World Journal of Pediatrics

, Volume 14, Issue 5, pp 419–428 | Cite as

Chinese guidelines for the assessment and provision of nutrition support therapy in critically ill children

  • Xue-Mei Zhu
  • Su-Yun QianEmail author
  • Guo-Ping Lu
  • Feng Xu
  • Ying Wang
  • Chun-Feng Liu
  • Xiao-Xu Ren
  • Yu-Cai Zhang
  • Heng-Miao Gao
  • Tao Zhou
  • Hong-Xing Dang
  • Chong-Fan Zhang
  • Yi-Min Zhu
Review Article



This document represents the first evidence-based guidelines to describe best practices in nutrition therapy in critically ill children (> 1 month and < 18 years), who are expected to require a length of stay more than 2 or 3 days in a Pediatric Intensive Care Unit admitting medical patients domain.


A total of 25,673 articles were scanned for relevance. After careful review, 88 studies appeared to answer the pre-identified questions for the guidelines. We used the grading of recommendations, assessment, development and evaluation criteria to adjust the evidence grade based on the quality of design and execution of each study.


The guidelines emphasise the importance of nutritional assessment, particularly the detection of malnourished patients. Indirect calorimetry (IC) is recommended to estimate energy expenditure and there is a creative value in energy expenditure, 50 kcal/kg/day for children aged 1–8 years during acute phase if IC is unfeasible. Enteral nutrition (EN) and early enteral nutrition remain the preferred routes for nutrient delivery. A minimum protein intake of 1.5 g/kg/day is suggested for this patient population. The role of supplemental parenteral nutrition (PN) has been highlighted in patients with low nutritional risk, and a delayed approach appears to be beneficial in this group of patients. Immune-enhancing cannot be currently recommended neither in EN nor PN.


Overall, the pediatric critically ill population is heterogeneous, and an individualized nutrition support with the aim of improving clinical outcomes is necessary and important.


Adolescents Children Critical illness Enteral nutrition Indirect calorimetry Infant Malnutrition Nutrition assessment Parenteral nutrition Pediatric Resting energy expenditure 


Author contributions

All authors contributed equally to this paper.


This study was funded in total by internal funds from the Emergency group of Chinese Pediatrics Society and Pediatrics Group of Chinese Emergency Society, both of which are affiliated to the Chinese Medical Association.

Compliance with ethical standards

Ethical approval

Not required for this Guideline.

Conflict of interest

No financial interests have been received directly or indirectly related to the subject of this article. The guidelines are intended for general information only, and do not replace professional medical care and physician advice, which always should be sought for any medical condition.

Supplementary material

12519_2018_175_MOESM1_ESM.tif (550 kb)
Supplementary Fig. 1 Mortality curves using Z score groups from both WFA OR WFH/BMI (TIFF 550 kb)
12519_2018_175_MOESM2_ESM.tif (949 kb)
Supplementary Fig.2 The aggregated MREE and the bias between MREE and EEEs (kcal/kg/d) (TIFF 949 kb)
12519_2018_175_MOESM3_ESM.tif (833 kb)
Supplementary Fig. 3 The aggregated MREE and the bias between MREE and EEEs (kcal/d) (TIFF 832 kb)
12519_2018_175_MOESM4_ESM.tif (1.6 mb)
Supplementary Fig. 4 Survival rates between immune-enhancing and non immune-enhancing groups (TIFF 1683 kb)
12519_2018_175_MOESM5_ESM.tif (1.2 mb)
Supplementary Fig. 5 Length of hospital stay between immune-enhancing and non immune-enhancing groups (TIFF 1258 kb)
12519_2018_175_MOESM6_ESM.tif (2.6 mb)
Supplementary Fig. 6 ICU stay between immune-enhancing and non immune-enhancing groups (TIFF 2674 kb)
12519_2018_175_MOESM7_ESM.tif (1 mb)
Supplementary Fig. 7 Duration of mechanical ventilation between immune-enhancing and non immune-enhancing groups (TIFF 1041 kb)
12519_2018_175_MOESM8_ESM.tif (1.2 mb)
Supplementary Fig. 8 Incidence of nosocomial infection between immune-enhancing and non immune-enhancing groups (TIFF 1258 kb)
12519_2018_175_MOESM9_ESM.tif (969 kb)
Supplementary Fig. 9 Incidence of adverse events between immune-enhancing and non immune-enhancing groups (TIFF 969 kb)


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Copyright information

© Children's Hospital, Zhejiang University School of Medicine 2018

Authors and Affiliations

  • Xue-Mei Zhu
    • 1
  • Su-Yun Qian
    • 2
    Email author
  • Guo-Ping Lu
    • 1
  • Feng Xu
    • 3
  • Ying Wang
    • 4
  • Chun-Feng Liu
    • 5
  • Xiao-Xu Ren
    • 6
  • Yu-Cai Zhang
    • 7
  • Heng-Miao Gao
    • 2
  • Tao Zhou
    • 8
  • Hong-Xing Dang
    • 3
  • Chong-Fan Zhang
    • 1
    • 8
  • Yi-Min Zhu
    • 9
  1. 1.Children’s HospitalFudan UniversityShanghaiChina
  2. 2.Beijing Children’s Hospital, Capital Medical UniversityNational Center for Children’s HealthBeijingChina
  3. 3.Children’s Hospital of Chongqing Medical UniversityChongqingChina
  4. 4.Shanghai Children’s Medical CenterShanghaiChina
  5. 5.Shengjing Hospital of China Medical UniversityShenyangChina
  6. 6.The Capital Institute of PediatricsBeijingChina
  7. 7.Shanghai Children’s HospitalShanghai Jiao Tong UniversityShanghaiChina
  8. 8.Boai Hospital of Zhongshan Affiliated to Southern Medical UniversityZhongshanChina
  9. 9.Hunan Provincial People’s HospitalChangshaChina

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