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Nilesh  Mehta, MD

Nilesh Mehta
Department:
Department of Anesthesiology, Perioperative and Pain Medicine Research
Division
Critical Care Medicine Research
Hospital Title:
Director, Critical Care Nutrition, Associate Medical Director, MSICU, Director of Quality and Outcomes
Academic Title:
Associate Professor in Anaesthesia, Harvard Medical School
Research Focus Area:
Nutritional and Metabolic Aspects of Critical Illness in Children
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Dr. Mehta has a keen interest in optimal nutrition therapy and its impact on outcomes in critically ill children. His scholarly pursuits have focused on describing the metabolic response to stress, energy and protein metabolism, changes in body composition and strategies to optimize nutrient intake in children with critical illness, injury and following surgery.

Research Overview

The central focus of my work is to research and implement optimal nutrition therapies in critically ill children, with the overall goal of improving clinically relevant outcomes. I have led multidisciplinary investigations to systematically address knowledge and evidence gaps in the field of critical care nutrition and metabolism. I have authored over 75 original scientific publications in a variety of leading journals, and my manuscripts have been cited over 1300 times in the literature; with an h-index of 17 and i10-index of 27. In 2007 I established the Critical Care Nutrition Program at Boston Children's Hospital. Our multidisciplinary research team has made a number of original observations. These include; i) prevalence of both underfeeding and overfeeding (calories) in the intensive care unit, ii) role of targeted indirect calorimetry to guide optimal energy intake, iii) alarming level of inadequacy of protein intake in critically ill infants and children worldwide; iv) unintended cumulative deficits of protein and muscle loss; v) protein requirement during critical illness; vi) tools to examine of protein flux, metabolism, balance and the lean body mass; vii) bedside body composition measurement; and viii) best-practice algorithms for bedside nutrient delivery. We have recently demonstrated the impact of individualized diet (optimized energy and protein intake based on measured energy expenditure and protein requirements) in chronically ventilated children. I have completed 2 large international studies of nutrient intake in over 1700 mechanically ventilated children from 66 PICUs (from over 12 countries), and demonstrated significant associations between nutrient delivery and outcomes such as mortality and acquired infections. These studies have helped establish a platform for future multicenter intervention trials.

As the principal investigator, I have extensive past experience with and am currently utilizing stable isotopes to study protein catabolism after thoracic surgery; and body composition in patients with intestinal failure and spinal muscular atrophy. In collaboration with molecular biologists at the Forsyth institute, we have described the aerodigestive microbiome using 16S rRNA arrays, in mechanically ventilated children. I have received awards for outstanding research contributions from leading organizations including the World Federation of Pediatric and Intensive Care Societies (WFPICCS), the Society of Critical Care Medicine (SCCM) and the American Society of Critical Care Anesthesiologists (ASCCA). In 2014, I received the highest research honor for mid-career investigators, "The Stanley Dudrick Research Scholar Award" from the American Society of Parenteral and Enteral Nutrition (ASPEN). I currently serve on the Board of ASPEN as the Vice President.

Awards

Young Investigator Award, presented by the American Society of Critical Care Anesthesiologists for Outstanding Investigative Research. "Pharmacokinetic considerations during extracorporeal membrane oxygenation". ASCCA 2006 annual meeting, Chicago, IL.

Key Publications

Mehta N, Bechard L Leavitt K, Duggan C. Cumulative energy imbalance in the pediatric intensive care unit: role of targeted indirect calorimetry. JPEN J Parenter Enteral Nutr. 2009 May-Jun;33(3):336-44. PMCID:PMC3217840

Mehta N, Compher C and the Board of Directors. A.S.P.E.N. Clinical Guidelines: Nutrition support of the critically ill child. JPEN 2009 May-Jun;33(3):260-76. PMID:19398612

Mehta NM, McAleer D, Hamilton S, Naples E, Leavitt K, Mitchell P, Duggan C. Challenges to optimal enteral nutrition in a multidisciplinary pediatric intensive care unit. JPEN J Parenter Enteral Nutr. 2010 Jan-Feb;34(1):38-45. PMID:19903872

Mehta N, Bechard L, Ariagno K, Dolan M, Jiang H, Duggan C. Energy imbalance and the risk of overfeeding in critically ill children. Pediatr Crit Care Med. 2011:12(4):398-405. PMID:20975614

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. PMID:22564954

Bechard LJ, Parrott JS, Mehta NM. Systematic review of the influence of energy and protein intake on protein balance in critically ill children. J Pediatr. 2012 Aug;161(2):333-9. PMID:22402566

Bechard LJ, Rothpletz-Puglia P, Touger-Decker R, Duggan C, Mehta NM. Influence of obesity on clinical outcomes in hospitalized children: a systematic review. JAMA Pediatr. 2013 May;167(5):476-82. PMID: 23478891

Mehta NM, Corkins MR, Lyman E et al. Defining Pediatric Malnutrition: A Paradigm Shift Toward Etiology-Related Definitions. JPEN 2013 Jul-Aug;37(4):460-81. PMID: 23528324

Mehta NM, Smallwood CD, Joosten KF, Hulst JM, Tasker RC and Duggan CP. Accuracy of a simplified equation for energy expenditure based on bedside volumetric carbon dioxide elimination measurement – a two center study. Clinical Nutrition 2014 Feb 26. [Epub ahead of print]

Mehta NM, Raphael B, Gutierrez IM, Quinn N, Mitchell PD, Litman HJ, Jaksic T and Duggan CP. Comparison of body composition assessment methods in pediatric intestinal failure. J Pediatr Gastroenterol Nutr. 2014 Jul;59(1):99-105. PMID: 24614122

Hamilton S, McAleer D, Ariagno K, Barrett M, Stenquist N, Duggan CP, Mehta NM. A stepwise enteral nutrition algorithm for critically ill children helps achieve nutrient delivery goals. Pediatr Crit Care Med. 2014 Sep;15(7):583-9. PMID: 25045848

Martinez EE, Smallwood CD, Bechard LJ, Graham RJ, Mehta NM. Metabolic Assessment and Individualized Nutrition in Children Dependent on Mechanical Ventilation at Home. J Pediatr. 2015 Feb;166(2):350-7. PMID: 25444009

Martinez EE, Smallwood CD, Bechard LJ, Duggan CP, Graham RJ, Mehta NM. Impact of Individualized Diet Intervention on Body Composition and Respiratory Variables in Children With Respiratory Insufficiency: A Pilot Intervention Study. Pediatr Crit Care Med. 2015 Jul;16(6):e157-64. PMID: 25944746

Mehta NM, Bechard LJ, Zurakowski D, Duggan CP, Heyland DK. Adequate enteral protein intake is associated with 60-day mortality in critically ill children: A multicenter prospective cohort study. Am J Clin Nutr. 2015 May 13. PMID: 25971721

Mehta NM. Parenteral Nutrition in Critically Ill Children. N Engl J Med. 2016 Mar 24;374(12):1190-2.

Publications

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  1. Lee JH, Rogers E, Chor YK, Samransamruajkit R, Koh PL, Miqdady M, Al-Mehaidib AI, Pudjiadi A, Singhi S, Mehta NM. Optimal nutrition therapy in paediatric critical care in the Asia-Pacific and Middle East: a consensus. Asia Pac J Clin Nutr. 2016 Dec; 25(4):676-696.
  2. Mehta NM, Bechard LJ. The authors reply. Crit Care Med. 2016 Oct; 44(10):e1007-8.
  3. Albert BD, Zurakowski D, Bechard LJ, Priebe GP, Duggan CP, Heyland DK, Mehta NM. Enteral Nutrition and Acid-Suppressive Therapy in the PICU: Impact on the Risk of Ventilator-Associated Pneumonia. Pediatr Crit Care Med. 2016 Oct; 17(10):924-929.
  4. Mehta NM. Benefits of late parenteral nutrition in critically ill children. J Pediatr. 2016 Sep; 176:221-4.
  5. Martinez EE, Mehta NM. The science and art of pediatric critical care nutrition. Curr Opin Crit Care. 2016 Aug; 22(4):316-24.
  6. Bechard LJ, Duggan C, Touger-Decker R, Parrott JS, Rothpletz-Puglia P, Byham-Gray L, Heyland D, Mehta NM. Nutritional Status Based on Body Mass Index Is Associated With Morbidity and Mortality in Mechanically Ventilated Critically Ill Children in the PICU. Crit Care Med. 2016 Aug; 44(8):1530-7.
  7. Compher C, Mehta NM. Diagnosing Malnutrition: Where Are We and Where Do We Need to Go? J Acad Nutr Diet. 2016 May; 116(5):779-84.
  8. Moreno YM, Hauschild DB, Barbosa E, Bresolin NL, Mehta NM. Problems With Optimal Energy and Protein Delivery in the Pediatric Intensive Care Unit. Nutr Clin Pract. 2016 Oct; 31(5):673-80.
  9. Strychowsky JE, Albert D, Chan K, Cheng A, Daniel SJ, De Alarcon A, Garabedian N, Hart C, Hartnick C, Inglis A, Jacobs I, Kleinman ME, Mehta NM, Nicollas R, Nuss R, Pransky S, Russell J, Rutter M, Schilder A, Thompson D, Triglia JM, Volk M, Ward B, Watters K, Wyatt M, Zalzal G, Zur K, Rahbar R. International Pediatric Otolaryngology Group (IPOG) consensus recommendations: Routine peri-operative pediatric tracheotomy care. Int J Pediatr Otorhinolaryngol. 2016 Jul; 86:250-5.
  10. Mehta NM. Parenteral Nutrition in Critically Ill Children. N Engl J Med. 2016 Mar 24; 374(12):1190-2.
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  12. Wong JJ, Ong C, Han WM, Mehta NM, Lee JH. Survey of contemporary feeding practices in critically ill children in the Asia-Pacific and the Middle East. Asia Pac J Clin Nutr. 2016; 25(1):118-25.
  13. Smallwood CD, Martinez EE, Mehta NM. A Comparison of Carbon Dioxide Elimination Measurements Between a Portable Indirect Calorimeter and Volumetric Capnography Monitor: An In Vitro Simulation. Respir Care. 2016 Mar; 61(3):354-8.
  14. Mehta NM, Newman H, Tarrant S, Graham RJ. Nutritional Status and Nutrient Intake Challenges in Children With Spinal Muscular Atrophy. Pediatr Neurol. 2016 Apr; 57:80-3.
  15. Martinez EE, Douglas K, Nurko S, Mehta NM. Gastric Dysmotility in Critically Ill Children: Pathophysiology, Diagnosis, and Management. Pediatr Crit Care Med. 2015 Nov; 16(9):828-36.
  16. Mehta NM. Early Enteral Nutrition in the PICU: Should We Trust Our Gut? Pediatr Crit Care Med. 2015 Oct; 16(8):786-9.
  17. Mehta NM, Sharma S, Laussen PC. Unplanned extubation: securing the tool of our trade. Intensive Care Med. 2015 Nov; 41(11):1983-5.
  18. Martinez EE, Bechard LJ, Smallwood CD, Duggan CP, Graham RJ, Mehta NM. Impact of Individualized Diet Intervention on Body Composition and Respiratory Variables in Children With Respiratory Insufficiency: A Pilot Intervention Study. Pediatr Crit Care Med. 2015 Jul; 16(6):e157-64.
  19. Mehta NM, Bechard LJ, Zurakowski D, Duggan CP, Heyland DK. Adequate enteral protein intake is inversely associated with 60-d mortality in critically ill children: a multicenter, prospective, cohort study. Am J Clin Nutr. 2015 Jul; 102(1):199-206.
  20. Smallwood CD, Gouldstone A, Mehta NM. Validation of the V(max) metabolic cart in a simulated pediatric model. JPEN J Parenter Enteral Nutr. 2015 May; 39(4):387-8.
  21. Mehta NM. Bringing back the (weighing) balance in the PICU--for good measure. Pediatr Crit Care Med. 2015 Mar; 16(3):301-2.
  22. Martinez EE, Ariagno K, Arriola A, Lara K, Mehta NM. Challenges to nutrition therapy in the pediatric critically ill obese patient. Nutr Clin Pract. 2015 Jun; 30(3):432-9.
  23. Smallwood CD, Walsh BK, Bechard LJ, Mehta NM. Carbon dioxide elimination and oxygen consumption in mechanically ventilated children. Respir Care. 2015 May; 60(5):718-23.
  24. Mehta NM. Energy expenditure: how much does it matter in infant and pediatric chronic disorders? Pediatr Res. 2015 Jan; 77(1-2):168-72.
  25. Martinez EE, Smallwood CD, Bechard LJ, Graham RJ, Mehta NM. Metabolic assessment and individualized nutrition in children dependent on mechanical ventilation at home. J Pediatr. 2015 Feb; 166(2):350-7.
  26. Bairdain S, Khan FA, Fisher J, Zurakowski D, Ariagno K, Cauley RP, Zalieckas J, Wilson JM, Jaksic T, Mehta NM. Nutritional outcomes in survivors of congenital diaphragmatic hernia (CDH)-factors associated with growth at one year. J Pediatr Surg. 2015 Jan; 50(1):74-7.
  27. Hamilton S, McAleer DM, Ariagno K, Barrett M, Stenquist N, Duggan CP, Mehta NM. A stepwise enteral nutrition algorithm for critically ill children helps achieve nutrient delivery goals*. Pediatr Crit Care Med. 2014 Sep; 15(7):583-9.
  28. Mehta NM, Raphael B, Guteirrez IM, Quinn N, Mitchell PD, Litman HJ, Jaksic T, Duggan CP. Comparison of body composition assessment methods in pediatric intestinal failure. J Pediatr Gastroenterol Nutr. 2014 Jul; 59(1):99-105.
  29. Duro D, Mitchell PD, Mehta NM, Bechard LJ, Yu YM, Jaksic T, Duggan C. Variability of resting energy expenditure in infants and young children with intestinal failure-associated liver disease. J Pediatr Gastroenterol Nutr. 2014 May; 58(5):637-41.
  30. Martinez EE, Bechard LJ, Mehta NM. Nutrition algorithms and bedside nutrient delivery practices in pediatric intensive care units: an international multicenter cohort study. Nutr Clin Pract. 2014 Jun; 29(3):360-7.
  31. Mehta NM, Smallwood CD, Graham RJ. Current applications of metabolic monitoring in the pediatric intensive care unit. Nutr Clin Pract. 2014 Jun; 29(3):338-47.
  32. Mehta NM, Smallwood CD, Joosten KF, Hulst JM, Tasker RC, Duggan CP. Accuracy of a simplified equation for energy expenditure based on bedside volumetric carbon dioxide elimination measurement--a two-center study. Clin Nutr. 2015 Feb; 34(1):151-5.
  33. Mehta NM. Feeding the gut during critical illness--it is about time. JPEN J Parenter Enteral Nutr. 2014 May; 38(4):410-4.
  34. Bechard LJ, Rothpletz-Puglia P, Touger-Decker R, Duggan C, Mehta NM. Influence of obesity on clinical outcomes in hospitalized children: a systematic review. JAMA Pediatr. 2013 May; 167(5):476-82.
  35. Radman M, Mack R, Barnoya J, Castañeda A, Rosales M, Azakie A, Mehta N, Keller R, Datar S, Oishi P, Fineman J. The effect of preoperative nutritional status on postoperative outcomes in children undergoing surgery for congenital heart defects in San Francisco (UCSF) and Guatemala City (UNICAR). J Thorac Cardiovasc Surg. 2014 Jan; 147(1):442-50.
  36. Smallwood CD, Mehta NM. Accuracy of gas exchange monitoring during noninvasive ventilation: an in vitro metabolic simulation. JPEN J Parenter Enteral Nutr. 2014 Jan; 38(1):86-91.
  37. Mehta NM, Corkins MR, Lyman B, Malone A, Goday PS, Carney LN, Monczka JL, Plogsted SW, Schwenk WF. Defining pediatric malnutrition: a paradigm shift toward etiology-related definitions. JPEN J Parenter Enteral Nutr. 2013 Jul; 37(4):460-81.
  38. Smallwood CD, Mehta NM. Gas exchange measurement during pediatric mechanical ventilation--agreement between gas sampling at the airway and the ventilator exhaust. Clin Nutr. 2013 Dec; 32(6):988-92.
  39. Mehta NM. The Goldilocks conundrum for optimal macronutrient delivery in the PICU--too much, too little, or just right? JPEN J Parenter Enteral Nutr. 2013 Mar; 37(2):178-80.
  40. 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.
  41. 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):685-92.
  42. Smallwood CD, 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):693-9.
  43. Skillman HE, Mehta NM. Nutrition therapy in the critically ill child. Curr Opin Crit Care. 2012 Apr; 18(2):192-8.
  44. Bechard LJ, Parrott JS, Mehta NM. Systematic review of the influence of energy and protein intake on protein balance in critically ill children. J Pediatr. 2012 Aug; 161(2):333-9.e1.
  45. Mehta NM, Bechard LJ, Dolan M, Ariagno K, Jiang H, Duggan C. Energy imbalance and the risk of overfeeding in critically ill children. Pediatr Crit Care Med. 2011 Jul; 12(4):398-405.
  46. Mehta NM, Turner D, Walsh B, Zurakowski D, Betit P, Wilson J, Arnold JH. Factors associated with survival in pediatric extracorporeal membrane oxygenation--a single-center experience. J Pediatr Surg. 2010 Oct; 45(10):1995-2003.
  47. Mehta NM, McAleer D, Hamilton S, Naples E, Leavitt K, Mitchell P, Duggan C. Challenges to optimal enteral nutrition in a multidisciplinary pediatric intensive care unit. JPEN J Parenter Enteral Nutr. 2010 Jan-Feb; 34(1):38-45.
  48. Mehta NM, Duggan CP. Nutritional deficiencies during critical illness. Pediatr Clin North Am. 2009 Oct; 56(5):1143-60.
  49. Mehta NM. Approach to enteral feeding in the PICU. Nutr Clin Pract. 2009 Jun-Jul; 24(3):377-87.
  50. Mehta NM, Compher C. A.S.P.E.N. Clinical Guidelines: nutrition support of the critically ill child. JPEN J Parenter Enteral Nutr. 2009 May-Jun; 33(3):260-76.
  51. Mehta NM, Bechard LJ, Leavitt K, Duggan C. Cumulative energy imbalance in the pediatric intensive care unit: role of targeted indirect calorimetry. JPEN J Parenter Enteral Nutr. 2009 May-Jun; 33(3):336-44.
  52. Mehta NM, Bechard LJ, Leavitt K, Duggan C. Severe weight loss and hypermetabolic paroxysmal dysautonomia following hypoxic ischemic brain injury: the role of indirect calorimetry in the intensive care unit. JPEN J Parenter Enteral Nutr. 2008 May-Jun; 32(3):281-4.
  53. Mehta NM, Halwick DR, Dodson BL, Thompson JE, Arnold JH. Potential drug sequestration during extracorporeal membrane oxygenation: results from an ex vivo experiment. Intensive Care Med. 2007 Jun; 33(6):1018-24.
  54. Mehta NM, Arnold JH. Genetic polymorphisms in acute respiratory distress syndrome: new approach to an old problem. Crit Care Med. 2005 Oct; 33(10):2443-5.
  55. Mehta NM, Arnold JH. Mechanical ventilation in children with acute respiratory failure. Curr Opin Crit Care. 2004 Feb; 10(1):7-12.
  56. Thomas RM, Mehta NM. Cases of congenital rubella may be the tip of the iceberg. BMJ. 2002 Sep 14; 325(7364):596.
  57. Mehta NM, Thomas RM. Antenatal screening for rubella-infection or immunity? BMJ. 2002 Jul 13; 325(7355):90-1.
  58. Mehta NM, Nicholl RM. Positioning of long lines. Arch Dis Child Fetal Neonatal Ed. 2002 Jan; 86(1):F68-9.
  59. Mehta N, Stone J, Whitelaw A. Practical management of hyperinsulinism in infancy. Arch Dis Child Fetal Neonatal Ed. 2001 May; 84(3):F218.
  60. Mehta NM, Hartnoll G. Congenital CMV with callosal lipoma and agenesis. Pediatr Neurol. 2001 Mar; 24(3):222-4.
  61. Mehta N, Macintosh I, Rivers R, Nadel S. Acute chest syndrome of sickle cell disease. J Pediatr. 2000 Oct; 137(4):589; author reply 590.
  62. Mehta N, DeMunter C, Habibi P, Nadel S, Britto J. Short-term propofol infusions in children. Lancet. 1999 Sep 4; 354(9181):866-7.
  63. Mehta N, Levin M. Management and prevention of meningococcal disease. Hosp Pract (1995). 2000 Aug 15; 35(8):75-6, 79-82, 85-6.
  64. Kerklaan D, Fivez T, Mehta NM, Mesotten D, van Rosmalen J, Hulst JM, Van den Berghe G, Joosten KF, Verbruggen SC. Worldwide Survey of Nutritional Practices in PICUs. Pediatr Crit Care Med. 2016 Jan; 17(1):10-8.
  65. Gusztak R, Hamilton S, Manning MJ, Lincoln P, Walsh B, Kohane D, Mehta N. 1074: SEVERITY OF HEMODYNAMIC INSTABILITY AROUND HIGH-DOSE VASOACTIVE SYRINGE CHANGES IN THE PICU. Crit Care Med. 2016 Dec; 44(12 Suppl 1):344.
  66. Mills K, French C, Baird C, Santos K, Tang X, Kheir J, Mehta N. 450: SUBOPTIMAL PROTEIN INTAKE MAY PROLONG CICU LENGTH OF STAY AND WORSEN NUTRITIONAL STATUS IN CHILDREN. Crit Care Med. 2016 Dec; 44(12 Suppl 1):189.
  67. Fullerton BS, Sparks EA, Khan FA, Fisher JG, Anzaldi R, Scoville MR, Yu YM, Wagner DA, Jaksic T, Mehta NM. Whole Body Protein Turnover and Net Protein Balance After Pediatric Thoracic Surgery: A Noninvasive Single-Dose 15N Glycine Stable Isotope Protocol With End-Product Enrichment. JPEN J Parenter Enteral Nutr. 2016 Nov 15.
  68. Smallwood C, Martinez E, Quinn N, Ariagno K, Bechard L, Duggan C, Mehta N. 451: INACCURACY OF EXISTING FAT-FREE MASS EQUATIONS IN PEDIATRICS-AND A NEW MACHINE LEARNING METHOD. Crit Care Med. 2016 Dec; 44(12 Suppl 1):189.
  69. Ariagno K, Armstrong L, Smallwood C, Arbuthnot M, Hong C, Jaksic T, Mehta N. 478: PROTEIN DELIVERY DURING THE FIRST WEEK OF PEDIATRIC ECMO: IMPACT ON OUTCOMES. Crit Care Med. 2016 Dec; 44(12 Suppl 1):196.
  70. French C, Mills K, Baird C, Santos K, Tang X, Kheir J, Mehta N. 462: BEDSIDE VCO2 AS A GUIDE TO INDIVIDUALIZED ENERGY PRESCRIPTION IN VENTILATED CHILDREN IN THE CICU. Crit Care Med. 2016 Dec; 44(12 Suppl 1):192.
  71. Velazco CS, Zurakowski D, Fullerton BS, Bechard LJ, Jaksic T, Mehta NM. Nutrient delivery in mechanically ventilated surgical patients in the pediatric critical care unit. J Pediatr Surg. 2016 Oct 28.
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