Pediatric Nutrition in Practice

276 Hulst  Joosten

Follow-Up of Nutritional Support
Once nutritional support is started, its adequacy
may be assessed by parameters of nutritional sta-
tus such as anthropometric measurements, indi-
rect calorimetry and the inflammatory condition
(C-reactive protein) of the patient. The minimum
standard for nutritional assessment should in-
clude measurements of weight, mid-upper-arm
circumference and possibly length, and indirect
calorimetry. Biochemical markers such as preal-
bumin (short-term) or albumin (long-term) can
be used to assess nutrition adequacy, but they are
not specific. An overall practical nutritional
guideline is shown in figure 1.

Conclusions

• Critically ill children are in a catabolic state,
  characterized by 3 major metabolic changes:
  (1) increased protein turnover with enhanced
  hepatic protein synthesis and muscle protein

breakdown with negative protein balance; (2)

increased lipolysis, and (3) insulin resistance

causing hyperglycemia

• Nutritional support is an essential aspect of
  clinical management of the critically ill child
  and should be integrated into daily care


• EN is the preferred route in patients with a
  functional gastrointestinal tract and can be
  initiated within 24 h after admission in the
  majority of the children


• The main advantages of EN over PN include
  preservation of gastrointestinal function, re-
  duced costs, manageability and safety


• The use of appropriate clinical feeding proto-
  cols that incorporate guidelines for nutritional
  assessment, early initiation of EN with proto-
  coled regular advancement, monitoring ener-
  gy balance with the use of indirect calorimetry,
  defining intolerance and minimizing inter-
  ruptions to EN are desirable and can help to
  overcome the barriers to achieving adequate
  EN in critically ill children

10 Koletzko B, Goulet O, Hunt J, Krohn K,

Shamir R; Parenteral Nutrition Guide-

lines Working Group; et al: 1. Guidelines

on Paediatric Parenteral Nutrition of the

European Society of Paediatric Gastro-

enterology, Hepatology and Nutrition

(ESPGHAN) and the European Society

for Clinical Nutrition and Metabolism

(ESPEN), Supported by the European

Society of Paediatric Research (ESPR).

J Pediatr Gastroenterol Nutr 2005;

41(suppl 2):S1–S87.

11 Preissig CM, Rigby MR: Hyperglycaemia

results from beta-cell dysfunction in

critically ill children with respiratory

and cardiovascular failure: a prospective

observational study. Crit Care 2009;

13:R27.

12 Verbruggen SC, Joosten KF, Castillo L,

van Goudoever JB: Insulin therapy in

the pediatric intensive care unit. Clin

Nutr 2007; 26: 677–690.

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Koletzko B, et al. (eds): Pediatric Nutrition in Practice. World Rev Nutr Diet. Basel, Karger, 2015, vol 113, pp 271–277

DOI: 10.1159/000360351