Pediatric Critical Care Nutrition

PEDIATRIC CRITICAL CARE NUTRITION

** Pediatric International Nutrition Study (PINS) 3! **

A worldwide effort

The data collection period has ended - analyses and production of site reports are underway.

Please contact the Project Leader with any inquiries about PINS 3.

We have enrolled over 70 sites and nearly 2000 patients!

Special thanks to all of the PINS 3 participating sites!

Lori J. Bechard, PhD, RD, Project Leader

lori.bechard@childrens.harvard.edu

Nilesh M. Mehta, MD, Principal Investigator

nilesh.mehta@childrens.harvard.edu

Pediatric Critical Care Nutrition Program @ Boston Children's Hospital

Bader 634, 300 Longwood Avenue

Boston, MA 02115

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Welcome to the Pediatric Critical Care Nutrition website

This site is dedicated to the multidisciplinary teams promoting and supporting optimal nutrition therapy for children during critical illness We aim to initiate multicenter dialogue, bedside practice evaluations, systematic investigations and implementation of evidence-based therapies. On this home page, we introduce some of our initiatives and highlight our nutrition strategies in the PICU. The site also serves as a portal for our ongoing studies.

Dr. Mehta is the Principal Investigator of 2 large international studies of nutrient delivery in mechanically ventilated children, also known as the Pediatric International Nutrition Study (PINS). These studies have led to several publications in major journals and ongoing collaborative efforts around the world.

We hope that you will find this information useful. Please feel free to send us comments, suggestions or questions at the email addresses below.

1st international study of Nutrition Therapy in the PICU - PubMed link: Crit Care Med. 2012 Jul;40(7):2204-11

The international studies in mechanically ventilated children (2009 and 2011) now include a total of over 1700 subjects. This is the largest pediatric database of prospective nutrient intake, clinical and outcome data. the results of the 1st international study highlighted the association between macronutrient intake adequacy and mortality. With the combined dataset, we expect further elucidation of optimal nutrition delivery, adjunvt therapies and their relationship with clinical outcomes in critically ill children.

2^nd Pediatric International Nutrition Study - Pubmed link: A m J Clin Nutr 2015;102:199-206

Data entry was completed on Jan 31st 2012. Over 60 sites completed data collection with more than 1200 subjects enroled. The study is now closed. Participating pediatric ICUs received (Nov-Dec 2012) a benchmarked, individualized site-report, which will allow comparison of practice at each center with the rest of the international cohort. Please review the report and consider ways to disseminate the observations among key stake holders, and identify areas in which your site practice could be further improved. We will be happy to help or suggest ways in which previous sites have utilized these reports. We are extremely grateful for your overwhelming participation and are positive that this collaborative effort will significantly help enhance the quality of bedside nutrition therapy in our PICUs.

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Recent studies from our Program:

1. International studies 2009 and 2011 - >1700 mechanically ventilated children recruited from 61 PICUs across the world. (Pubmed abstract links for publications; 1, 2, 3.)

2. Isotope studies to elucidate whole body protein kinetics and seletal muscle breakdown - ongoing.

3. Body composition in children with intestinal failure - DXA, isotope dilution and BIA - (Pubmed Abstract)

4. Indirect Calorimetry - innovation for subjects on noninvasive ventilation (PubMed Abstract)

5. Indirect calorimetry - comparing gas sampling techniques - completed (PubMed abstract).

6. Metabolic monitoring - practical aspects and clincal role in the PICU. (Pubmed Abstract)

7. Nutritional interventions in home ventilated patients - completed. (Please see links to Pubmed Abstract #1 and Pubmed Abstract #2)

RECENT PUBLICATIONS from our group

Fullerton BS, Sparks EA, Khan FA, Fisher JG, Anzaldi R, Scoville MR, Yu YM, Wagner DA, Jaksic T, Mehta NM. Whole body protein turnover and net protein balance after pediatric thoracic surgery: A noninvasive single-dose 15N glycine stable isotope protocol with end-product enrichment. J Parenter Enteral Nutr 2016 Nov 15 [Epub ahead of print].
Velazco CS, Zurakowski D, Fullerton BS, Bechard LJ, Jaksic T, Mehta NM. Nutrient delivery in mechanically ventilated surgical patients in the pediatric critical care unit. J Pediatr Surg. 2016 Oct 28 [Epub ahead of print].
Albert BD, Zurakowski D, Bechard LJ, Priebe GP, Duggan CP, Heyland DK, Mehta NM. Enteral nutrition and acid-suppressive therapy in the PICU: Impact on the risk of ventilator-associated pneumonia. Pediatr Crit Care Med. 2016 Oct;17(10):924-929.
Martinez EE, Mehta NM. The science and art of pediatric critical care nutrition. Curr Opin Crit Care. 2016 Aug;22(4):316-24.
Bechard LJ, Duggan C, Touger-Decker R, Parrott JS, Rothpletz-Puglia P, Byham-Gray L, Heyland D, Mehta NM. Nutritional status based on body mass index is associated with morbidity and mortality in mechanically ventilated critically ill children in the PICU. Crit Care Med. 2016 Aug;44(8):1530-7.
Mehta NM, Bechard LJ, Zurakowski D, Duggan CP, Heyland DK. Adequate enteral protein intake is inversely associated with 60-d mortality in critically ill children: a multicenter, prospective, cohort study. Am J Clin Nutr 2015 Jul;102(1):199-206.
Martinez EE, Ariagno K, Arriola A, Lara K, Mehta NM. Challenges to nutrition therapy in the pediatric critically ill obese patient. Nutr Clin Pract. 2015 Jun;30(3):432-9.
Hamilton S, McAleer DM, Ariagno K, Barrett M, Stenquist N, Duggan CP, Mehta NM. A stepwise enteral nutrition algorithm for critically ill children helps achieve nutrient delivery goals. Pediatr Crit Care Med. 2014 Sep;15(7):583-9.
Mehta NM, Corkins MR, Lyman B, Malone A, Goday PS, Carney LN, Monczka JL, Plogsted SW, Schwenk WF; American Society for Parenteral and Enteral Nutrition Board of Directors. Defining pediatric malnutrition: a paradigm shift toward etiology-related definitions. JPEN J Parenter Enteral Nutr. 2013 Jul;37(4):460-81.
Bechard LJ, Rothpletz-Puglia P, Touger-Decker R, Duggan C, Mehta NM. Influency of obesity on clinical outcomes in hospitalized children: a systematic review. JAMA Pediatr. 2013 May;167(5):476-82.
Mehta NM, Bechard LJ, Cahill N, Wang M, Day A, Duggan CP, Heyland DK. Nutritional practices and their relationship to clinical outcomes in critically ill children–an international multicenter cohort study. Crit Care Med. 2012 Jul;40(7):2204-11.
Smallwood C, Mehta NM. Accuracy of abbreviated indirect calorimetry protocols for energy expenditure measurement in critically ill children. JPEN J Parenter Enteral Nutr. 2012 Nov;36(6):693-699.
Mehta NM, Costello JM, Bechard LJ, Johnson VM, Zurakowski D, McGowan FX, Laussen PC, Duggan CP.Resting Energy Expenditure After Fontan Surgery in Children With Single-Ventricle Heart Defects. JPEN J Parenter Enteral Nutr. 2012 Nov;36(6):685-692.
Skillman HE, Mehta NM. Nutrition therapy in the critically ill child. Curr Opin Crit Care. 2012 Apr;18(2):192-8.
Bechard LJ, Parrott JS, Mehta NM. Systematic review of energy and protein intake on protein balance in critically ill children. J Pediatr. 2012 Aug;161(2):333-339.