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Impact of enteral nutrition interruption in critically ill children: A systematic review and meta-analysis
Jinjiu Hu1, Hangyang Li1, Ziyang Wang1
1Department of Nursing, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatric Metabolism and Inflammatory Diseases, Chongqing, China.
Insights
More than half of critically ill children in pediatric intensive care units (PICUs) experience interruptions to their enteral nutrition (EN). These interruptions, often due to procedures or feeding intolerance, may prolong PICU stays.
Area of Science:
- Pediatric Intensive Care
- Clinical Nutrition
- Critical Care Medicine
Background:
- Enteral nutrition (EN) is crucial for critically ill children in pediatric intensive care units (PICUs).
- Interruptions to EN (ENIs) are common and can exacerbate malnutrition in this vulnerable population.
- Understanding the prevalence, causes, and consequences of ENIs is vital for improving patient outcomes.
Purpose of the Study:
- To systematically review the prevalence, causes, and clinical consequences of EN interruptions in critically ill children admitted to the PICU.
- To synthesize existing evidence on the impact of ENIs on patient outcomes.
- To identify gaps in current research and recommend future study methodologies.
Main Methods:
- Comprehensive literature searches were conducted across multiple databases (Web of Science, PubMed, Embase, etc.).
- Included studies were cohort, case-control, or cross-sectional designs published up to February 2025.
- Data synthesis involved random-effects modeling for prevalence and outcome associations, acknowledging high heterogeneity.
Main Results:
- Sixteen studies involving 4325 children were included.
- The overall prevalence of ENIs was 52.8%, with significant heterogeneity (I² = 94.64%).
- Common causes included intra-PICU procedures (34.4%), surgery (23.2%), and feeding intolerance (19.8%). ENI may be associated with a 7.02-day longer PICU stay (I² = 87.7%).
Conclusions:
- Over half of PICU children experience ENIs, highlighting a significant clinical challenge.
- High heterogeneity across studies hinders definitive interpretation of pooled data.
- Standardized methodologies are recommended for future international studies to provide robust evidence on ENIs in critically ill children.
Abstract:
Children in pediatric intensive care units (PICUs) often experience forced interruptions of enteral nutrition (EN), which can worsen malnutrition. This systematic review aims to assess the prevalence, causes, and clinical consequences of EN interruptions (ENIs) in critically ill children admitted to the PICU. For this review, literature searches were performed in the Web of Science, PubMed, Embase, Cochrane Library, Medline, CNKI, and WanFang Data databases. Studies included those that were cohort, case-control, or cross-sectional designs and were published from the inception of each database to February 2025. Sixteen studies were included, including 14 cohort and 2 cross-sectional studies, involving 4325 children. Thirteen studies reported on the prevalence of ENI, with an overall prevalence of 52.8% (95% CI, 0.415-0.638) for the random-effects combination and high heterogeneity (I² = 94.64%, P < 0.001). Twelve studies detailed the reasons for interruptions, and the three most common reasons were intra-PICU procedures, surgery, and feeding intolerance, with median prevalences of 34.4%, 23.2%, and 19.8%, respectively. Six studies described the impact on clinical outcomes for children. Some results showed that ENI may be associated with a longer PICU stay for critically ill children by 7.02 days (95% CI, 1.16-12.88), with high heterogeneity (I2 = 87.7%; P < 0.001). More than half of PICU children experience ENIs; however, the extreme heterogeneity hinders the meaningful interpretation of the pooled indices. We therefore recommend standardizing the methodology to conduct future internationally representative studies, providing data support for future systematic reviews.
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