Feeding Modality is a Barrier to Providing Adequate

Feeding Modality is a Barrier to Providing Adequate Protein to Pediatric Patients Receiving Continuous Renal Replacement Therapy Molly Wong Vega, MS, RDN Marisa Juarez, MPH, RDN; Sarah Swartz, MD, Poyyapakkam Srivaths, MD; Helen Currier, BSN, RN; Ayse Akcan-Arikan, MD Pediatrics

Introduction • Higher protein provision benefits patients receiving CRRT • Higher protein needs in pediatrics ‐ Losses + growth • 12 month retrospective review at our institution ‐ Only 54% patients met protein goals within 7 days of CRRT initiation ‐ Nutrition identified as primary monitoring metric in quality improvement program Zappitelli et al. Intensive Care Med 2009; 35(4): 698‐ 706 Scheinkestel et al. Nutrition 2003; 19: 733: 740 Pediatrics Page 2 xxx 00. #####. ppt 12/18/2021 6: 54: 17 AM

Introduction • Development of quality improvement program focusing on acute renal extracorporeal therapies ‐ Interdisciplinary ‐ Continuous quality improvement cycle ‐ Thrice weekly bedside quality improvement rounds • Analysis of individual prescriptions revealed changes in protein amount received when delivery method changed • Hypothesis: feeding modality may be a factor limiting protein provision Pediatrics Page 3 xxx 00. #####. ppt 12/18/2021 6: 54: 18 AM

Methods • Daily prospective monitoring of pts on CRRT performed over 10 months ‐ Nutrition Parameters: • Nutrition prescription • Nutrition delivery • Feeding modality • Nutrition status ‐ Minimum goal defined as 2. 5 grams/kg/day • Exclusion criteria: ‐ <2 days receiving CRRT ‐ Inborn errors of metabolism Pediatrics Page 4 xxx 00. #####. ppt 12/18/2021 6: 54: 19 AM

Results • Demographics ‐ N=42 patients • 5 received CRRT with ECMO • 3 received extracorporeal liver support-albumin dialysis ‐ Mean age: 8. 9 ± 6. 9 years (27 male, 15 female) ‐ Mean CRRT duration: 15. 2 ± 15. 5 days (range: 2 -89 days) ‐ 18 patients were malnourished via anthropometric criteria ‐ Most common treatments indications: clearance & fluid removal Pediatrics Page 5 xxx 00. #####. ppt 12/18/2021 6: 54: 20 AM

Results • Pediatrics Page 6 xxx 00. #####. ppt 12/18/2021 6: 54: 22 AM

Results Percentage of Time Meeting Protein Goals Decreased to 19% for those weaned from Combination of TPN + tube/oral to full tube/oral (N=17) (p<0. 001) 46% 36% 25% TPN Only Pediatrics Combination Page 7 xxx 00. #####. ppt 12/18/2021 6: 54: 23 AM Tube/Oral Only

Conclusion • Protein provision continues lower than goal levels • Achievement of protein goals varied by delivery modality • Tube/oral feeding modalities receive the lowest amounts of protein • Parenteral to enteral transition was identified as period of nutritional risk Pediatrics Page 8 xxx 00. #####. ppt 12/18/2021 6: 54: 31 AM

Thank you! Questions? Contact: mrvega@texaschildrens. org Pediatrics Page 9 xxx 00. #####. ppt 12/18/2021 6: 54: 31 AM