Children admitted to the pediatric intensive care unit (PICU) are at high risk of malnutrition due to the stress of critical illness, and challenges with meeting nutrient needs. The objectives of this study were to describe the prevalence of malnutrition (undernutrition) at admission and discharge from the PICU and the adequacy of dietary intakes during PICU stay according to current practice guidelines. Sixty patients (median age 1.8y) were enrolled. Malnutrition (moderate-severe) was identified in 12% of patients at admission and 15% at discharge using weight-for-length and BMI-for-age z scores. Mid-upper arm circumference z score declined significantly (p=0.002) during PICU stay. Median (IQR) delivery of enteral energy and protein during the first 10 days was 64 (50-73)% and 62 (40-82)%, respectively, of prescribed goal. A total of 174 feeding interruptions were noted in 36 enterally fed patients. Malnutrition was present in the PICU and areas for improvement in nutrient delivery were identified.

Magister Public Health - MPH / Malnutrition continues to be a major public health problem in Africa, yet the compliance to the IMAM, a treatment protocol that began in KwaZulu-Natal and viewed as a highly efficacious approach to treat malnutrition, is very low. The Dietetics outpatient department at a regional hospital in Pietermaritzburg, KwaZulu-Natal, where the study was conducted, has about 375 children enrolled in the outpatient nutrition programme. The outpatient nutrition programme enables patients with stable Severe Acute Malnutrition and Moderate Acute Malnutrition to access nutritional supplements and to manage malnutrition outside the hospital. It is estimated that about 124 children between the age of 6 to 59 months default from the outpatient nutrition programme annually, accounting for a defaulter rate of 33%.

Objectives: Negative energy balance can impair regeneration of the respiratory epithelium and limit the functionality of respiratory muscles, which can prolong mechanical ventilation. The present study sought to quantify and identify deviation in energy requirements of patients with septic shock during and upon liberation from mechanical ventilation. Methods: Patients admitted into intensive care with initial diagnosis of septic shock and mechanical ventilation-dependent were recruited. Their metabolic requirements before and after liberation from mechanical ventilation were measured by indirect calorimetry. Paired t-test was used to examine the variance between the two modes of breathing and Spearman rho correlation coefficient to examine relationship of selected indicators. Results: Thirty-five patients, 20 males and 15 females mean age 69 ±10 years, body height of 1.58 ±0.08 meters, and ideal body weight 59.01 ±7.63 kg were recruited. Median APACHEII score was 22, length of stay in the intensive care was 45 ±65 days and duration on mechanical ventilation was 24 ±25 days. Measured energy expenditure during ventilation was 2090 ±489 kcal∙d-1 upon liberation from ventilation was 1910 ±579 kcal∙d-1, and actual caloric intake was 1148 ±495 kcal∙d-1. Paired-t test showed that measured energy expenditure (p=0.02), actual calories provision and energy expenditure with (p=0.00) and without (p=0.00) ventilator support were all significantly different. Mean carbohydrate oxidation was 0.17 ±0.09 g·min-1 when patients were on mechanical ventilation compared to 0.14 ±0.08 g·min-1 upon liberalization from it, however, the results were not statistically significant. Furthermore, mean lipid oxidation was 0.08 ±0.05 g·min-1 during mechanical ventilation and 0.09±0.07 g·min-1 upon liberalization from it and the mean difference was not statistically significant. Spearman correlation coefficient showed a positive relationship between actual calorie provision and duration of stay in intensive care (r=0.41 and p=0.01) and duration on mechanical ventilation (r=0.55 and p=0.00). Oxygen consumption (r=0.49 and p=0.00) and carbon dioxide production (r=0.4 and p=0.02) were moderately strong and positive during and upon liberation from mechanical ventilation. Correlation between lipid oxidation and oxygen consumption during ventilation (r=0.74, p=0.00) and after ventilation (r=0.82, p=0.00) as well as lipid oxidation and carbon dioxide production during ventilation (r=0.37, p=0.03) and liberation from ventilator (r=0.91, p=0.00) were significantly correlated with each other in grams per minute only. Conclusions: This is a pioneering study to examine energy expenditure and substrate utilization and oxidation within a single cohort of patients. The lower measured energy expenditure upon liberation from mechanical ventilation among critically ill patients could result from positive pressure support from ventilation, the repeated cycle of “rest” and “work” during weaning from ventilators and the asynchronization between self-initiated breathing effort and the ventilatory support. The positive relationship in duration on mechanical ventilation and length of stay with calorie consumption could be longer stay led to more time for progression to reach nutrition targets. . Any discrepancy in energy expenditure and substrate utilization with and without ventilatory support should be monitored. Future studies are important to examine whether matching energy expenditure with energy intake could promote positive clinical outcomes.

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The purpose of this study was to ascertain the number of registered dietitians in Tennessee who perceive they are practicing at advanced levels versus those making recommendations only. Job satisfaction according to order writing privileges was also assessed. A five question survey was sent to hospitals meeting selection criteria. Thirty-three surveys (89%) were returned. Eighty-nine percent of dietitians with order writing privileges considered themselves to be advanced level practitioners compared to 60% in the group of dietitians who did not have order writing privileges. Dietitians with order writing privileges indicated greater job satisfaction compared to dietitians that did not have that privilege. Greater job satisfaction was reported with advanced level skills which included order writing privileges. This study may show the need for dietitians to pursue advanced level skills in order to be challenged by their work, which may improve job satisfaction, and advancement in the field of nutritional care.