Supplement: survey questions part 1 (survey) and part 2 (point-prevalence)
Part 1: survey
General information
1. What is your country of work?
2. What is the name of your institution?
3. What type of hospital do you work in?  general hospital  university hospital 
children’s hospital (non-university) university-children’s hospital  other, specify
4. What is your profession?  pediatric intensivist  anesthesiologist  pediatrician 
surgeon  dietician/nutritionist  Nurse/nurse practitioner
5. How many years of experience do you have working in a PICU?  1-5
20
 >20
 6-10
 11-
6. What type of a PICU do you work in?  multidisciplinary/mixed  surgical  cardiac
medical  other, specify
7. Is the PICU combined with an adult ICU or a neonatal ICU?  Not combined
 adult  Both neonatal and adult
8. What is the number of ICU beds in your unit?
 1-10
 11-20

 neonatal
 21-30
 >30
9. What is the average number of admissions in your unit per year?
10. On average, what percentage of your patients are mechanically ventilated at some stage
during their PICU course?  <25%  25-50%
 >50-75%  >75%
Nutritional assessment and demands
1. Is there a pediatric nutrition support team or unit in your institution?  No
 Yes
a. If yes: This nutritional team consists of:  pediatric intensivist  anesthesiologist
 pediatrician  surgeon  dietician  nurse  pharmacist  other
b. If yes: How often is this team visiting the PICU?  daily except weekends & bank
holidays  > 1x a week  1-4x/month  6-12 x/year  < 6x/year  other
2.
Is there a nutritional protocol used in your PICU?  No
 Yes
a. If Yes: This protocol contains information about (yes/no):
i. Assessment of energy requirements
ii. Assessment of protein requirements
iii. Assessment and management of gastric residual volume
iv. Administration of type of enteral formula
v. Administration of amount of enteral formula
vi. Administration of composition of parenteral nutrition
vii. Administration of amount of parenteral nutrition
b. If yes: Is an age- (or weight-) differentiated nutritional protocol used in your
PICU?  No  Yes, for parenteral nutrition  Yes, for enteral nutrition  Yes, for
both parenteral and enteral nutrition
c. If No:Who is responsible for assessment of nutritional demands?  Nutritional
team
 pediatric intensivist  anesthesiologist  pediatrician  dietician 
pharmacist  other (specify ______)
3. How are the basal energy requirements of your patients in your PICU estimated?
 Harris-Benedict equation  Schofield equation for weight  Schofield equation for
weight and height  WHO  White  Talbot  Don’t know  other (specify _____)
4. What weight is used in the calculation of energy requirements?  Estimated body weight
 Actual body weight  Ideal body weight (growth chart)  No weight used
 other
5. Are correction factors applied to resting energy expenditure to estimate total energy
expenditure?  Fever  Specific diagnosis  Growth  Catch-up growth  Absorption
 Blood parameters  No correction factors used  other
6. Is nutritional status monitored… (yes/no)
a. On admission
b. During PICU course/stay
c. At discharge
7. How is nutritional status monitored?  weight  height  upper arm/leg circumference 
head circumference  skin fold thickness
 blood parameters  not
 other (specify)
8. How much of the prescribed energy intake do you think a child in your PICU actually
receives per day on the 2nd day? and on the 4th day? >90%  76-90%  51-75%  3150%  <30%
9. Is indirect calorimetry used to measure resting energy requirements?  NO  YES, only
in mechanical ventilated patients  YES, in mechanical ventilated and non-ventilated
patients (canopy mode)
If Yes
a. Which machine/device is used for indirect calorimetric measurements? 
Deltatrac
 Quark RMR  Other
b. When using indirect calorimetry, how long does a measurement take?  <1 hour
 1-5 hours  5-24 hours
c. When is the first indirect calorimetric measurement performed?  As soon as
ventilator settings are appropriate  Weight loss  Expected stay > 4 days 
other
d. When are consecutive indirect calorimetric measurements performed?  Not,
single measurement  4-7x/week  1-3x/week  1-3x/month  On indication 
Other
e. Is the prescribed energy intake adjusted to the measured energy expenditure? 
NO
f.
 YES
Is the Respiratory Quotient (RQ) used?  No  Yes, to decide if a patient is
over/underfed  Yes, to decide if the balance between carbohydrate/lipid intake
is adequate  Yes, to decide if the measurement is valid Other
10. The protein target used in your PICU is closest to the following guideline:
 ASPEN (0-2 years 2-3 g/kg/d, 2-13 years 1,5-2 g/kg/d, 13-18 years 1,5 g/kg/d)
 ESPEN/ESPGHAN (neonates 1,5-3 g/kg/d, 2 months-3 years 1-2,5 g/kg/d, 3-18 years
1-2 g/kg/d, critically ill 3 /kg/d)
 National Recommended Daily Allowances (RDA) (NL: neonates 1,8 g/kg/d, 1-12
months 1,2 g/kg/d, > 1 year 0,9 g/kg/d)
11. What is the (parenteral) lipid target used in your PICU (g/kg/day)?
 < 1.5 g/kg/d
 1.5 tot 2.5 g/kg/d
 2.5-3.5 g/kg/d
 > 3.5 g/kg/d
 No idea
 Other
Enteral nutrition (EN)
1. What is the (average) target time for starting enteral feeds after PICU admission?  No
target time, depends on the attending physician’s choice
 <6 hours  6-12 hours 
13-24 hours  25-48 hours  >48 hours
2. In your opinion, how many days (average) post-admission would you be able to feed
patients exclusively by enteral route in your PICU?  <2 days  2-3 days  4-5 days  67 days  >7 days
3. What is the preferred route for EN administration?  Jejunal  duodenal  gastric  no
preference
4. How is a post-pyloric tube inserted?  By endoscopy
insertion  Echographic  Other
 By fluoroscopy  Blind
5. How is a post-pyloric tube position controlled?  Radiographic  Biochemical indicators
 Not  Other
6. Are intermittent or continuous feedings preferred?
a. In ventilated patients:  intermittent  continuous  no preference
b. In non-ventilated patients  intermittent  continuous  no preference
c. In patients fed by gastric tube  intermittent  continuous  no preference
d. In patients fed by post-pyloric tube:  intermittent  continuous  no preference
7. For what reasons is enteral feeding stopped or decreased?  High gastric residuals 
Abdominal distension or pain  Diarrhoea  Vomiting  Reduced or altered bowel
sounds  Haemodynamic instability  Use of muscle relaxants  Frequent procedures
requiring fasting  Surgical post-op orders  other (specify
8. Are prokinetic agents used?  No  Yes, if a child is not tolerating feeds  Yes, in
every patient with a feeding tube  Other
9. Is use of stress ulcer prophylaxis common in your unit?  No  Yes, in all PICU
patients  Yes, if a child is on mechanical ventilation  Yes, in every patient with
coagulopathy  Yes, if a child is on steroids other
Parenteral nutrition (PN)
1. How much glucose is administered during the first 12-24 hours of admission: < 10KG
and 10-30KG and >30 KG:
 2-4 mg/kg/min  4-6 mg/kg/min  6-8 mg/kg/min  8-10 mg/kg/min
2. How do you define hypoglycemia in your PICU?  < 4,4 mmol/L (<80 mmg/dl)  < 3,9
mmol/L (,70 mg/dl)  < 2.8 mmol/L (<50 mg/dl)  < 2,2 mmol/L (<40 mg/dl)  <1,7
mmol/L (<30 mg/dl)  other
3. At what glucose level is extra glucose administered (bolus or increased intake)?
 < 3,9 mmol/L (<70 mg/dl)  < 2.8 mmol/L (,50 mg/dl)  < 2,2 mmol/L (,40 mg/dl) 
<1,7 mmol/L (<30 mg/dl)  other
5. Is the definition of hypoglycemia age or weight-dependent?  No  Yes
4. Is there a protocol for hyperglycemia treatment available?  No  Yes
5. What is the target blood glucose level in your PICU patients?  <10 mmol/L (<180 mg/dl)
 <8 mmol/L (<144 mg/dl)  <6 mmol/L (<108 mg/dl)  <5 mmol/L (<90
mg/dl)  2.8-4.4 mmol/L (age < 1 year) 3.9-5.5 mmol/L (age 1-16 y)
6. Is the target blood glucose..?
a. age/weight-dependent?  No  Yes
b. different for certain patient populations (e.g. brain injury)?  No  Yes
7. At what point would you start PN in a child (expected to be) intolerable to enteral feeds?
 < 24 hours  < 48 hours  2-4 days  4-7 days  >7 days  other
8. When enteral nutrition is provided but is insufficient to meet target goals, would PN be
added? No  Yes, always  Yes, if enteral nutrition covers < 80% of target calories 
Yes, if enteral nutrition covers < 50% of target calories  other
9. If PN is given in combination with EN at what moment (percentage of nutritional target
achieved by EN) is PN stopped?  If enteral nutrition covers 100% of target calories  If
enteral nutrition covers > 80% of target calories  If enteral nutrition covers > 50% of
target calories  Other
10. How is PN provided in your institution?:  Pharmacy-customized, age/weight specific 
Commercial mixed bags  Other
11. Is it possible to administer PN without a central venous line?  No  Yes
12. Which lipid emulsion(s) is/are used?  Intralipid (Fresenius)  Smoflipid (Fresenius) 
Omegaven (Fresenius)  Clinoleic (Baxter)  Lipoplus (Braun)  Other…
13. What is your policy regarding parenteral lipid administration?  Start at maximal dose
Start at 50% of maximal dose Dose depends on blood parameters  Dose depends on
clinical parameters  Other…
14. When is lipid administration stopped? Or decreased?  Triglycerides > 5 mmol/L 
Triglycerides 3,5- 5 mmol/L  Triglycerides <3,5 mmol/L  Fever  Sepsis  Other
15. When is protein administration stopped? or decreased?  Urea < 10 mmol/L  Urea 1015 mmol/L  Urea > 15 mmol/L  Kidney failure  Other …..
16. Do you routinely administer vitamins and trace elements, when no PN is given.  No 
Yes
17. Do you have anything to add to this survey?
18. What’s your name and email-address (for future references, not mandatory)
Part 2: point-prevalence
Patient number 1:
Patient demographics
1. Gender
a. Male
b. Female
2. Age category
a. Neonate (0-1 month)
b. Infant (1 month – 1 year)
c. Child 1-5 years
d. Child 5-10 years
e. Child 10-15 years
f. Adolescent > 15 years
3. Diagnosis category
a. Medical – respiratory
b. Medical – neurologic
c. Medical – cardiac
d. Medical – other
e. Surgical – abdominal
f. Surgical – cardiac
g. Surgical - trauma
h. Surgical – neurologic
i. Surgical - other
General information
1. PICU length of stay at moment of data entry : … days
2. Ventilation at moment of data entry
a. Yes, invasive
b. Yes, non-invasive
c. No
3. Weight used for calculation of requirements: … kg
Enteral nutrition details
1. Is enteral nutrition (EN) provided in this patient?
2. If yes: How is enteral nutrition provided?
a. Gastric tube
b. Duodenal tube
c. Jejunal tube
d. Other
3. If yes: What type of enteral formula was used for today? (select up to 3) Please also note
the volume of enteral nutrition administered.
Parenteral nutrition details
1. What type of dextrose infusion (No TPN!) and volume was administered today? (select
up to 3) If no dextrose infusion is provided, please go on to the next question
2. Is continuous insulin administered to treat hyperglycemia?
a. Yes
b. No
3. How is parenteral nutrition provided:
a. Commercial mixed bag with dextrose, protein and lipids
b. Commercial bags: separated dextrose, protein and lipids
c. Commercial bags: combined dextrose and protein, separated lipids
d. Handmade/pharmacy made
4. If Commercial mixed bag: what type of parenteral nutrition (commercial mixed bag) was
provided and what volume?
Type of mixed bag (eg
Olimel)
Volume (ml/hour)
Volume (ml/24 hours)
5. If commercial bags: separated glucose, protein and lipids: What type of dextrose, protein
and lipids were provided and what volume?
Type of dextrose bag (eg
20% dextrose)
Volume (ml/hour)
Volume (ml/24 hours)
Type of protein (eg primene
10%)
Type of lipid (eg intralipid)
6. If commercial bags: combined glucose and protein, separated lipids : What type of
dextrose/protein and lipids were provided and what volume
Type of dextrose/protein bag
(eg clinimix)
Type of lipid (eg intralipid)
Volume (ml/hour)
Volume (ml/24 hours)
7. If handmade/pharmacy made: please provide a description of the different components
of the handmade parenteral nutrition and if possible the energy and protein provided in
total/day. Only fill out the fields that apply to your handmade PN
Type of dextrose Volume
(ml/hour)
(eg dextrose
20%)
Volume (ml/24
hours)
Energy provided Protein
in kcal/day
provided in
(NOT per kg)
g/day (NOT
per kg)
Type of protein
(eg primene
10%)
Type of lipid (eg
intralipid)
Combined PN
(eg dextrose
20%, amino
acids 5%)
8. If no parenteral nutrition: Are vitamins/trace elements provided intravenously?
a. Yes
b. No
9. Do you want to add another patient?
If yes  same questions for patient 2 and so on…