Pediatric Nutrition Support - Critically
Ill Children Exam Questions and
Answers
What are the effects of malnutrition on outcomes in critically ill children? - ANS-
malnutrition, including obesity, is associated with adverse clinical outcomes, longer
periods of ventilation, higher risk of hospital-acquried infection, longer hospital stay,
increased mortality
What age range are the pediactric critical care nutrition guidelines by ASPEN and the
SCCM established for? - ANS-greater than 1 month of age and less than 18 years
PICU - ANS-pediatric intensive care unit
When should patients admitted to the PICU have a detailed nutrition assessment
completed? - ANS-within 48 hours of admission
When should patients in the PICU be reevaluated for nutritional status? - ANS-at least
weekly throughout hospitalization
What are the recommended screening measures to identify pediatric patients with
malnutrition to the PICU? - ANS-weight and height/ length should be measured on PICU
admission and z scores for "body mass index for age" or "weight for age" be used for
nutritional screening
What are the z score benchmarks for classification of pediatric malnutrition? - ANS-Z
scores for weight-for-height, BMI-for-age, and midd-upper arm circumference:
mild malnutrition: z score = -1 to -1.9
moderate malnutrition: z score = -2 to -2.9
severe malnutrition: z score = -3 or greater
What additional screening measure should be taken in patients less than 36 months of
age? - ANS-head circumference should also be documented upon PICU admission
as of 2017, are any validated pediatric nutritional screening tools available? - ANS-not
as of 2017. screening tools exist, but have not been validated for use in critically ill
pediatric patients
What are the components of a pediatric nutritional assessment? - ANS-- dietary history
- detection of changes in anthropometry
, - functional status
- nutrition focused physical examination
How should energy requirements of critically ill children be determined? *gold standard*
- ANS-measured energy expenditure by indirect calorimetry should be used to
determine energy requirements
IC - ANS-indirect calorimetry
How should energy requirements be determined in absence of IC? - ANS-use of the
Schofield or FAO/WHO United Nations equations may be used *without* stress factors
How are the energy needs of critically ill and postoperative neonates different from full
term, non-surgical infants? - ANS-critically ill and post-op neonates have significantly
lower energy needs compared to healthy neonates because of absence of growth,
decreased activity, and reduction in insensible losses during stress states
MREE - ANS-Measured resting energy expenditure
hypometabolism - ANS-MREE less than 90% of predicted energy requirement
normal metabolism - ANS-MREE of 90-110% predicted energy requirements
hypermetabolism - ANS-MREE greater than 110% predicted energy
What is the *target* energy provision in critically ill children? - ANS-at least 66%, or two
thirds, of prescribed daily energy requirements by the end of first week in PICU
Why are the usage of stress factors not recommended when calculating needs of
pediatric patients with the Schofield or FAO/WHO energy equations? - ANS-routine use
of stress factors is more likely to result in overfeeding, therefore stress factors either
should not be used or used with caution
clinical signs of overfeeding - ANS-- hyperglycemia
- hypertriglyceridemia
- increase CO2 production, respiratory acidosis
- increased arm circumference
- rapid of excessive weight gain
clinical signs of underfeeding - ANS-- weight loss
- decreased arm circumference
- prolonged dependency on mechanical ventilation
- increased length of PICU stay
Why should the Harris-Benedict and RDAs be avoided for use of determination of
protein and energy requirements in critically ill children? - ANS-the Harris-Benedict and
Ill Children Exam Questions and
Answers
What are the effects of malnutrition on outcomes in critically ill children? - ANS-
malnutrition, including obesity, is associated with adverse clinical outcomes, longer
periods of ventilation, higher risk of hospital-acquried infection, longer hospital stay,
increased mortality
What age range are the pediactric critical care nutrition guidelines by ASPEN and the
SCCM established for? - ANS-greater than 1 month of age and less than 18 years
PICU - ANS-pediatric intensive care unit
When should patients admitted to the PICU have a detailed nutrition assessment
completed? - ANS-within 48 hours of admission
When should patients in the PICU be reevaluated for nutritional status? - ANS-at least
weekly throughout hospitalization
What are the recommended screening measures to identify pediatric patients with
malnutrition to the PICU? - ANS-weight and height/ length should be measured on PICU
admission and z scores for "body mass index for age" or "weight for age" be used for
nutritional screening
What are the z score benchmarks for classification of pediatric malnutrition? - ANS-Z
scores for weight-for-height, BMI-for-age, and midd-upper arm circumference:
mild malnutrition: z score = -1 to -1.9
moderate malnutrition: z score = -2 to -2.9
severe malnutrition: z score = -3 or greater
What additional screening measure should be taken in patients less than 36 months of
age? - ANS-head circumference should also be documented upon PICU admission
as of 2017, are any validated pediatric nutritional screening tools available? - ANS-not
as of 2017. screening tools exist, but have not been validated for use in critically ill
pediatric patients
What are the components of a pediatric nutritional assessment? - ANS-- dietary history
- detection of changes in anthropometry
, - functional status
- nutrition focused physical examination
How should energy requirements of critically ill children be determined? *gold standard*
- ANS-measured energy expenditure by indirect calorimetry should be used to
determine energy requirements
IC - ANS-indirect calorimetry
How should energy requirements be determined in absence of IC? - ANS-use of the
Schofield or FAO/WHO United Nations equations may be used *without* stress factors
How are the energy needs of critically ill and postoperative neonates different from full
term, non-surgical infants? - ANS-critically ill and post-op neonates have significantly
lower energy needs compared to healthy neonates because of absence of growth,
decreased activity, and reduction in insensible losses during stress states
MREE - ANS-Measured resting energy expenditure
hypometabolism - ANS-MREE less than 90% of predicted energy requirement
normal metabolism - ANS-MREE of 90-110% predicted energy requirements
hypermetabolism - ANS-MREE greater than 110% predicted energy
What is the *target* energy provision in critically ill children? - ANS-at least 66%, or two
thirds, of prescribed daily energy requirements by the end of first week in PICU
Why are the usage of stress factors not recommended when calculating needs of
pediatric patients with the Schofield or FAO/WHO energy equations? - ANS-routine use
of stress factors is more likely to result in overfeeding, therefore stress factors either
should not be used or used with caution
clinical signs of overfeeding - ANS-- hyperglycemia
- hypertriglyceridemia
- increase CO2 production, respiratory acidosis
- increased arm circumference
- rapid of excessive weight gain
clinical signs of underfeeding - ANS-- weight loss
- decreased arm circumference
- prolonged dependency on mechanical ventilation
- increased length of PICU stay
Why should the Harris-Benedict and RDAs be avoided for use of determination of
protein and energy requirements in critically ill children? - ANS-the Harris-Benedict and
