Registered Dietitians Help Critically Ill Children Get Necessary Nutrition for Recovery

Registered Dietitians Help Critically Ill Children Get Necessary Nutrition for

PR Newswire

June 27

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


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:

  oCompared to patients without a CR, these patients were younger, had a
    higher risk of mortality, and were less likely to be post-operative
  oPatients were more likely to receive enteral nutrition on each of the
    first four days of admission to the PICU
  oPatients 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
  oMore than 90 percent showed an estimated CR equal to or greater than the
    World Health Organization's calculated resting energy expenditure (REE).
  oA 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."


"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 to
obtain copies. Journalists wishing to set up interviews with the authors
should contact Martin Wakeham, MD, FAAP at 414 266 2339 or

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


The official journal of the Academy of Nutrition and Dietetics
(, the Journal of the Academy of Nutrition and Dietetics
( 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.

The Academy of Nutrition and Dietetics (, 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.

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Eileen Leahy
Tel: 732-238-3628

Ryan O'Malley
Academy of Nutrition and Dietetics
Tel: 800-877-1600, ext. 4769

/PRNewswire-USNewswire -- June 27, 2013/

SOURCE Academy of Nutrition and Dietetics

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