Targets for Initiation

Timely Initiation of Nutrition Support: Targets for Initiation

When should nutrition support be started in the PICU?

Infants under the age of 2 and infants and children identified at nutrition risk due to an underlying condition or as identified through a complete nutritional assessment should be started on nutrition support in a timely manner as follows:

  1. Infants and malnourished children: initiate nutrition, preferably from the enteral route, by Hospital Day #3 (within 48 hours of admission).
  2. For older children and those identified to have had good nutritional status prior to admission: initiate nutrition, preferably from the enteral route, by Hospital Day #3 - #5 (within 48 - 96 hours of admission)

 

Nutritional Support Targets for the PICU Patient

Stage
Clinical Goals
Hospital Day
Nutritional Targets
I Fluid Resuscitation & restore tissue perfusion. Day #1 to 2 Fluid and electrolyte management.
II Metabolic Resuscitation: limit protein catabolism & elevated glucose levels; Hypermetabolic phase which may continue with infection Day #2 to 9 Achieve BEE for energy with significant protein source; Next step progress to BEE X stress factor (Table 1 & Table 2) as tolerated.
II Nutritional Recovery - recovery repletion, increasing activity and growth Day #7 to 10 and beyond Full targets at BEE X injury factor or even higher using RDA table (Table 3) or catch-up growth once stress subsides and growth resumes.
For infants & malnourished Initiate nutrition by Day #3 Achieve BEE X Stress factor by Day #5 - 6.
For older children & good nutritional status prior to admission Initiate nutrition by Day #3 - 5. Achieve BEE X Stress factor by Day #5 - 8.