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Optimal nutrition therapy of critically ill children has emerged as an important goal. Studies indicate up to 64% of children admitted to pediatric intensive care units (PICUs) are malnourished,1-4 and these children are at a greater risk for prolonged mechanical ventilation and hospital stay, compared to their well-nourished counterparts.4,5 The degree of malnutrition depends on the disease type, duration, and comorbidities. The provision of adequate nutrition to the critically ill child is paramount to reducing further nutritional deterioration in an already compromised host. Malnutrition evolves during critical illness and most prominently affects newborns and infants.2 The American Society for Parenteral and Enteral Nutrition (A.S.P.E.N) guidelines (Please see Table 9.1) recommend early enteral nutrition (EN) in critically ill children with a functional gastrointestinal (GI) tract.6


There are emerging data supporting the role of enteral feeds in critically ill children. Enteral nutrition in this population is well tolerated,7-11 is associated with reduced complications compared with parenteral nutrition (PN),4,7 and can be delivered via the gastric or transpyloric route.12,13 Enteral nutrition is also associated with reduced mortality and length of stay in this population.4,14 Despite its perceived benefits, EN delivery in the PICU remains challenging. When enteral feeding is protocolized or supported through a nutrition support team, time to feeding and tolerance improve.15,16-20 Children who are in intensive care units (ICUs) for whom a feeding protocol is implemented experience fewer infections4 are more likely to meet energy needs19 and achieve positive protein and energy balance21 sooner than do those who do not received protocolized enteral feeding. However, a majority of critically ill children do not meet recommended daily allowance of energy and protein intake,3 and even with feeding protocols, children may be under- or overfed when using respiratory quotient (RQ) as a measurement.22

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TABLE 9-1.

A.S.P.E.N Pediatric Nutrition Support Guideline Recommendations

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