Nutritional Support in Critically Ill Pediatric Patients
Summary
Critically ill children are at high risk of malnutrition due to increased metabolic demands, inflammatory responses and interruptions in routine care. Optimal nutritional support in paediatric intensive care units (PICUs) seeks to preserve lean body mass, maintain organ function and modulate immune responses. Early initiation of enteral nutrition, ideally within the first 24–48 hours of admission, is associated with improved tolerance and reduced infectious complications. Energy requirements vary with age, underlying pathology and intensity of life-support modalities, necessitating dynamic assessment of energy expenditure through predictive equations or indirect calorimetry. Protein targets of 1.5–2.5 g/kg/day support anabolic processes and wound healing. Micronutrient and trace-element provision must be carefully balanced to avoid deficiencies of vitamins A, D and zinc, which influence immune function. Barriers to effective feeding include gastrointestinal dysmotility, perceived feeding intolerance and procedural interruptions, all of which contribute to cumulative energy and protein deficits. Modern practice emphasises stepwise feeding algorithms, multidisciplinary rounds involving dietitians and nurses, and protocols to minimise avoidable interruptions. Emerging approaches explore circadian timing of nutrition, immune-modulating substrates such as glutamine and omega-3 fatty acids, and the role of the gut microbiome in maintaining mucosal integrity. Integration of nutritional strategies with organ support—especially in extracorporeal membrane oxygenation and renal replacement therapy—recognises that each modality alters nutrient kinetics and requirements. Globally, standardisation of terminology and consensus on best practice are evolving, with an emphasis on personalised nutrition to improve short- and long-term outcomes in this vulnerable population.
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Nutritional Support in Critically Ill Pediatric Patients publication trend
The graph below shows the total number of articles in nutritional support in critically ill pediatric patients across all publications each year (not limited to Nature Index journals).
Technical terms
Enteral nutrition (EN): Delivery of nutrients directly into the gastrointestinal tract via feeding tubes, recommended as first-line support in critical care.
Parenteral nutrition (PN): Intravenous administration of macro- and micronutrients when EN is contraindicated or insufficient to meet metabolic needs.
Extracorporeal membrane oxygenation (ECMO): A form of life support providing cardiac and respiratory assistance, associated with increased catabolism and complex nutritional management.
Enteral nutrition interruptions (ENIs): Unplanned cessation of tube feeding due to procedures or perceived intolerance, leading to deficits in energy and protein intake.
References
- Research progress on nutritional support in the neonatal and pediatric populations receiving extracorporeal membrane oxygenation. Frontiers in Nutrition (2024).
- Prevalence, Risk Factors and Impact of Nutrition Interruptions in Critically Ill Children. Nutrients (2023).
- Feeding critically ill patients at the right time of day. Critical Care (2024).
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