It is well established that optimal nutrition in the pediatric intensive care unit (PICU) plays an important role in sustaining organ function; preventing further dysfunction of the cardiovascular, respiratory, and immune systems; and improving patient outcomes.1,2 Good knowledge about nutritional issues is essential for PICU nurses to enable them to effectively contribute to the multidisciplinary team management of critically ill children. The nurse's role entails assessment and problem identification, planning, delivery, and evaluation.3 The nursing considerations for nutritional support will be discussed in this chapter within these key areas of nursing practice. This chapter will focus on the role of the nursing staff in providing nutritional support and will be supported by best evidence, where available.
NUTRITION SCREENING AND ASSESSMENT
Nutrition screening should be undertaken at the time of admission or within the first 24 hours of admission. Each PICU should have a defined mechanism for having nutrition screening accomplished within this time frame. This screen should identify children who are malnourished or are at risk of malnutrition. No screen has been specifically validated in the PICU, but several pediatric screens are available. Please see chapter 2 for more details on nutrition assessment. Nursing staff must play an important role in nutrition screening. Anthropometric assessments documented on admission by a trained nurse provide crucial information on the nutritional status. Furthermore, the involvement of nursing staff will facilitate safe conduct of anthropometric measurements in critically ill children.
Assessment of the individual child is a fundamental step in planning care delivery. Each child will have a different underlying injury or illness that has resulted in admission to the PICU and will be at a different stage of physiological maturity; as a result, each child can be expected to have different nutritional requirements and respond differently to nutritional support. A baseline assessment should be undertaken for all children in intensive care at the start of the nurse's shift. First, the pathology or injury that has caused the child's critical care unit admission is fundamental for the nurse to consider. Certain diagnoses may contraindicate enteral feeding, such as necrotizing entercolitis (NEC), abdominal trauma, or surgery on an acute abdomen; other conditions or therapies are considered to present a high risk for NEC and gut ischemia in neonates, such as coarctation of the aorta (CoA), hypoplastic left heart syndrome (HLHS), having an umbilical artery line, and being on a prostaglandin infusion.4-8 The pathology may also affect the child's predicted energy requirements (e.g., sepsis, burns, or severe traumatic brain injury); thus, it is essential that the nurse considers the pathology and child's reason for PICU admission, as well as the time point at which the child is currently in the illness/injury timeline. The risk of aspiration, and therefore the safety of commencing enteral feeding, must be considered. Factors known to increase the risk of ...