An evaluation of nutritional support given to critically ill children admitted to paediatric wards and the intensive care unit at Kenyatta National Hospital

Abstract

Nutritional support of critically ill patients has been found to improve nutritional outcomes. This support aims to correct the pre-existing nutritional deficits and supply substrae for the various phases of the meLbolic response to critical illness. Early enteral feeding has been found to be well tolerated in this population of patients, iIustrating a highly feasible accessible option especially for resource 6mited settings. provision of optimal nutritional support has challenges, some of which are avoidable interruptions. Identification of these facilitates improvement in nutrient delivery which may impact positively on clinical outcomes.

Objectives This study evaluates the prescription and delivery of caloric support in critically ill paediatric patients at Kenyatta National Hospital and describes factors associated with lack of optimal delivery of prescribed feeds.

Methods A short longitudinal study of patients aged 28 days to 12years, admitted to the paediatric wards and the intensive care unit at Kenyatta National Hospital was carried out Critically ill patients, 24hours - post admission, without severe malnutrition ~ included. Their caloric requirements and caloric values of their prescribed and delivered nutrients were determined. The mail outcome measure was the percentage of patients receiving adequate nutritional support. The association between various factors and inadequate nutritional support was determined.

Results 150 critically ill children were recruited. Majority had normal Weight for Height Z scores at recruitrnent.A kltal of 37 (24.7%) of the patients did not have a nutritional prescription throughout the entire period they were in the study. A total of 21 (18.6%) out of the 113 children with a prescription had an average daily calorie prescription that was inadequate. Overall, 34 (35%) of caloric intake reported by guardians was inadequae compared to 44 (47.3%) of intake recorded on feeding charts. Involvement of guardians in feeding was significantly associated with adequate caloric intake.

Conclusions Nubitional support of critically ill paediatric patients in KNH is inadequate. Appropriate nutritional prescriptions and involvement of guardians in feedilg of critically ill children where feasible improves the nutritional support.