Intensive Care Medicine

, Volume 30, Issue 9, pp 1807–1813 | Cite as

Nutritional support in 111 pediatric intensive care units: a European survey

  • Martijn van der Kuip
  • Michiel J. S. Oosterveld
  • Marian A. E. van Bokhorst–de van der Schueren
  • K. de Meer
  • Harry N. Lafeber
  • Reinoud J. B. J. GemkeEmail author
Neonatal and Pediatric Intensive Care



To study current strategies in nutritional management of pediatric intensive care units (PICUs) in Europe, focusing on energy requirements.

Design and setting

Survey by a 35-item questionnaire sent to representatives of 242 PICUs in 28 countries. Addresses were obtained from national PICU associations and the members’ list of the European Society of Pediatric and Neonatal Intensive Care.


Staff members of 111 European PICUs (46%) from 24 countries.

Measurements and results

Predominantly physicians were reported to be responsible for nutritional support. In 73% of PICUs a multidisciplinary nutritional team was available. In most PICUs daily energy requirements were estimated using weight, age, predictive equations and correction factors. In 17% of PICUs energy expenditure was regularly measured by indirect calorimetry. Nutritional status was mostly assessed by weight, physical examination, and a wide range of biochemical blood parameters. Approximately 70% of PICUs used dedicated software for nutritional support. A similar percentage of PICUs regarded “nutrition” as a research topic and part of the residents’ training program.


Most European PICUs regard nutritional support as an important aspect of patient care, as shown by the presence of nutritional teams, software, research, and education. However, energy requirements of pediatric intensive care patient were based predominantly on estimations rather than on measurements.


Pediatric intensive care Nutritional support Nutritional management Energy expenditure Nutritional status 



We thank the European Society of Pediatric and Neonatal Intensive Care for providing their membership database, and all physicians who participated in our survey. We thank Hanneke Schaapherder for compiling the SPSS database of all responses.


  1. 1.
    Pollack MM, Wiley JS, Holbrook PR (1981) Early nutritional depletion in critically ill children. Crit Care Med 9:580–583PubMedGoogle Scholar
  2. 2.
    Coss-Bu JA, Jefferson LS, Walding D, David Y, Smith EO, Klish WJ (1998) Resting energy expenditure in children in a pediatric intensive care unit: comparison of Harris-Benedict and Talbot predictions with indirect calorimetry values. Am J Clin Nutr 67:74–80PubMedGoogle Scholar
  3. 3.
    Briassoulis G, Zavras N, Hatzis T (2001) Malnutrition, nutritional indices, and early enteral feeding in critically ill children. Nutrition 17:548–557CrossRefPubMedGoogle Scholar
  4. 4.
    Taylor RM, Preedy VR, Baker AJ, Grimble G (2003) Nutritional support in critically ill children. Clin Nutr 22:365–369CrossRefPubMedGoogle Scholar
  5. 5.
    Pollack MM, Ruttimann UE, Wiley JS (1985) Nutritional depletions in critically ill children: associations with physiologic instability and increased quantity of care. JPEN J Parenter Enteral Nutr 9:309–313PubMedGoogle Scholar
  6. 6.
    van Bokhorst-de van der Schueren MA, van Leeuwen PA, Kuik DJ, Klop WM, Sauerwein HP, Snow GB, Quak JJ (1999) The impact of nutritional status on the prognoses of patients with advanced head and neck cancer. Cancer 86:519–527CrossRefPubMedGoogle Scholar
  7. 7.
    Border JR, Hassett J, LaDuca J, Seibel R, Steinberg S, Mills B, Losi P, Border D (1987) The gut origin septic states in blunt multiple trauma (ISS=40) in the ICU. Ann Surg 206:427–448PubMedGoogle Scholar
  8. 8.
    Chwals WJ (1994) Overfeeding the critically ill child: fact or fantasy? New Horiz 2:147–155PubMedGoogle Scholar
  9. 9.
    Verhoeven JJ, Hazelzet JA, van der Voort E, Joosten KF (1998) Comparison of measured and predicted energy expenditure in mechanically ventilated children. Intensive Care Med 24:464–468PubMedGoogle Scholar
  10. 10.
    Taylor RM, Cheeseman P, Preedy V, Baker AJ, Grimble G (2003) Can energy expenditure be predicted in critically ill children? Pediatr Crit Care Med 4:176–180CrossRefPubMedGoogle Scholar
  11. 11.
    Vazquez Martinez JL, Martinez-Romillo PD, Diez SJ, Ruza TF (2004) Predicted versus measured energy expenditure by continuous, online indirect calorimetry in ventilated, critically ill children during the early postinjury period. Pediatr Crit Care Med 5:19–27CrossRefPubMedGoogle Scholar
  12. 12.
    Seashore JH (1984) Nutritional support of children in the intensive care unit. Yale J Biol Med 57:111–134PubMedGoogle Scholar
  13. 13.
    Schofield WN (1985) Predicting basal metabolic rate, new standards and review of previous work. Hum Nutr Clin Nutr 39 [Suppl 1]:5–41Google Scholar
  14. 14.
    Fleisch A (1951) Le metabolisme basal standard et se determination au moyen du “Metabocalculator.” Helv Med Acta 23–45Google Scholar
  15. 15.
    Harris JA, Benedict FG (1919) A biometric study of basic metabolism in man. Publ no 297. Carnegie Institute, WashingtonGoogle Scholar
  16. 16.
    Talbot FB (1938) Basal metabolism standard for children. Am J Dis Child 55:455–459Google Scholar
  17. 17.
    FAO/WHO/UNU (1985) Energy and protein requirements. In: WHO technical report series 724. World Health Organization, GenevaGoogle Scholar
  18. 18.
    White MS, Shepherd RW, McEniery JA (2000) Energy expenditure in 100 ventilated, critically ill children: improving the accuracy of predictive equations. Crit Care Med 28:2307–2312PubMedGoogle Scholar
  19. 19.
    Briassoulis G, Venkataraman S, Thompson AE (2000) Energy expenditure in critically ill children. Crit Care Med 28:1166–1172Google Scholar
  20. 20.
    Merritt RJ, Suskind RM (1979) Nutritional survey of hospitalized pediatric patients. Am J Clin Nutr 32:1320–1325PubMedGoogle Scholar
  21. 21.
    Preiser JC, Berre J, Carpentier Y, Jolliet P, Pichard C, Van Gossum A, Vincent JL (1999) Management of nutrition in European intensive care units: results of a questionnaire. Working Group on Metabolism and Nutrition of the European Society of Intensive Care Medicine. Intensive Care Med 25:95–101CrossRefPubMedGoogle Scholar
  22. 22.
    McMahon SR, Iwamoto M, Massoudi MS, Yusuf HR, Stevenson JM, David F, Chu SY, Pickering LK (2003) Comparison of e-mail, fax, and postal surveys of pediatricians. Pediatrics 111:e299–e303PubMedGoogle Scholar
  23. 23.
    Rogers EJ, Gilbertson HR, Heine RG, Henning R (2003) Barriers to adequate nutrition in critically ill children. Nutrition 19:865–868PubMedGoogle Scholar
  24. 24.
    Kuip M van der, Hoos MB, Forget PP, Westerterp KR, Gemke RJ, de Meer K (2003) Energy expenditure in infants with congenital heart disease, including a meta-analysis. Acta Paediatr 92:921–927CrossRefPubMedGoogle Scholar
  25. 25.
    Mayes T, Gottschlich MM, Khoury J, Warden GD (1996) Evaluation of predicted and measured energy requirements in burned children. J Am Diet Assoc 96:24–29CrossRefPubMedGoogle Scholar
  26. 26.
    Phillips R, Ott L, Young B, Walsh J (1987) Nutritional support and measured energy expenditure of the child and adolescent with head injury. J Neurosurg 67:846–851PubMedGoogle Scholar
  27. 27.
    Turi RA, Petros AJ, Eaton S, Fasoli L, Powis M, Basu R, Spitz L, Pierro A (2001) Energy metabolism of infants and children with systemic inflammatory response syndrome and sepsis. Ann Surg 233:581–587CrossRefPubMedGoogle Scholar
  28. 28.
    Taylor RM, Cheeseman P, Preedy V, Baker AJ, Grimble G (2003) Can energy expenditure be predicted in critically ill children? Pediatr Crit Care Med 4:176–180CrossRefPubMedGoogle Scholar
  29. 29.
    Vernon DD, Witte MK (2000) Effect of neuromuscular blockade on oxygen consumption and energy expenditure in sedated, mechanically ventilated children. Crit Care Med 28:1569–1571CrossRefPubMedGoogle Scholar
  30. 30.
    Petros S, Engelmann L (2001) Validity of an abbreviated indirect calorimetry protocol for measurement of resting energy expenditure in mechanically ventilated and spontaneously breathing critically ill patients. Intensive Care Med 27:1164–1168CrossRefGoogle Scholar
  31. 31.
    Frankenfield DC, Sarson GY, Blosser SA, Cooney RN, Smith JS (1996) Validation of a 5-minute steady state indirect calorimetry protocol for resting energy expenditure in critically ill patients. J Am Coll Nutr 15:397–402PubMedGoogle Scholar
  32. 32.
    Joosten KF, Verhoeven JJ, Hop WC, Hazelzet JA (1999) Indirect calorimetry in mechanically ventilated infants and children: accuracy of total daily energy expenditure with 2 hour measurements. Clin Nutr 18:149–152PubMedGoogle Scholar
  33. 33.
    Klerk G de, Hop WC, de Hoog M, Joosten KF (2002) Serial measurements of energy expenditure in critically ill children: useful in optimizing nutritional therapy? Intensive Care Med 28:1781–1785CrossRefPubMedGoogle Scholar
  34. 34.
    Witte MK (1996) Metabolic measurements during mechanical ventilation in the pediatric intensive care unit. Respir Care Clin N Am 2:573–586PubMedGoogle Scholar
  35. 35.
    Kuip M van der, de Meer K, Oosterveld MJ, Lafeber HN, Gemke RJ (2004) Simple and accurate assessment of energy expenditure in ventilated paediatric intensive care patients. Clin Nutr 24 (in press)Google Scholar
  36. 36.
    Wells JC, Mok Q, Johnson AW, Lanigan JA, Fewtrell MS (2002) Energy requirements and body composition in stable pediatric intensive care patients receiving ventilatory support. Food Nutr Bull 23:95–98Google Scholar
  37. 37.
    Ellis KJ (2000) Human body composition: in vivo methods. Physiol Rev 80:649–680PubMedGoogle Scholar
  38. 38.
    Butte NF, Moon JK, Wong WW, Hopkinson JM, Smith EO (1995) Energy requirements from infancy to adulthood. Am J Clin Nutr 62:1047S–1052SPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2004

Authors and Affiliations

  • Martijn van der Kuip
    • 1
  • Michiel J. S. Oosterveld
    • 1
  • Marian A. E. van Bokhorst–de van der Schueren
    • 2
  • K. de Meer
    • 1
  • Harry N. Lafeber
    • 1
  • Reinoud J. B. J. Gemke
    • 1
    Email author
  1. 1.Department of PediatricsVU University Medical CenterAmsterdamThe Netherlands
  2. 2.Department of Nutrition and DieteticsVU University Medical CenterAmsterdamThe Netherlands

Personalised recommendations