Pediatric Critical Care Nutrition Program

The Pediatric Critical Care Nutrition Program at Boston Children's Hospital consists of dietitians, clinical nutrition specialists, pharmacists, nurses, and physicians, all working together to advance the nutritional health of children with critical illness.

We conduct clinical trials, evaluate practice standards, and examine existing evidence in order to develop the best possible nutrition therapies for your child.

Dr. Mehta is the principal investigator of two large international studies of nutrient delivery in mechanically ventilated children. The results of the first study have now been published. (Crit Care Med. 2012 Jul;40(7):2204-11)

The second international study of nutrition practice in mechanically ventilated children started May 11, 2011. We had a large number of returning and new sites this year. Data entry was completed on Jan. 31, 2012. More than 60 sites completed data collection with more than 1,200 subjects enrolled. The study is now closed for data entry. Data cleaning is complete. Participating pediatric ICUs will soon receive a bench-marked, individualized site-report, which will allow comparison of practice at each center with the rest of the international cohort.

The second international study of nutrition practice in mechanically ventilated children started May 11, 2011. We had a large number of returning and new sites this year. Data entry was completed Jan. 31, 2012. Over 60 sites completed data collection with more than 1,200 subjects enrolled.

The study is now closed for data entry and data cleaning is complete. Participating pediatric ICUs received a benchmarked, individualized site report in December 2012, which allowed comparison of practice at each center with the rest of the international cohort. Please review the report and consider ways to disseminate the observations among key stake holders, and identify areas in which your site practice could be further improved. We will be happy to help or suggest ways in which previous sites have utilized these reports. We are extremely grateful for your overwhelming participation and are positive that this collaborative effort will significantly help enhance the quality of bedside nutrition therapy in our PICUs.

1. Mehta NM, Bechard LJ, Cahill N, Wang M, Day A, Duggan CP, Heyland DK. Nutritional practices and their relationship to clinical outcomes in critically ill children–an international multicenter cohort study. Crit Care Med. 2012 Jul;40(7):2204-11.
2. Smallwood C, Mehta NM. Accuracy of abbreviated indirect calorimetry protocols for energy expenditure measurement in critically ill children. JPEN J Parenter Enteral Nutr. 2012 Nov;36(6):693-699.
3. Mehta NM, Costello JM, Bechard LJ, Johnson VM, Zurakowski D, McGowan FX, Laussen PC, Duggan CP.Resting Energy Expenditure After Fontan Surgery in Children With Single-Ventricle Heart Defects. JPEN J Parenter Enteral Nutr. 2012 Nov;36(6):685-692
4. Skillman HE, Mehta NM. Nutrition therapy in the critically ill child. Curr Opin Crit Care. 2012 Apr;18(2):192-8.
5. Bechard LJ, Parrott JS, Mehta NM. Systematic review of energy and protein intake on protein balance in critically ill children. J Pediatr. 2012 Aug;161(2):333-339.
6. Bechard LJ, Feldman HA, Venick R, Gura K, Gordon CM, Sonis A, Mehta NM, Guinan EC, Duggan C. Attenuation of resting energy expenditure following hematopoietic stem cell transplantation in children. Bone Marrow Transplant. 2012 Feb 20. doi: 10.1038/bmt.2012.19. [Epub].
7. Mehta NM. The Goldilocks conundrum for optimal macronutrient delivery in the PICU – too much, too little or just right? JPEN (in press).
8. Bechard LJ, Feldman HA, Venick R, Gura K, Gordon C, Sonis A, Mehta N, Guinan EC, Duggan C. Attenuation of resting energy expenditure following hematopoietic SCT in children. Bone Marrow Transplant 2012 Oct;47(10):1301-1306.

Metabolic state after cardiopulmonary bypass in infants following Fontan surgery

Mehta, Costello, Bechard, Laussen, Duggan
This study is aimed at assessing the feasibility of continuous measurements of resting energy expenditure and determining the metabolic profile of infants during the critical early post-operative period.

Body composition and serial intestinal adaptation in children with short bowel syndrome (SBS)

Mehta, Raphael, Jaksic, Duggan
The aim of this study is to serially measure lean body mass and fat mass changes in children with SBS, using bioelectric impedance, DXA scanning and isotope dilution techniques and to examine the impact of serial energy balance and absorptive function on changes in lean body mass in children with SBS.

Challenges to enteral nutrient delivery in critically ill children due to avoidable barriers in the PICU

Mehta, Hamilton, Leavitt, McAleer, Mitchell, Duggan
This multidisciplinary study was conducted with an aim to describe nutrient intake in critically ill children, to identify risk factors associated with avoidable interruptions to enteral nutrition (EN) and to highlight opportunities to improve enteral nutrient delivery in a busy tertiary pediatric intensive care unit (PICU).

Multidisciplinary and multistep intervention to enhance nutrient delivery at the bedside in critically ill children

Mehta, Hamilton, McAleer, Kleinman, Duggan
We have designed a multipronged nutritional intervention for physicians and nurses that addresses deficiencies highlighted in Phase 1 study (now completed) - a) time of initiation of EN after PICU admission, b) nutritional assessment and establishing caloric goal for individual patients, c) preventing avoidable interruptions to EN, d) assisting bedside EN delivery using evidence and consensus-based guidelines. We hypothesize that such a multipronged, stepwise approach to systemic deficiencies / barriers to EN delivery in the PICU will decrease PN utilization and costs, decrease CVL utilization, decrease length of PICU stay and potentially impact on the incidence of infectious complications in critically ill children.

Targeted Indirect Calorimetry (IC) in Critically Ill Children – Impact On Nutrition Delivery At The Bedside

Mehta, Bechard, Leavitt, Duggan
Accurate prediction of energy requirements is difficult in children with metabolic instability, and the likelihood of cumulative energy imbalance is high. We have described a model of targeted IC in selected critically ill children who are at high risk of metabolic derangements. We are now examining the bedside impact of such an approach in terms of influencing nutrient intake and its role in avoiding large energy imbalances during the PICU stay.

Nutrition Support in Pediatric Stem Cell Transplantation – A Randomized, Controlled Trial

Bechard, Gordon, Gura, Feldman, Guinan, Duggan
We aim to compare the effects of titrating parenteral nutrition (PN) to measured energy expenditure on body composition, glycemic control, and infectious complications in children undergoing hematopoetic stem cell transplantation. Subjects will be randomized to receive standard PN vs. PN titrated to resting energy expenditure (by indirect calorimetry). We hypothesize that children receiving PN closely matched to energy expenditure will have improved outcomes.