Incidence of opioid-induced constipation in the pediatric intensive care unit: A descriptive cohort study.

Background: Opioid-induced constipation (OIC) is a well-known phenomenon, although there is limited literature evaluating the incidence of OIC in children admitted to the pediatric intensive care unit (PICU). The primary aim of this study was to determine the incidence of OIC in the PICU and to determine if it is associated with a higher rate of morbidities or prolonged length of stay (LOS).

Methods: We conducted a single-center retrospective chart review from July 1, 2014, to June 30, 2015, in our PICU.

Nutrition Screening in the Pediatric Intensive Care Unit: Evaluation of an Electronic Medical Record-Based Tool.

Hospitalized, critically ill children are at increased risk of developing malnutrition. While several pediatric nutrition screening tools exist, none have been validated in the pediatric intensive care units (PICU). The Children's Wisconsin Nutrition Screening Tool (CWNST) is a unique nutrition screening tool that includes the Pediatric Nutrition Screening Tool (PNST) and predictive elements from the electronic medical record and was found to be more sensitive than the PNST in acute care units.

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.

Nutrition practices and outcomes in patients with pediatric acute respiratory distress syndrome.

Background: Pediatric acute respiratory distress syndrome (PARDS) remains a significant cause of morbidity and mortality. Evidence suggests enteral nutrition (EN) may be protective in critically ill children.

Methods: This is a retrospective cohort study comparing intubated patients with PARDS who received EEN and those who did not.

Bolus gastric feeds improve nutrition delivery to mechanically ventilated pediatric medical patients: Results of the COntinuous vs BOlus multicenter trial.

Background: Comparison of bolus gastric feeding (BGF) vs continuous gastric feeding (CGF) with respect to timing and delivery of energy and protein in mechanically ventilated (MV) pediatric patients has not been investigated. We hypothesized that bolus delivery would shorten time to goal nutrition and increase the percentage of goal feeds delivered.

Methods: Multicenter, prospective, randomized comparative effectiveness trial conducted in seven pediatric intensive care units (PICUs).

Early Parenteral Nutrition in Critically Ill Children Not Receiving Early Enteral Nutrition Is Associated With Significantly Higher Mortality.

Background: To determine whether early parenteral nutrition (PN) (25% of goal energy within 48 hours of PICU admission) is associated with poorer outcomes in children receiving no enteral nutrition (EN).

Methods: Multicenter retrospective study of patients aged 1 month to 18 years who had a PICU length of stay (PLOS) >96 hours. We obtained weight, sex, pediatric index of mortality 2 score (PIM-2), PLOS, duration of mechanical ventilation (DMV), mortality data, and nutrition intake data.

Early Enteral Nutrition Is Associated With Significantly Lower Hospital Charges in Critically Ill Children.

Background: Previous studies have shown that early enteral nutrition (EEN) is associated with lower mortality in critically ill children. The purpose of this study was to determine the association between EEN (provision of 25% of goal calories enterally over the first 48 hours) and pediatric intensive care unit (PICU) and hospital charges in critically ill children.

Methods: We conducted a supplementary study to our previous multicenter retrospective study of nutrition and outcomes in critically ill patients who had a PICU length of stay (LOS) ≥96 hours for the years 2007-2008.

Pediatric Specialty Transport Teams Are Not Associated With Decreased 48-Hour Pediatric Intensive Care Unit Mortality: A Propensity Analysis of the VPS, LLC Database.

Objective: The purpose of this study was to determine if pediatric specialty pediatric team (SPT) interfacility-transported children from community emergency departments to a pediatric intensive care unit (PICU) have improved 48-hour mortality.

Methods: This is a multicenter, historic cohort analysis of the VPS, LLC PICU clinical database (VPS, LLC, Los Angeles, CA) for all PICU directly admitted pediatric patients ≤ 18 years of age from January 1, 2007, to March 31, 2009. Categoric variables were analyzed by the chi-square and Mann-Whitney tests for non-normally distributed continuous variables.

Safety of Enteral Feedings in Critically Ill Children Receiving Vasoactive Agents.

Background: The objective of this retrospective study was to evaluate the safety of enteral feeding in children receiving vasoactive agents (VAs).

Methods: Patients aged 1 month to 18 years with a pediatric intensive care unit stay for ≥96 hours during 2007 and 2008 who received any VA (epinephrine, norepinephrine, vasopressin, milrinone, dopamine, and dobutamine) were included and categorized into fed and nonfed groups. Their demographics, clinical characteristics, type and dose of VA, and presence of gastrointestinal (GI) outcomes were obtained.

Early enteral nutrition is associated with lower mortality in critically ill children.

Background: The purpose of this study was to examine the association of early enteral nutrition (EEN), defined as the provision of 25% of goal calories enterally over the first 48 hours of admission, with mortality and morbidity in critically ill children.

Methods: We conducted a multicenter retrospective study of patients in 12 pediatric intensive care units (PICUs). We included patients aged 1 month to 18 years who had a PICU length of stay (LOS) of ≥96 hours for the years 2007-2008.

The need for evidence based nutritional guidelines for pediatric acute lymphoblastic leukemia patients: acute and long-term following treatment.

High survival rates for pediatric leukemia are very promising. With regard to treatment, children tend to be able to withstand a more aggressive treatment protocol than adults. The differences in both treatment modalities and outcomes between children and adults make extrapolation of adult studies to children inappropriate.

Under pressure: preventing pressure ulcers in critically ill infants.

Purpose: To determine whether a pressure ulcer prevention bundle was associated with a significant reduction in pressure ulcer development in infants in the pediatric intensive care unit.

Design And Methods: Quasi-experimental design involving 399 infants 0 to 3 months of age at a large tertiary care medical center.

Results: The implementation of the care bundle was associated with a significant drop in pressure ulcer incidence from 18.

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.

Background: Establishing a caloric requirement or energy target is a recommended part of any nutrition care plan.

Objective: Our objective was to describe early documentation of a caloric requirement in critically ill children, and to determine if this would have any effect on daily energy intake and route of nutrition.

Design: We used a descriptive chart review of a subgroup of patients included as part of a larger, retrospective multicenter study.

Obesity is not associated with increased mortality and morbidity in critically ill children.

Aim: To evaluate the effect of obesity on mortality, length of mechanical ventilation, and length of stay (LOS) in critically ill children.

Methods: Retrospective cohort study in 2- to 18-year-olds, admitted to the pediatric intensive care unit (PICU) at the Children's Hospital of Wisconsin from 2005-2009 who required invasive ventilation. Weight z score was used to categorize patients as normal (-1.

Can utilization review criteria be used to determine appropriate pediatric patient placement for a critical care bed expansion?

The rising trend in critical care utilization has led to the expansion of critical care beds in many hospitals across the country. Traditional models of estimating bed capacity requirements use administrative data such as inpatient admissions, length of stay, and case mix index. The use of such data has been limited in quantifying the complexities of demand variables in critical care bed needs.

Protecting fragile skin: nursing interventions to decrease development of pressure ulcers in pediatric intensive care.

Background: The reported incidence of pressure ulcers in critically ill infants and children is 18% to 27%. Patients at risk for pressure ulcers and nursing interventions to prevent the development of the ulcers have not been established.

Objectives: To determine the incidence of pressure ulcers in critically ill children, to compare the characteristics of patients in whom pressure ulcers do and do not develop, and to identify prevention strategies associated with less frequent development of pressure ulcers.

Breastfeeding and genetic factors in the etiology of inflammatory bowel disease in children.

Inflammatory bowel disease is a chronic, debilitating disorder of the gastrointestinal tract. The etiology of inflammatory bowel disease has not been elucidated, but is thought to be multifactorial with both environ-mental and genetic influences. A large body of research has been conducted to elucidate the etiology of inflammatory bowel disease.

Skin integrity in critically ill and injured children.

Background: Skin breakdown increases the cost of care, may lead to increased morbidity, and has negative psychosocial implications because of secondary scarring or alopecia. The scope of this problem has not been widely studied in critically ill and injured children.

Objectives: To determine the incidence of skin breakdown in critically ill and injured children and to compare the characteristics of patients who experience skin breakdown with those of patients who do not.

A prospective evaluation of opioid weaning in opioid-dependent pediatric critical care patients.

Critically ill children are treated with opioid medication in an attempt to decrease stress and alleviate pain during prolonged pediatric intensive care. This treatment plan places children at risk for opioid dependency. Once dependent, children need to be weaned or risk development of a withdrawal syndrome on abrupt cessation of medication.