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Registered Dietitians Help Critically Ill Children Get Necessary Nutrition for Recovery

2013-06-28

Documented Caloric Requirements in Medical Records Lead to Higher Caloric Intake and Improved Critical Outcomes, According to Journal of the Academy of Nutrition and Dietetics Report

Media Contacts: Ryan O'Malley, Allison MacMunn
800/877-1600, ext. 4769, 4802 media@eatright.org

For the first time, researchers investigated enteral nutrition and caloric requirements (CR) among critically ill children in a new report published in the Journal of the Academy of Nutrition and Dietetics. This study also showed the value of including registered dietitians in the medical team.

Providing early nutritional support through the intestine, or enteral route, to critically ill adults has been an effective strategy to improve the healing process. Using a similar approach with critically ill children, however, may present challenges, such as an inability to accurately estimate CR or an inability to administer the CR because of fluid restrictions, procedures, and other barriers. Despite these perceived challenges and a lack of data, many experts believe that early enteral nutrition should be considered in most Pediatric Intensive Care Unit (PICU) patients.

"Our main objective was to examine the practice of early documentation of estimated caloric requirement in the medical record of critically ill children to determine if this would have any effect on their daily caloric intake and the route of nutrition being used to provide them with nutritional support," says lead investigator Martin Wakeham, MD, FAAP, Assistant Professor of Pediatrics, Pediatric Critical Care, Medical College of Wisconsin, Children's Hospital of Wisconsin, Milwaukee. "We hypothesized that there would be a higher total daily caloric intake and more frequent use of enteral nutrition when a CR is estimated and documented in the medical record within 48 hours of PICU admission."

Five PICUs participated in the study. Four of these units were located in independent children's hospitals and one was part of a large community hospital. The study team collected and analyzed data from two sources: Medical records detailing the nutritional intake (nutrition route, quantity, content, presence or absence of an estimated CR) of 1349 patients, who were admitted between January 1, 2007 and December 31, 2008, aged between 30 days and 18 years, and remained in the PICU for 96 hours or more; and a multisite clinical database dedicated to data sharing and benchmarking among PICUs. Investigators also noted the type of provider when an estimated CR was present.

Careful analysis of data revealed that nearly 50 percent of the patients had a documented CR. Other findings include the following:

  • Compared to patients without a CR, these patients were younger, had a higher risk of mortality, and were less likely to be post-operative
  • Patients were more likely to receive enteral nutrition on each of the first four days of admission to the PICU
  • Patients had a higher total daily caloric intake by enteral route and parenteral route combined on each of the first four days of their stay in the PICU
  • More than 90 percent showed an estimated CR equal to or greater than the World Health Organization's calculated resting energy expenditure (REE)
  • A registered dietitian determined the documented CR in more than 95 percent of the cases

"A CR documented in the medical record is evidence that at least a member of the health care delivery team included nutritional support and therapy in the treatment plan for that particular patient. Likewise, not having a CR present in the medical record might be evidence that the subject of nutritional therapy was never addressed in those patients," says Dr. Wakeham. "Another interesting finding is that almost all of the CRs present early in the medical records were entered by a registered dietitian and not by an attending physician or other medical care provider. This finding illustrates the favorable and important impact that registered dietitians can have on the nutritional outcomes of PICU patients."

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NOTES FOR EDITORS
“Registered Dietitians Making a Difference: Early Medical Record Documentation of Estimated Energy Requirement in Critically Ill Children Is Associated with Higher Daily Energy Intake and with Use of the Enteral Route,” Martin Wakeham, MD, FAAP; Melissa Christensen, Jennifer Manzi; Evelyn M. Kuhn, PhD; Matthew Scanlon, MD; Praveen S. Goday, MBBS; and Theresa A. Mikhailov, MD, PhD. Journal of the Academy of Nutrition and Dietetics, DOI: 10.1016/j.jand.2013.04.025, published by Elsevier.

Full text of this article is available to credentialed journalists upon request. Contact Eileen Leahy at 732-238-3628 or andjrnlmedia@elsevier.com to obtain copies. Journalists wishing to set up interviews with the authors should contact Martin Wakeham, MD, FAAP at 414 266 2339 or mwakeham@mcw.edu.

An audio podcast featuring Dr. Wakeham and information specifically for journalists are located at andjrnl.org/content/mediapodcast. Excerpts from the audio may be reproduced by the media; contact Eileen Leahy to obtain permission.

ABOUT THE JOURNAL OF THE ACADEMY OF NUTRITION AND DIETETICS
The official journal of the Academy of Nutrition and Dietetics (www.eatright.org), the Journal of the Academy of Nutrition and Dietetics (www.andjrnl.org) is the premier source for the practice and science of food, nutrition and dietetics. The monthly, peer-reviewed journal presents original articles prepared by scholars and practitioners and is the most widely read professional publication in the field. The Journal focuses on advancing professional knowledge across the range of research and practice issues such as: nutritional science, medical nutrition therapy, public health nutrition, food science and biotechnology, food service systems, leadership and management and dietetics education.

The Journal has a current Impact Factor of 3.797 in the Nutrition and Dietetics category of the 2012 Journal Citation Reports®, published by Thomson Reuters. It was previously published as the Journal of the American Dietetic Association.

ABOUT THE ACADEMY OF NUTRITION AND DIETETICS
The Academy of Nutrition and Dietetics (www.eatright.org), formerly the American Dietetic Association, is the world’s largest organization of food and nutrition professionals. The Academy is committed to improving the nation’s health and advancing the profession of dietetics through research, education and advocacy.

ABOUT ELSEVIER
Elsevier is a world-leading provider of scientific, technical and medical information products and services. The company works in partnership with the global science and health communities to publish more than 2,000 journals, including The Lancet (www.thelancet.com) and Cell (www.cell.com), and close to 20,000 book titles, including major reference works from Mosby and Saunders. Elsevier’s online solutions include ScienceDirect (www.sciencedirect.com), Scopus (www.scopus.com), Reaxys (www.reaxys.com), ClinicalKey (www.clinicalkey.com) and Mosby’s Suite (www.confidenceconnected.com), which enhance the productivity of science and health professionals, and the SciVal suite (www.scival.com) and MEDai’s Pinpoint Review (www.medai.com), which help research and health care institutions deliver better outcomes more cost-effectively.

A global business headquartered in Amsterdam, Elsevier (www.elsevier.com) employs 7,000 people worldwide. The company is part of Reed Elsevier Group plc (www.reedelsevier.com), a world leading provider of professional information solutions. The group employs more than 30,000 people, including more than 15,000 in North America. Reed Elsevier Group plc is owned equally by two parent companies, Reed Elsevier PLC and Reed Elsevier NV. Their shares are traded on the London, Amsterdam and New York Stock Exchanges using the following ticker symbols: London: REL; Amsterdam: REN; New York: RUK and ENL.