Background

The Metabolism and Nutrition (MEN) section of the European Society of Paediatric and Neonatal Intensive Care (ESPNIC) has developed clinical recommendations for nutritional support in PICU. A systematic literature search was conducted to answer 14 clinical questions which generated 33 recommendations. The lack of methodologically sound trials using clinically relevant outcomes and the very heterogeneous character of a PICU population were important barriers in the completion of these recommendations. Most of the recommendations are based on expert consensus and have a (very) low level of evidence. Acknowledging these limitations, the recommendations summarize the available literature and are intended to provide practical guidance to clinicians around important clinical questions including different subgroups of critically ill children, many of which are not covered by previous guidelines. Our recommendations support the use of a nutritional assessment and a feeding protocol in all PICUs. The optimal dose of macronutrients during the course of illness remains an area of great interest, and the awareness of overfeeding a child during acute critical illness is emerging. In addition to caloric intake, the optimal timing and dose of proteins require an alternate perspective and more investigation. Although early enteral nutrition is recommended, accepting low enteral intakes appears to be beneficial and should not be supplemented with PN during the first week in PICU. Focus is shifting towards optimizing enteral nutrition during critical illness with use of enriched and/or hydrolysed formulas.

Objectives

objectives

Methods

Methods Methods

Results

Results Results

Conclusion

.Conclusion