is associated with higher mortality, however, data is scarce on nutrition adequacy in children with critical neurological illness (CNI). We aimed to describe the feasibility of achieving caloric and protein adequacy in children with CNI and clinical outcomes.

Methods: We performed a retrospective cohort study of children admitted (index) to PICU with CNI from 1/2018- 6/2021. Inclusion criteria were ICU LOS >7 days with calculable nutrition intake. Underweight was defined by WFA z score <-2 ( CDC/WHO). Caloric and protein adequacy were defined as Intake/BMR (Schofield equation), and Intake/1.5 g/kg respectively. Optimal adequacy defined (intake/prescribed ≥ 60%). Analyses by Mann-Whitney and Kruskal Wallis tests.

Results: Out of 1,112 patients, 180 (females 39%) met the criteria, of which 7 patients were on ketogenic diet. The median (IQR) for age 4.8(0.8-12) yrs, weight 17(8.8-35) kg, MV duration (n=148) 170(98-358) hours, PIM3 ROM 1.7(0.8-3.9)%, ICU LOS 11(7-20) days, and hospital LOS 23(14.5-42) days. Prevalence of underweight patients 21.6%, and mortality rate 0.5%. CNI etiology included seizures 31%, infections 22.7%, neurovascular 17.7%, and other categories i.e. demyelination, malformations, and trauma combined 27.7%. There was no difference in nutrition adequacy among the diagnostic groups. On the 3rd day of admission, 50% of patients under the age of 2 years (n=73) achieved optimal caloric and protein adequacy, compared to 25% of patients older than 2 years (n=107), p-value of < 0.01. Among underweight patients (n=39), 60% achieved optimal caloric and protein adequacy by day 3 vs 30% of non-underweight patients (n=141), p-value of < 0.01. There was no difference in mortality between patients who achieved nutrition adequacy and those who did not.

Conclusions: Optimal caloric and protein adequacy were reached by the majority of the patients by day 3 of admission, particularly younger ( < 2 years old) and underweight patients. Findings show that it’s feasible to achieve nutrition adequacy in patients with CNI. There was no difference in nutrition adequacy in patients with different CNI etiologies.