Provision of parental nutrition (PN) is complex, enteral and PN requirements frequently change.^{1 2} It is imperative that patients undergo detailed regular nutritional assessment to avoid growth faltering. This includes identifying individual nutritional needs. Generic guides exist for PN requirements however, individual assessment is multifactorial^{1 2} which dietitians are uniquely placed to evaluate and ensure adequate growth.^{2 3} Despite this, dietitians are not always included in managing paediatric PN. This study assesses if dietitian involvement in PN is essential to ensure adequate growth.

Children receiving PN were identified retrospectively via clinical records between January2022-June 2022. Patients excluded if on critical care ward or >18 years. Dietetic assessment identified through electronic notes. Growth was assessed calculating changes in weight-for-age Z-scores (delta-Z-Score) from start to end of PN.

78 children identified. 73 complete data.

50/73 patients had dietetic assessment prior to commencing PN. Further 8 assessed on average 6 days after PN commenced [range 2–15 days]. Dietitian initial PN assessment of these 8 recommended 25% no changes, 50% to increase macronutrients due to not meeting requirements and poor growth, 25% to reduce macronutrients due to requirements being exceeded.

Delta Z-scores changed on average by +0.31 (range -2.21 to + 4.96) for patients assessed by a dietitian and -0.724 (range -1.89 to +0.39) for patients not seen by a dietitian. The interquartile ranges of each group was 1.06 and 1.01 for no dietitian and dietitian involvement respectively.

Average length of time patients received PN when assessed by dietitian 55.5days (SD 56.5d) and 21.06days (SD 16.63d) for those not seen by dietitian.

In total, 79% PN patients were assessed by a dietitian, those without dietetic assessment prior to commencing PN, have 75% risk of inappropriate nutrient provision.

Patients with dietetic assessment are more likely to have positive growth trajectory. As it is essential to meet energy and protein requirements for adequate growth, it can be concluded that PN patients not reviewed by a dietitian are less likely to meet their individual requirements. This study has shown that it is essential for paediatric patients receiving PN in an acute setting to be assessed by a dietitian to ensure adequate growth. It highlights the importance of dietitians being integral members of teams that manage paediatric PN in acute settings.

References

1. Joosten K, Embleton N, Yan W, et al. Espghan/Espen/ESPR/CSPEN guidelines on pediatric parenteral nutrition: energy. Clinical Nutrition. 2018;37(6):2309–14.

2. Johnson T, Sexton E. Managing children and adolescents on parenteral nutrition: challenges for the nutritional support team. Proceedings of the Nutrition Society. 2006;65(3):217–21.

3. Vlug LE, Nagelkerke SC, Jonkers-Schuitema CF, et al. The role of a nutrition support team in the management of intestinal failure patients. Nutrients. 2020;12(1):172.