• Santiago Campos-Miño, López-Herce Cid Jesús J Department of Pediatric Intensive Care, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid, , Figueiredo Delgado Artur A Pediatric Intensive Care of Instituto da Criança do Hospital das Clinicas da Faculdade de Medicina - Sao Paulo University, San Paulo, Brazil., Eliana Muñoz Benavides, Jorge A Coss-Bu, and Nutrition Committee, Latin American Society of Pediatric Intensive Care (SLACIP).
• Pediatric Intensive Care Unit, Hospital Metropolitano, Facultad de Medicina, Pontificia Universidad Católica del Ecuador, Quito, Ecuador.
• Pediatr Crit Care Me. 2019 Jan 1; 20 (1): e23-e29.

ObjectiveTo characterize the practices of nutritional support in Latin American and Spanish PICUs.DesignSurvey with a questionnaire sent to Latin American Society of Pediatric Intensive Care members.SettingPICUs of participant hospitals.PatientsCritically ill children between 1 month and 18 years old.InterventionsNone.Measurements And Main ResultsForty-seven surveys from 17 countries were analyzed. Sixty-seven percent of PICUs were from university-affiliated hospitals, with a median of 380 admissions/yr. Sixty-eight percent and 48.9% had a nutritional support team and nutritional support protocol, respectively. Seventy-five percent completed nutritional evaluations, with 34.2% at admission. PICUs with high-volume admissions were likely to have a nutritional support team (p < 0.005), and university-affiliated hospitals showed a trend of having a nutritional support team (p = 0.056). Measured, estimated, and ideal weights were used in 75%, 14.6%, and 10.4%, respectively. Energy requirements were calculated using Holliday & Segar and Schofield equations in 90% of the PICUs; 43% used correction factors. Only three PICUs had indirect calorimetry. At day 3 of initiation of nutritional support, 57.3% of PICUs provided at least 50% of the calculated energy requirement, and 91.5% at day 5. Protein needs were estimated according to American Society for Parenteral and Enteral Nutrition and European Society for Clinical Nutrition and Metabolism/European Society for Paediatric Gastroenterology Hepatology and Nutrition guidelines in 55.3% and 40.4%, respectively. Enteral nutrition was the preferred feeding method, initiated in 97.7% at 48 hours. The feeding route was gastric (82.9%), by bolus (42.5%) or continuous (57.4%). Monitoring methods included gastric residual measurement in 55.3%. Enteral nutrition was discontinued in 82.8% when gastric residual was 50% of the volume. Prokinetics were used in 68%. More than half of PICUs used parenteral nutrition, with 95.8% of them within 72 hours. Parenteral nutrition was administered by central vein in 93.6%. Undernourished children received parenteral nutrition sooner, whether or not enteral nutrition intolerance was present. When enteral nutrition was not tolerated beyond 72 hours, parenteral nutrition was started in 57.4%. Parenteral nutrition was initiated when enteral nutrition delivered less than 50% in 97%.ConclusionsNutritional practices are heterogeneous in Latin American PICUs, but the majority use nutritional support strategies consistent with international guidelines.

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