Nutritional Requirements in the PICU Patient

Nutritional requirements in the critically ill PICU patient may be significantly different from those of healthy or unstressed children. During periods of injury or illness induced metabolic stress, excess nutritional delivery or "overfeeding" can further increase the metabolic demands on the lungs and liver, and may result in increased mortality. Complications of overfeeding may include:

  • Excess CO2 production & increased minute ventilation
  • Pulmonary edema & respiratory failure
  • Hyperglycemia, which may increase infection rates
  • Lipogenesis due to increased insulin production
  • Immunosuppression
  • Hepatic complications: fatty liver, intrahepatic cholestasis

Determining Calorie and Protein Needs in Critically Ill Children

Studies in critically ill pediatric patients have demonstrated the importance of not using the standard RDA tables initially to calculate energy requirements. The patient's calorie and protein needs may be determined as follows:

  • Estimate basal energy needs (BEE) - Refer to Table 1
  • Determine Stress Factor - Refer to Table 2
    Total Calories = BEE X Stress Factor
  • Estimate patient's protein requirements - Refer to RDAs - Table 3
    Total Protein = Protein RDAs X Stress Factor
  • Continue to evaluate and adjust recommendations based on nutrition monitoring.

Calculation of Catch-Up Growth in the Term Infant and Child

Children who are below normal growth parameters due to chronic undernutrition or illness affecting their nutritional intake and status require additional calories and protein to achieve catch-up growth.

Kcal/kg =
RDA (kcal/kg) for weight age* x Ideal weight (kg)**
Actual weight

* Age at which present weight is at the 50th %-ile
** 50th %-ile for age or ideal body weight for height

Nutritional Calculator from Yale University