Bridget Little 

Paediatric Dietitian, Starship Child Health, Auckland, NZ

Bridget is the lead dietitian working in the Starship Paediatric Intensive Care Unit.  Her areas of specialty include paediatric critical care, intravenous nutrition and the management of feeding difficulties in children.  Bridget began working as a dietitian in 2001. She has had a diverse clinical career, which includes work in the Northland community and a Dietitian Team Leader role at Waitemata DHB, but her passion lies in the field of paediatric dietetics, where she has been working since 2007.  Bridget’s clinical practice at Starship is both challenging and rewarding. She enjoys the diversity of patient care in the ICU setting.

How to Feed Kids in ICU 

Children, especially infants, in the paediatric intensive care unit are at high risk for developing nutritional deficiencies, yet adequate nutrition is critical to patient outcomes.¹    The stress response to critical illness results in the catabolism of protein and muscle tissue.  Compared to adults, critically ill children have an increased risk of malnutrition due to generally lower body fat and muscle mass stores and a higher calorie per kilogram resting energy expenditure.  Both malnutrition and overfeeding can have deleterious consequences including increases in ventilatory requirements, risk of hospital-acquired infection, length of stay and mortality.²  However, accurately determining the energy and nutritional requirements of sick children is difficult.³  The 2017 SCCM-ASPEN guidelines support earlier research recommending Schofield or FAO/WHO/UN equations without the addition of stress factors.²  Protein is emphasised as essential to recovery and a minimum intake of 1.5g/kg/day is advocated.²  Achievement of nutritional goals may be compromised by delayed feeding, fluid restrictions, interruptions to feeds and feed intolerance. Therefore, precise feed modification and fortification is often required.  Nutrition algorithms can guide appropriate initiation of enteral feeding.  A dedicated intensive care dietitian can facilitate early and optimal nutritional management of critically ill children.^2,4

1. Mehta NM, Duggan CP. Nutritional deficiencies during critical illness. Pediatr Clin North Am. 2009; 56(5):1143-1160

2.  Mehta NM, Skillman HE, Irving SY et al.  Guidelines for the provision and assessment of nutrition support therapy in the pediatric critically ill patient: Society of Critical Care Medicine and American Society for Parenteral and Enteral Nutrition. JPEN. 2017; 41:706-742

3. Lambe C, Hubert P, Jouvet P et al. A nutritional support team in the paediatric intensive care unit: Changes and factors impeding appropriate nutrition. Clin Nutr. 2007; 26(3):355-363

4. Mehta NM, Bechard LJ, Zurakowski D et al.  Adequate enteral protein intake is inversely associated with 60-d mortality in critically ill children: A multicentre, prospective cohort study. Am J Clin Nutr. 2015; 102(1):199-206