Pediatric Critical Care Nutrition
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.