Changes in Global Nutrition Practices in Critically Ill Children and the Influence of Emerging Evidence: A Secondary Analysis of the Pediatric International Nutrition Studies, 2009-2018.

Background: The timeline of the 3 Pediatric International Nutrition Studies (PINS) coincided with the publication of 2 major guidelines for the timing of parenteral nutrition (PN) and recommended energy and protein delivery dose.

Objective: The study's main objective was to describe changes in the nutrition delivery practice recorded in PINS1 and PINS2 (PINS1-2) (conducted in 2009 and 2011, preexposure epoch) vs PINS3 (conducted in 2018, postexposure epoch), in relation to the published practice guidelines.

Design: This study is a secondary analysis of data from a multicenter prospective cohort study.

Stress Ulcer Prophylaxis Versus Placebo-A Blinded Pilot Randomized Controlled Trial to Evaluate the Safety of Two Strategies in Critically Ill Infants With Congenital Heart Disease.

Objectives: The routine use of stress ulcer prophylaxis (SUP) in infants with congenital heart disease (CHD) in the cardiac ICU (CICU) is controversial. We aimed to conduct a pilot study to explore the feasibility of performing a subsequent larger trial to assess the safety and efficacy of withholding SUP in this population (NCT03667703).

Design, Setting, Patients: Single-center, prospective, double-blinded, parallel group (SUP vs.

Long-Term Functional Outcomes at 1-Year After Hospital Discharge in Critically Ill Neonates With Congenital Diaphragmatic Hernia.

Objectives: Congenital diaphragmatic hernia (CDH) is a birth defect associated with long-term morbidity. Our objective was to examine longitudinal change in Functional Status Scale (FSS) after hospital discharge in CDH survivors.

Design: Single-center retrospective cohort study.

Intermittent versus continuous enteral nutrition in critically ill children: A pre-planned secondary analysis of an international prospective cohort study.

Background & Aims: Intermittent enteral nutrition (EN) may have physiologic benefits over continuous feeding in critical illness. We aimed to compare nutrition and infection outcomes in critically ill children receiving intermittent or continuous EN.

Methods: International, multi-center prospective observational study of mechanically ventilated children, 1 month to 18 years of age, receiving EN.

Bio-impedance spectroscopy for total body water assessment in pediatric surgical patients: A single center pilot cohort study.

Background: Excess peri‑operative fluid administration is associated with higher morbidity and mortality. We aimed to examine the feasibility of bio-impedance spectroscopy (BIS) to record serial peri‑operative fluid volumes in the pediatric surgical population.

Methods: Children who underwent major elective general surgery from March 2019 to March 2020 were included.

Feasibility of bioimpedance spectroscopy and long-term functional assessment in critically ill children.

Background & Aims: Lean body mass loss due to critical illness in childhood could be detrimental to long term outcomes, including functional status and quality of life. We describe the feasibility of body composition assessment by bioimpedance spectroscopy (BIS) in the pediatric intensive care unit (PICU), and functional status and quality of life assessments up to 6 months following admission in a cohort of mechanically ventilated, critically ill children.

Methods: We conducted a prospective, observational pilot study in a multidisciplinary PICU.

Nutritional screening tool for critically ill children: a systematic review.

Context: Nutritional screening tools (NSTs) are used to identify patients who are at risk of nutritional status (NS) deterioration and associated clinical outcomes. Several NSTs have been developed for hospitalized children; however, none of these were specifically developed for Pediatric Intensive Care Unit (PICU) patients.

Objective: A systematic review of studies describing the development, application, and validation of NSTs in hospitalized children was conducted to critically appraise their role in PICU patients.

Time to achieve delivery of nutrition targets is associated with clinical outcomes in critically ill children.

Background: Optimal nutrition in critically ill children involves a complex interplay between the doses, route, and timing of macronutrient delivery.

Objectives: We aimed to examine the association between the time to achieve delivery of 60% of the prescribed energy and protein targets and clinical outcomes in mechanically ventilated children.

Methods: We conducted a prospective, observational cohort study of mechanically ventilated children admitted to pediatric intensive care units (PICUs) worldwide.

Postsecondary nutrition program education in the hashemite Kingdom of Jordan: A brief report.

Background: Obesity is a growing public health concern in Jordan, which has experienced a noticeable transition associated with increased morbidity and mortality, due to nutrition-related noncommunicable diseases. The nutrition profession has also advanced in Jordan, but the expansion is not as robust as changes happening in other healthcare sectors. This brief report examines the current nutrition-affiliated programs offered in postsecondary institutions in Jordan.

Timing of parenteral nutrition is associated with adequacy of nutrient delivery and anthropometry in critically ill children: A single-center study.

Background: The optimal timing of supplemental parenteral nutrition (PN) use in the pediatric intensive care unit (ICU) is unclear. We aimed to describe patterns of PN use in the ICU and the association between the timing of PN initiation and macronutrient delivery and anthropometry.

Methods: We enrolled patients (aged <18 years) with an ICU stay >3 days were started on PN in the ICU.

Stress ulcer prophylaxis versus placebo-a blinded randomized control trial to evaluate the safety of two strategies in critically ill infants with congenital heart disease (SUPPRESS-CHD).

Background: Critically ill infants with congenital heart disease (CHD) are often prescribed stress ulcer prophylaxis (SUP) to prevent upper gastrointestinal bleeding, despite the low incidence of stress ulcers and limited data on the safety and efficacy of SUP in infants. Recently, SUP has been associated with an increased incidence of hospital-acquired infections, community-acquired pneumonia, and necrotizing enterocolitis. The objective of this pilot study is to investigate the feasibility of performing a randomized controlled trial to assess the safety and efficacy of withholding SUP in infants with congenital heart disease admitted to the cardiac intensive care unit.

Food-based dietary guidelines of Arabic-speaking countries: a culturally congruent profile.

Objective: Dietary guidelines for food groups, types and portion sizes are common practice at the national level. As the relationship between nutrition and disease and the influence of cultural identity on individual behaviour become clearer, dietary guidelines necessarily evolve. Today, the Arabic-speaking region is experiencing a dual burden of undernutrition and increasing rates of overweight and obesity.

Development and validation of a quantitative choline food frequency questionnaire for use with drinking and non-drinking pregnant women in Cape Town, South Africa.

Background: Although animal and human studies have demonstrated interactions between dietary choline and fetal alcohol spectrum disorders, dietary choline deficiency in pregnancy is common in the US and worldwide. We sought to develop and validate a quantitative food frequency questionnaire (QFFQ) to estimate usual daily choline intake in pregnant mothers.

Methods: A panel of nutrition experts developed a Choline-QFFQ food item list, including sources with high choline content and the most commonly consumed choline-containing foods in the target population.

Feasibility of Enteral Protein Supplementation in Critically Ill Children.

Background: We describe the protein type and concentration in standard enteral nutrition (EN) formulas and the effect of protein supplementation on the osmolality of standard formulas. We also aimed to examine factors associated with optimal protein delivery in critically ill children.

Methods: Protein content and other characteristics of pediatric EN formulas used worldwide were recorded.

Body Composition in Children with Chronic Illness: Accuracy of Bedside Assessment Techniques.

Objective: To evaluate the accuracy of estimated fat mass and fat-free mass from bedside methods compared with reference methods in children with chronic illnesses.

Study Design: Fat mass and fat-free mass values were obtained by skinfold, bioelectrical impedance analysis (BIA), dual-energy x-ray absorptiometry (DXA), and deuterium dilution method in children with spinal muscular atrophy, intestinal failure, and post hematopoietic stem cell transplantation (HSCT). Spearman's correlation and agreement analyses were performed between (1) fat mass values estimated by skinfold equations and by DXA and (2) fat-free mass values estimated by BIA equations and by DXA and deuterium dilution methods.

Maternal Alcohol Use and Nutrition During Pregnancy: Diet and Anthropometry.

Background: Despite known risks of prenatal nutritional deficiencies and studies documenting increased prevalence of poor dietary intake among nonpregnant alcohol abusers, the nutritional status of heavy drinking pregnant women remains largely unstudied. Animal models have found interactions between prenatal ethanol exposure and micronutrients, such as choline, folate, B12, and iron, and human studies have reported that lower maternal weight and body mass confer increased fetal alcohol-related risk.

Methods: One hundred and twenty-three heavy drinking Cape Coloured pregnant women and 83 abstaining controls were recruited at their first antenatal clinic visit.

Importance of Dietary Sources of Iron in Infants and Toddlers: Lessons from the FITS Study.

Iron deficiency (ID) affects 13.5% of 1-2 years old children in the US and may have a negative impact on neurodevelopment and behavior. Iron-fortified infant cereal is the primary non-heme iron source among infants aged 6-11.

Nutrient delivery in mechanically ventilated surgical patients in the pediatric critical care unit.

Purpose: Inadequate nutrient intake is associated with poor outcomes in critically ill children. We examined macronutrient delivery in surgical patients in the pediatric intensive care unit (PICU).

Methods: In a prospective international cohort study of mechanically ventilated children (1month to 18years), we recorded adequacy of cumulative nutrient delivery in the PICU.

Enteral Nutrition and Acid-Suppressive Therapy in the PICU: Impact on the Risk of Ventilator-Associated Pneumonia.

Objective: Enteral nutrition has been implicated as a risk factor for ventilator-associated pneumonia. We explored the prevalence of ventilator-associated pneumonia and its association with clinical and nutrition-related therapies in mechanically ventilated children.

Design: Prospective, multicenter, cohort study.

Nutritional Status Based on Body Mass Index Is Associated With Morbidity and Mortality in Mechanically Ventilated Critically Ill Children in the PICU.

Objective: To determine the influence of admission anthropometry on clinical outcomes in mechanically ventilated children in the PICU.

Design: Data from two multicenter cohort studies were compiled to examine the unique contribution of nutritional status, defined by body mass index z score, to 60-day mortality, hospital-acquired infections, length of hospital stay, and ventilator-free days, using multivariate analysis.

Setting: Ninety PICUs from 16 countries with eight or more beds.

Adequate enteral protein intake is inversely associated with 60-d mortality in critically ill children: a multicenter, prospective, cohort study.

Background: The impact of protein intake on outcomes in pediatric critical illness is unclear.

Objective: We examined the association between protein intake and 60-d mortality in mechanically ventilated children.

Design: In a prospective, multicenter, cohort study that included 59 pediatric intensive care units (PICUs) from 15 countries, we enrolled consecutive children (age: 1 mo to 18 y) who were mechanically ventilated for ≥48 h.