Résumé
Nutrition in the pediatric intensive care unit (PICU) is a therapy. It represents a challenge due to the lack of standardization of practices, the complexity of its day-to-day assessment, and the variability of physiological determinants. Nutrition guidelines recommend that early enteral nutrition be introduced within the first 48 hours, followed by a gradual increase to achieve nutritional objectives within 5 days. Objective: this study aimed to explore nutritional practices in our polyvalent PICU on a selected population of children over 10kg intubated for more than 48 hours (population eligible for the calorimeter used), and to assess the difficulties in introducing appropriate early enteral nutrition. Methods: this retrospective cohort study was conducted between January 2016 and December 2023. The nutritional data was collected during the intubation period with a maximum of 7 days. The success of enteral nutrition will be assessed on nutritional thresholds reached on day 2 and day 3.Results: 146 patients were included (60 girls, 86 boys) with a median age of 7.5 years. The thresholds found for caloric intakes predicted by the Schofield equation on day 2 to discriminate patients with 100% of predicted caloric enteral intakes on day 5 was 60%, and 100% on day 3. Determinants associated with enteral feeding difficulties were high lactates (OR [95%CI]=1.42 [1.04; 1.95]; p=0.03), and a blood transfusion used (OR [95%CI]=2.89 [1.14; 7.33]; p=0.03) at day 2 ; and a high PELOD II score (OR [95%CI]=1.12 [1.00; 1.26]; p=0.06) and the presence of tunneled catheters (OR [95%CI]=8.87 [1.24; 63.41]; p=0.03) at day 3. A low Glasgow score was protector(OR [95%CI]=0.89 [0.8; 0.98]; p=0.02) at day 2, and the use of plasmapheresis or immunoadsorption (OR [95%CI]=0.10 [0.01; 0.69]; p=0.02) and a low PICU length of stay (OR [95%CI]=0.98 [0.95; 0.99]; p=0.03) at day 3. Conclusion: this study showed that nutritional recommendations are more difficult to follow for more severe patients: high PELOD 2 score, blood transfusions, chronic diseases (tunneled catheters), use of vasopressors, and patients with cardiac pathology. This contrasted with patients with a neurological or respiratory reason for admission. This study highlighted the need to individualize the nutritional management of PICU patients using indirect calorimetry.