ABOUT THE RESEARCHER
OVERVIEW
My research is focused on the nutritional and metabolic aspects of critical illness in children, aimed at identifying and implementing optimal nutrition therapies that improve clinical outcomes. With intramural and extramural support, I have systematically conducted investigations to address knowledge and evidence gaps in the field. Some of our original observations and contributions to the literature include the following 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) 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; viii) barriers to and strategies for optimal enteral nutrition, ix) delayed gastric emptying during critical illness, and x) best-practice algorithms for optimal bedside nutrient delivery.
My group has extensive experience with stable isotope methodology for protein turnover, body composition, total body water and energy expenditure determination in humans and animal models. We perform studies that use a variety of body composition analysis techniques, including BIA, BIS, muscle ultrasound, and DXA.
We have demonstrated the impact of individualized diet (optimized energy and protein intake based on measured energy expenditure and protein requirements) in chronically ventilated children. We are currently conducting a randomized controlled double-blind trial of antacids versus placebo, in infants with congenital heart disease, exploring the safety profile and impact on gastrointestinal microbiome of withholding antacids in this group. I have completed 3 large international studies of nutrient intake in over 3000 mechanically ventilated children from 90 PICUs (from over 15 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.
BACKGROUND
Dr. Mehta completed his residency at the Boston Combined Pediatric Residency Program, and Fellowship in Pediatric Critical Care Medicine at Boston Children’s Hospital. He is a Faculty member in the Critical Care Medicine, and Senior Associate in the Department of Anesthesia, Critical Care and Pain Medicine. His prior training includes pediatric and critical training in the United Kingdom. As the founder and Director of the Critical Care Nutrition Program, he leads a group of multidisciplinary researchers in conducting clinical and translational studies in this field. He has 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, he received the " Stanley Dudrick Research Scholar Award" from the American Society of Parenteral and Enteral Nutrition (ASPEN). He currently serves as the President of ASPEN.
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.
PUBLICATIONS
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- Timing of Parenteral Nutrition is associated with adequacy of nutrient delivery and anthropometry in critically ill children -a single center study. JPEN J Parenter Enteral Nutr. 2021 Feb 19. View abstract
- Pediatric Sarcopenia: Hidden in Plain Sight? J Pediatr Gastroenterol Nutr. 2021 Feb 01; 72(2):181-183. View abstract
- Current State of Nutrition Education in Pediatric Critical Care Medicine Fellowship Programs in the United States and Canada. Pediatr Crit Care Med. 2020 09; 21(9):e769-e775. View abstract
- Biomarkers in critical care nutrition. Crit Care. 2020 08 12; 24(1):499. View abstract
- Estimating Energy Expenditure and Metabolism at the Bedside-Still Shooting in the Dark? Pediatr Crit Care Med. 2020 08; 21(8):776-777. View abstract
- Stress ulcer prophylaxis versus placebo-a blinded randomized control trial to evaluate the safety of two strategies in critically ill infants with congenital heart disease (SUPPRESS-CHD). Trials. 2020 Jun 29; 21(1):590. View abstract
- Interleukin-10 and Zonulin Are Associated With Postoperative Delayed Gastric Emptying in Critically Ill Surgical Pediatric Patients: A Prospective Pilot Study. JPEN J Parenter Enteral Nutr. 2020 Nov; 44(8):1407-1416. View abstract
- Forty-Third ASPEN Presidential Address: "Our Time Is Now-Challenges and Strategies for the Field of Nutrition". JPEN J Parenter Enteral Nutr. 2020 05; 44(4):567-580. View abstract
- Early Enteral Nutrition Is Associated With Improved Clinical Outcomes in Critically Ill Children: A Secondary Analysis of Nutrition Support in the Heart and Lung Failure-Pediatric Insulin Titration Trial. Pediatr Crit Care Med. 2020 03; 21(3):213-221. View abstract
- Long-term outcomes related to timing of parenteral nutrition in critically ill children. Lancet Respir Med. 2020 03; 8(3):224-226. View abstract
- Surviving Sepsis Campaign International Guidelines for the Management of Septic Shock and Sepsis-Associated Organ Dysfunction in Children. Pediatr Crit Care Med. 2020 02; 21(2):e52-e106. View abstract
- Executive Summary: Surviving Sepsis Campaign International Guidelines for the Management of Septic Shock and Sepsis-Associated Organ Dysfunction in Children. Pediatr Crit Care Med. 2020 02; 21(2):186-195. View abstract
- Surviving sepsis campaign international guidelines for the management of septic shock and sepsis-associated organ dysfunction in children. Intensive Care Med. 2020 02; 46(Suppl 1):10-67. View abstract
- Executive summary: surviving sepsis campaign international guidelines for the management of septic shock and sepsis-associated organ dysfunction in children. Intensive Care Med. 2020 02; 46(Suppl 1):1-9. View abstract
- Bedside Postpyloric Tube Placement and Enteral Nutrition Delivery in the Pediatric Intensive Care Unit. Nutr Clin Pract. 2020 Apr; 35(2):299-305. View abstract
- Multidisciplinary Quality Improvement Intervention to Achieve Sustained Improvement in Hand Hygiene Reliability in a Pediatric Intensive Care Unit. Pediatr Qual Saf. 2019 Nov-Dec; 4(6):e227. View abstract
- Undernutrition at PICU Admission Is Predictor of 60-Day Mortality and PICU Length of Stay in Critically Ill Children. J Acad Nutr Diet. 2020 02; 120(2):219-229. View abstract
- ICU Management & Practice. Ed. J.L.Vincent. Emerging Concepts in Nutritional Therapy for the Critically Ill Child. 2019; 19(3):150-157. View abstract
- From body habitus to body composition-Predicting outcomes in the PICU. J Pediatr. 2019 10; 213:248. View abstract
- Gastrointestinal Hormone Profiles Associated With Enteral Nutrition Tolerance and Gastric Emptying in Pediatric Critical Illness: A Pilot Study. JPEN J Parenter Enteral Nutr. 2020 03; 44(3):472-480. View abstract
- ICU Management & Practice, Ed. J.L. Vincent. Quality improvement in the PICU – a primer for intensivists. 2019; 19(2):74-77. View abstract
- Incorporating the latest pediatric nutrition support guidelines into clinical practice. Nursing. 2019 Feb; 49(2):38-44. View abstract
- Priorities for Nutrition Research in Pediatric Critical Care. JPEN J Parenter Enteral Nutr. 2019 09; 43(7):853-862. View abstract
- Nutritional Status and Outcomes in Pediatric Severe Sepsis-Size Matters. Crit Care Med. 2018 11; 46(11):1886-1887. View abstract
- Nutrition Support During Pediatric Extracorporeal Membrane Oxygenation. Nutr Clin Pract. 2018 Dec; 33(6):747-753. View abstract
- Micronutrients in Critical Illness: Essential and Enigmatic. Pediatr Crit Care Med. 2018 09; 19(9):907-908. View abstract
- Research Agenda 2018: The American Society for Parenteral and Enteral Nutrition. JPEN J Parenter Enteral Nutr. 2018 Jul; 42(5):838-844. View abstract
- Enteral Protein Supplementation in Critically Ill Children: A Randomized Controlled Pilot and Feasibility Study. JPEN J Parenter Enteral Nutr. 2019 02; 43(2):281-289. View abstract
- Nutrition for term neonates in the paediatric intensive care unit. Lancet Child Adolesc Health. 2018 07; 2(7):469-471. View abstract
- Nutrition Delivery During Pediatric Extracorporeal Membrane Oxygenation Therapy. JPEN J Parenter Enteral Nutr. 2018 Sep; 42(7):1133-1138. View abstract
- Comprehensive nutritional and metabolic assessment in patients with spinal muscular atrophy: Opportunity for an individualized approach. Neuromuscul Disord. 2018 06; 28(6):512-519. View abstract
- Unexplained iron deficiency anemia: does Helicobacter pylori have a role to play? Gastroenterol Rep (Oxf). 2018 Aug; 6(3):215-220. View abstract
- Nutrition Delivery and Growth Outcomes in Infants With Gastroschisis. JPEN J Parenter Enteral Nutr. 2018 Jul; 42(5):913-919. View abstract
- Whole Body Protein Turnover and Net Protein Balance After Pediatric Thoracic Surgery: A Noninvasive Single-Dose 15 N Glycine Stable Isotope Protocol With End-Product Enrichment. JPEN J Parenter Enteral Nutr. 2018 02; 42(2):361-370. View abstract
- The Quest to Preserve Muscle Mass-Lessons From Pediatric Burn Injury. Pediatr Crit Care Med. 2017 12; 18(12):1186-1187. View abstract
- Feasibility of Enteral Protein Supplementation in Critically Ill Children. JPEN J Parenter Enteral Nutr. 2018 01; 42(1):61-70. View abstract
- Response to "Pediatric Intensive Care Nutrition Guidelines 2017: Key Questions Remain Unanswered". JPEN J Parenter Enteral Nutr. 2018 01; 42(1):10-11. View abstract
- Body Composition in Children with Chronic Illness: Accuracy of Bedside Assessment Techniques. J Pediatr. 2017 11; 190:56-62. View abstract
- Ultrasound Measurement of Muscle Thickness: A Novel Biomarker for the PICU? Pediatr Crit Care Med. 2017 08; 18(8):817-819. View abstract
- 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. Pediatr Crit Care Med. 2017 Jul; 18(7):675-715. View abstract
- Risk Factors for Fractures in Children Hospitalized in Intensive and Intermediate Care Units. Hosp Pediatr. 2017 Jul; 7(7):395-402. View abstract
- 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 J Parenter Enteral Nutr. 2017 07; 41(5):706-742. View abstract
- Impact of the structure and dose of protein intake on clinical and metabolic outcomes in critically ill children: A systematic review. Nutrition. 2017 Sep; 41:97-106. View abstract
- Timing of the initiation of parenteral nutrition in critically ill children. Curr Opin Clin Nutr Metab Care. 2017 May; 20(3):227-231. View abstract
- Nutritional Assessment Must be Prioritized for Critically Ill Children in the PICU. Crit Care Med. 2017 04; 45(4):e464. View abstract
- Estimating Energy Expenditure in Critically Ill Children: Still Shooting in the Dark? J Pediatr. 2017 05; 184:10-12. View abstract
- Accuracy of Oxygen Consumption and Carbon Dioxide Elimination Measurements in 2 Breath-by-Breath Devices. Respir Care. 2017 Apr; 62(4):475-480. View abstract
- Gastric Emptying in Critically Ill Children. JPEN J Parenter Enteral Nutr. 2017 09; 41(7):1100-1109. View abstract
- 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. View abstract
- 1074: SEVERITY OF HEMODYNAMIC INSTABILITY AROUND HIGH-DOSE VASOACTIVE SYRINGE CHANGES IN THE PICU. Crit Care Med. 2016 Dec; 44(12 Suppl 1):344. View abstract
- 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. View abstract
- 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. View abstract
- 478: PROTEIN DELIVERY DURING THE FIRST WEEK OF PEDIATRIC ECMO: IMPACT ON OUTCOMES. Crit Care Med. 2016 Dec; 44(12 Suppl 1):196. View abstract
- 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. View abstract
- 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. View abstract
- Nutrient delivery in mechanically ventilated surgical patients in the pediatric critical care unit. J Pediatr Surg. 2017 Jan; 52(1):145-148. View abstract
- Nutritional status, metabolic state and nutrient intake in children with bronchiolitis. Int J Food Sci Nutr. 2017 May; 68(3):378-383. View abstract
- Energy and Protein Delivery in Overweight and Obese Children in the Pediatric Intensive Care Unit. Nutr Clin Pract. 2017 Jun; 32(3):414-419. View abstract
- The authors reply. Crit Care Med. 2016 10; 44(10):e1007-8. View abstract
- Enteral Nutrition and Acid-Suppressive Therapy in the PICU: Impact on the Risk of Ventilator-Associated Pneumonia. Pediatr Crit Care Med. 2016 10; 17(10):924-929. View abstract
- Benefits of late parenteral nutrition in critically ill children. J Pediatr. 2016 09; 176:221-4. View abstract
- The science and art of pediatric critical care nutrition. Curr Opin Crit Care. 2016 08; 22(4):316-24. View abstract
- 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. View abstract
- Nutritional status as a predictor of duration of mechanical ventilation in critically ill children. Nutrition. 2017 Jan; 33:91-95. View abstract
- Diagnosing Malnutrition: Where Are We and Where Do We Need to Go? J Acad Nutr Diet. 2016 05; 116(5):779-84. View abstract
- Problems With Optimal Energy and Protein Delivery in the Pediatric Intensive Care Unit. Nutr Clin Pract. 2016 Oct; 31(5):673-80. View abstract
- International Pediatric Otolaryngology Group (IPOG) consensus recommendations: Routine peri-operative pediatric tracheotomy care. Int J Pediatr Otorhinolaryngol. 2016 Jul; 86:250-5. View abstract
- Parenteral Nutrition in Critically Ill Children. N Engl J Med. 2016 Mar 24; 374(12):1190-2. View abstract
- Worldwide Survey of Nutritional Practices in PICUs. Pediatr Crit Care Med. 2016 Jan; 17(1):10-8. View abstract
- 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. View abstract
- 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. View abstract
- Nutritional Status and Nutrient Intake Challenges in Children With Spinal Muscular Atrophy. Pediatr Neurol. 2016 Apr; 57:80-3. View abstract
- Gastric Dysmotility in Critically Ill Children: Pathophysiology, Diagnosis, and Management. Pediatr Crit Care Med. 2015 Nov; 16(9):828-36. View abstract
- Early Enteral Nutrition in the PICU: Should We Trust Our Gut? Pediatr Crit Care Med. 2015 Oct; 16(8):786-9. View abstract
- Unplanned extubation: securing the tool of our trade. Intensive Care Med. 2015 Nov; 41(11):1983-5. View abstract
- 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. View abstract
- 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. View abstract
- Validation of the V(max) metabolic cart in a simulated pediatric model. JPEN J Parenter Enteral Nutr. 2015 May; 39(4):387-8. View abstract
- Bringing back the (weighing) balance in the PICU--for good measure. Pediatr Crit Care Med. 2015 Mar; 16(3):301-2. View abstract
- Challenges to nutrition therapy in the pediatric critically ill obese patient. Nutr Clin Pract. 2015 Jun; 30(3):432-9. View abstract
- Carbon dioxide elimination and oxygen consumption in mechanically ventilated children. Respir Care. 2015 May; 60(5):718-23. View abstract
- Energy expenditure: how much does it matter in infant and pediatric chronic disorders? Pediatr Res. 2015 Jan; 77(1-2):168-72. View abstract
- Metabolic assessment and individualized nutrition in children dependent on mechanical ventilation at home. J Pediatr. 2015 Feb; 166(2):350-7. View abstract
- 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. View abstract
- A stepwise enteral nutrition algorithm for critically ill children helps achieve nutrient delivery goals*. Pediatr Crit Care Med. 2014 Sep; 15(7):583-9. View abstract
- Comparison of body composition assessment methods in pediatric intestinal failure. J Pediatr Gastroenterol Nutr. 2014 Jul; 59(1):99-105. View abstract
- 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. View abstract
- 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. View abstract
- Current applications of metabolic monitoring in the pediatric intensive care unit. Nutr Clin Pract. 2014 Jun; 29(3):338-47. View abstract
- 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. View abstract
- Feeding the gut during critical illness--it is about time. JPEN J Parenter Enteral Nutr. 2014 May; 38(4):410-4. View abstract
- Influence of obesity on clinical outcomes in hospitalized children: a systematic review. JAMA Pediatr. 2013 May; 167(5):476-82. View abstract
- 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. View abstract
- Accuracy of gas exchange monitoring during noninvasive ventilation: an in vitro metabolic simulation. JPEN J Parenter Enteral Nutr. 2014 Jan; 38(1):86-91. View abstract
- Defining pediatric malnutrition: a paradigm shift toward etiology-related definitions. JPEN J Parenter Enteral Nutr. 2013 Jul; 37(4):460-81. View abstract
- 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. View abstract
- 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. View abstract
- 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. View abstract
- Resting energy expenditure after Fontan surgery in children with single-ventricle heart defects. JPEN J Parenter Enteral Nutr. 2012 Nov; 36(6):685-92. View abstract
- 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. View abstract
- Nutrition therapy in the critically ill child. Curr Opin Crit Care. 2012 Apr; 18(2):192-8. View abstract
- 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. View abstract
- Attenuation of resting energy expenditure following hematopoietic SCT in children. Bone Marrow Transplant. 2012 Oct; 47(10):1301-6. View abstract
- Energy imbalance and the risk of overfeeding in critically ill children. Pediatr Crit Care Med. 2011 Jul; 12(4):398-405. View abstract
- Factors associated with survival in pediatric extracorporeal membrane oxygenation--a single-center experience. J Pediatr Surg. 2010 Oct; 45(10):1995-2003. View abstract
- Challenges to optimal enteral nutrition in a multidisciplinary pediatric intensive care unit. JPEN J Parenter Enteral Nutr. 2010 Jan-Feb; 34(1):38-45. View abstract
- Nutritional deficiencies during critical illness. Pediatr Clin North Am. 2009 Oct; 56(5):1143-60. View abstract
- Approach to enteral feeding in the PICU. Nutr Clin Pract. 2009 Jun-Jul; 24(3):377-87. View abstract
- 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. View abstract
- 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. View abstract
- 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. View abstract
- Potential drug sequestration during extracorporeal membrane oxygenation: results from an ex vivo experiment. Intensive Care Med. 2007 Jun; 33(6):1018-24. View abstract
- Genetic polymorphisms in acute respiratory distress syndrome: new approach to an old problem. Crit Care Med. 2005 Oct; 33(10):2443-5. View abstract
- Mechanical ventilation in children with acute respiratory failure. Curr Opin Crit Care. 2004 Feb; 10(1):7-12. View abstract
- Cases of congenital rubella may be the tip of the iceberg. BMJ. 2002 Sep 14; 325(7364):596. View abstract
- Antenatal screening for rubella-infection or immunity? BMJ. 2002 Jul 13; 325(7355):90-1. View abstract
- Positioning of long lines. Arch Dis Child Fetal Neonatal Ed. 2002 Jan; 86(1):F68-9. View abstract
- Practical management of hyperinsulinism in infancy. Arch Dis Child Fetal Neonatal Ed. 2001 May; 84(3):F218. View abstract
- Congenital CMV with callosal lipoma and agenesis. Pediatr Neurol. 2001 Mar; 24(3):222-4. View abstract
- Acute chest syndrome of sickle cell disease. J Pediatr. 2000 Oct; 137(4):589; author reply 590. View abstract
- Management and prevention of meningococcal disease. Hosp Pract (1995). 2000 Aug 15; 35(8):75-6, 79-82, 85-6. View abstract
- Short-term propofol infusions in children. Lancet. 1999 Sep 04; 354(9181):866-7. View abstract
- How To Guide- PICCs in children. Care of the critically ill. Aug 1999 (15.5). View abstract
- Yearbook of Intensive Care and Emergency Medicine published by Springer-Verlag. Ed J. L. Vincent. 2005. View abstract