Inpatient Pediatric Services in the Pediatric Intensive Care Unit (PICU)

Introduction: 
Nutrition support of the critically ill, post-trauma or post-operative pediatric patient continues to develop as a clinical science in light of advances in nutrition, pharmacology and technology.   Given the wide diversity in pediatric critical care states, we are challenged to accurately assess the nutritional requirements of our patients and the best mode of nutrition support to optimize their recovery and their nutritional and medical outcomes.

Purpose and Mission: 

  • Provision of adequate calories and protein during catabolism to prevent protein-energy malnutrition (PEM) ie, sepsis, trauma, post-surgery
  • Promote improved immunological status, and wound wealing, to minimize the risk infections
  • Prevent or minimize the catabolic response and breakdown of protein stores
  • Improvement of nutritional status; management of disease specific deficiencies
  • Reversal of growth failure and when applicable, promotion of "catch-up" growth
  • Promote early initiation of enteral or parenteral nutrition support, as indicated, within 24-48 hours to minimize risk for poor nutritional and clinical outcomes
  • Promotion of enteral nutrition over parenteral nutrition, whenever possible, to minimize the risk of infections and poor clinical outcomes

Role of the PICU Nutritionist:

  • Screen all PICU patients for nutritional risk with comprehensive nutritional assessment of all patients determined to be at risk
  • Development of nutrition care plan with recommendations for enteral or parenteral nutrition support, as needed (within 72 hours of PICU admission)
  • Monitoring of nutritional status; timely follow-up and intervention 
  • Conduct nutritional analysis and compare intake to nutrition goals
  • Family and staff education on nutrition support
  • Assist the PICU team with nutrition management 
  • Assist PICU team with nutritional order entry including diet orders, tube feeding and TPN and lipid orders

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