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Nutrition, PICU/PCU, Initiantion and Advancement Pathway

All PICU patients require nutrition support EXCEPT:

  • Patients already on oral feeds/home feeding regimen or those with a plan to start oral feeds/home feeding regimen

  • General surgery/trauma patients

  • Patients with a known metabolic disorder

  • Intestinal rehabilitation program patients

  • Patients requiring a ketogenic diet

Ordering provider to initiate nutritional support : No later than 48 hours after PICU admission

  • Obtain Anthropometry Measurements

  • Place Nutrition Consult Order in Cerner

Barriers to Enteral Nutrition (EN) initiate Parenteral Nutrition (PN)

  • Known/Presumed Gut Ischemia

  • Persistent Hemodynamic Instability

  • Gut Graft vs. Host Disease (GVHD)

  • Malabsorptive State (e.g.: Short Gut)

  • Intra-abdominal Hypertension/Abdominal Compartment Syndrome

  • Intractable Emesis

  • Planned NPO Time > 72 Hours (Includes Post-surgical Patients)

These guidelines do not establish a standard of care to be followed in every case. It is recognized that each case is different and those individuals involved in providing health care are expected to use their judgment in determining what is in the best interests of the patient based on the circumstances existing at the time. It is impossible to anticipate all possible situations that may exist and to prepare guidelines for each. Accordingly these guidelines should guide care with the understanding that departures from them may be required at times.