Energy goal documentation and early initiation of enteral nutrition in critically ill children: A retrospective evaluation of a quality improvement project

BACKGROUND: Early documentation of energy goals has been associated with better nutrition outcomes. We performed a successful project improving the rate of early documentation of energy goals from 30% to 97%. We then conducted a retrospective study of children admitted to the pediatric intensive care unit (PICU) the year before and after intervention to determine whether we improved initiation and delivery of nutrition. MATERIALS AND METHODS: We identified patients with PICU length of stay (LOS) of at least 48 h from Virtual Pediatrics Systems, LLC (VPS) from May 2020 to April 2022. We obtained clinical, demographic, and nutrition data for the first 96 h of admission from the electronic medical record and VPS. We defined early enteral nutrition (EEN) as delivery of 25% of goal calories within 48 h of admission. We analyzed data using Mann-Whitney test for continuous variables and chi-square test for categorical variables and multivariable regression analyses. RESULTS: A total of 1510 patients were included (702 preintervention, 808 postintervention). Median ICU LOS (4.05 vs 3.64 days; P = 0.030) and hospital LOS (8.25 vs 6.99 days; P = 0.009) were significantly reduced. EEN was significantly more likely to be initiated in the postintervention group than in the preintervention group (P < 0.0001), adjusted for age, sex, race, ethnicity, Pediatric Index of Mortality 3 (PIM3) score, and documentation of energy goal. CONCLUSION: Energy goal documentation improved EEN initiation and demonstrated shorter LOS in multivariable analysis. Findings highlight need for standardized documentation, greater dietitian involvement, and further study of how nutrition planning affects outcomes in critically ill children.