Feed Modification for Improved Energy and Protein Provision for Infants and Young Children in the Pediatric Critical...

The aim of this review was to explore key definitions, concepts, methods, and evidence for feed modification for improved energy and protein provision for infants and young children in the pediatric critical care setting. Attaining nutrition targets in the pediatric intensive care unit (PICU) is challenging, with suboptimal nutrition associated with poor outcomes. Modification of oral and enteral feeds, via supplementation or substitution with concentrated formula, to increase energy and protein provision is a common strategy utilized to address these gaps. However, there is limited literature and no expert consensus to guide this practice. We conducted a scoping review following JBI (Joanna Briggs Institute) methodology of all English-language studies (excluding reviews) exploring feed modification in the PICU in children aged up to 5 years published between 2010 and January 4, 2025. Of 2696 studies screened, 14 were included, with 57% (n = 8) published since 2020. Ten (71%) studies were randomized controlled trials and 8 (80%) of these explored congenital heart disease. Interventions comprised concentrated infant formula powder (n = 3; 30%), ready-to-feed liquid formula (n = 3; 30%), and expressed breast milk (n = 2; 20%). Primary outcomes varied with nutritional intake-related (n = 5; 50%) measures most frequently utilized. No consistent terminology was used to refer to "feed modification". Tolerance, ease of preparation, and contamination risk were identified as important considerations. In conclusion, a variety of techniques were used, with no consistent definitions, and the randomized trials were inconsistent in methodology and did not measure patient-centered outcomes. Further research is required to reach consensus for practice guidelines following further establishment of methods of feed modification that address nutrition gaps and improve patient outcomes.