The Science of Effective Pediatric Inpatient Nutrition 2005. Kevin M. Creamer M.D., FAAP Medical Director, PICU WRAMC Chief, Pediatric Nutrition Support Team. A hypothetical case .
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The Science of Effective Pediatric Inpatient Nutrition 2005
Kevin M. Creamer M.D., FAAP
Medical Director, PICU WRAMC
Chief, Pediatric Nutrition Support Team
The 5 W’s of Inpatient Nutrition
Why, Who, When, Where, What ?
Stechmiller JK, Am J Crit Care, 1997
Deitch EA, Ann Surg, 1987, 1990;Border JR, AnnSurg, 1987; Carrico CJ, Arch Surg, 1986; Alverdy JC, Surgery, 1988; Moore J, JPEN, 1991,Kudsk,Am J Surg, 2002
WHY ?Is nutrition such a big deal?
Nutrition Status and Outcomes
Gut Bacterial Translocation
Parsons, AJCN,1980; Mize, Nutr Supt Ser, 1984; Merritt, Am J Clin Nutr, 1979, Huddleston KC, CC Clin of NA, 1993, Cameron, Arch Ped 1995, Cooper, J Ped Surg 1981
Hendricks, Arch Ped Adol Med, 1995
Robinson G, JPEN, 1987
Low Prealbumin 95% specific, in 147 consecutive admissions
8 measures of malnutrition in 134 patients
50 cardiac surgery patients assessed
Potter, Clin Invest Med, 1999; Weinsier,Am J Clin Nut, 2005 Leite, Rev Paul Med, 1995
Nutrition Screen predictive of outcome in 25 RSV PICU admits
Mezoff, Pediatrics, 1996
Pollack MM, JPEN, 1985
Bassili HR, JPEN,1980
Gurgueira, JPEN, 2005
WHO ?Needs to know? Gets assessed?
Lasswell AB, J of Med Ed, 1984, Levine BS, Am J Clin Nut, 1993
Spain, JPEN, 1999
I wonder if I’m missing out on some critical piece of information
In your continuity clinic
Fleck, A. Br J Clin Pract, 1988
Chwals WJ, Surg Clin NA, 1992, Elhasid, Cancer, 1999, Erstad, Pharmaco, 1994
Expert roundtable, 10th World Congress of Gastroenterolgy
WHEN?Should I start?
Early Enteral vs Standard timing
Braga, CCM, 2001 Grahm T, Neurosurgery, 1989 Taylor, CCM 1999 Heyland DK, CC Clin of NA, 1998 Zaloga. CCM 1999
Chellis MJ, JPEN, 1996, Trocki, Burns, 1995
Ibraham, JPEN, 2002
WHERE? In the gut do I put the food?
Oral vs.Tube feeding
Gastric vs. Transpyloric feeds
Esparza, Intens C Med, 2001,Kortbeek, J Trauma, 1999, Heyland, CCM, 2001, Boivin, CCM, 2001
Lyons, JPEN, 2002
Pettignano, CCM, 1998
McClave SA, CCM, 1999,DeJonghe, CCM, 2001, Fry-Brower +McCunn, CCM(a), 2002,
WHAT?Amount of calories do I Feed Them?
How much to feed
Enteral vs. Parenteral
Leite, Rev Assoc Med Bras, 1996
Krishnan, Chest, 2003
Omura, Ann Surg, 2000, Okada, J Ped Surg, Robinson,CCM, 2004
Trophic feeds are stress ulcer and antibiotic prophylaxis rolled into one
Marik, CCM(a), 2002
McClure RJ, Arch Dis child , 2000
Schroeder D, JPEN, 1991, Hadfield R, Am J Resp Crit Care Med, 1995 Robert Dimand, UC Davis, Peds CC Update 2002, Gramlich, Nutrition, 2004
Heyland DK, JAMA, 1999, Simpson, Int Care Med, 2005, Doig, CCM(A) 2005
“The major advance in TPN since the
1980’s is that it is not used as much”
Bresson, Am J Clin Nut 1991,Tilden, AJDC, 1989, Schears, Crit Care Clin, 1997
Age appropriate weight gain
Diarrhea / Constipation
Emesis / Aspiration
Proper wound healing
Fluid and electrolyte balance
Improved N2 balance and Prealbumin