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Nutritional Support in the Pediatric ICU

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Abstract

Nutritional status and adequacy are associated with clinical outcomes during critical illness. Though there are significant knowledge gaps in our understanding of the optimal nutrient strategy for critically ill children, there have been incremental advances in the field to guide bedside practice. Malnutrition and nutritional deterioration are prevalent among critically ill children and have been associated with poor clinical outcomes. However, early detection of malnutrition and those at risk of nutritional deterioration is hindered by the lack of reliable screening tools and availability of accurate anthropometry. The optimal prescription of nutrition would require consideration of the body’s unpredictable response to metabolic stress. Currently available equations provide inaccurate estimates of energy requirements during critical illness. Indirect calorimetry remains the gold standard for measuring resting energy expenditure and helps prevent unintended underfeeding and overfeeding. Ultimately, the goal of optimal nutrition during critical illness is to improve patient outcomes. Preventing lean muscle loss is an important target, as muscle loss has been associated with worse clinical outcomes. Minimum protein intake of 1.5 g/kg/day may be necessary to achieve a positive protein balance. Enteral nutrition is the preferred route of nutrient delivery, and strategies to diagnose and manage enteral feeding intolerance are being investigated. Recent data should guide the timing of supplemental parenteral nutrition when enteral nutrition is not feasible or insufficient. Future studies designed to assess the efficacy of immunonutrition are desired before this practice can be recommended.

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Authors and Affiliations

  1. Division of Cardiovascular Critical Care, Department of Cardiology, Boston Children’s Hospital, Boston, MA, USA

    Kimberly I. Mills

  2. Division of Critical Care Medicine, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Boston, MA, USA

    Nilesh M. Mehta

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  1. Kimberly I. Mills
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  2. Nilesh M. Mehta
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Correspondence to Kimberly I. Mills .

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Editors and Affiliations

  1. Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN, USA

    Christopher W. Mastropietro

  2. Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN, USA

    Kevin M. Valentine

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Mills, K.I., Mehta, N.M. (2019). Nutritional Support in the Pediatric ICU. In: Mastropietro, C., Valentine, K. (eds) Pediatric Critical Care. Springer, Cham. https://doi.org/10.1007/978-3-319-96499-7_8

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