Assessment, Intervention, and Monitoring: Stepwise Nutritional Management in Pediatric Intensive Care Units: A Short Review

Previous studies have indicated that 24 - 53% of children admitted to pediatric intensive care units (PICUs) suffer from acute or chronic malnutrition at admission. Furthermore, a large number of them undergo deterioration in nutritional status during hospitalization. Critically ill children are at an increased risk of malnutrition because of altered metabolism, and baseline nutritional assessment helps identify those patients at risk of developing malnutrition or further nutritional deterioration. This leads to an early nutritional intervention, which is the ultimate goal of nutrition support therapy. This review was conducted to describe three main steps of nutritional management (baseline nutritional assessment, nutritional intervention, and monitoring) in PICU admitted patients and discuss the importance and considerations of each step. According to the fact that early and proper nutritional support is seriously important in intensive care medicine, considering a stepwise approach toward nutrition management in pediatric intensive care units might be so useful. The assessment of nutritional status, identifying patients at risk of further nutritional deterioration, accurate measurement of energy and nutrient need for each patient, initiating nutrition support based on the nutrition support team (NST)-approved protocols, and regular assessment of anthropometry and nutritional parameters during the admission period are the stepwise phases of nutritional management in PICU patients. Following these steps might reduce the number of PICU patients who deteriorate mainly due to the poor or late nutritional support.