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Outcomes in a Pediatric Intensive Care Unit Before and After the Implementation of a Nutrition Support Team

Gisele Limongeli Gurgueira, MD, MSc^*, Heitor Pons Leite, MD, PhD, José Augusto de Aguiar Carrazedo Taddei, MD, DrPH and Werther Brunow de Carvalho, MD, PhD^*

From the ^* Pediatric Intensive Care Unit and the Discipline of Nutrition and Metabolism, Department of Pediatrics, Federal University of São Paulo, São Paulo, Brazil

Correspondence: José Augusto de Aguiar Carrazedo Taddei, MD, DrPH, Discipline of Nutrition and Metabolism, Department of Pediatrics, Federal University of São Paulo, Rua Loefgreen 1647 Vila Clementino, São Paulo 04040032, Brazil. Electronic mail may be sent to limongeli{at}uol.com.br.

Background: We evaluated the effect of parenteral nutrition (PN) and enteral nutrition (EN) on in–pediatric intensive care unit (PICU) mortality before and after a continuous education program in nutrition support that leads to implementation of a nutrition support team (NST). Methods: We used a historical cohort study of infants hospitalized for >72 hours at the PICU from 1992 to 2003. Five periods were selected (P1 to P5), considering the modifications incorporated into the program: P1, without intervention; P2, basic themes and original articles discussion; P3, clinical and nursing staff participation; P4, clinical visits; P5, NST. The samples were compared in terms of sex, age, admitting service (ie, medical vs surgical), prognostic index of mortality, length of stay (LOS), duration of mechanical ventilation, in-PICU mortality rate, and percentage of time receiving EN and PN for each patient. Bi- and multivariate analyses were performed. Statistical significance was set at 0.05 level. Results: Progressive increase was observed in EN use (p = .0001), median values for which were 25% in P1 and rose to 67% by P5 in medical patients; there was no significant difference in surgical patients. A reduction was observed in PN use; in P1 medians were 73% and 69% for medical and surgical patients respectively, and decreased to 0% in P5 for both groups (p = .0001). There was significant reduction in-PICU mortality rate during P4 and P5 among medical patients (p < .001). The risk of death was 83% lower in patients that received EN for >50% of LOS (odds ratio, 0.17; confidence interval, 0.066–0.412; p = .000). Conclusions: The program motivated an increase in EN and a decrease in PN use, mainly after implementation of NST and reduced in-PICU mortality rate.

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