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Feasibility and safety of a modified volume-based feeding protocol in critically ill children: A pilot study

María José Solana García1,2,3,4, Jorge López González1,3,4, Gema Manrique Martín1,3,4

  • 1Pediatric Intensive Care Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain.

Journal of Pediatric Gastroenterology and Nutrition
|January 6, 2026
PubMed

Insights

A modified volume-based feeding practice (MVBFP) is feasible and safe for critically ill children, ensuring adequate nutrition despite enteral nutrition interruptions. This approach improves caloric and protein delivery without adverse effects.

Area of Science:

  • Pediatric critical care
  • Clinical nutrition
  • Medical interventions

Background:

  • Enteral nutrition interruptions (ENIs) are frequent in critically ill children, often leading to underfeeding.
  • Volume-based feeding practices (VBFPs) can mitigate ENIs but lack reporting in pediatric critical care.

Purpose of the Study:

  • To assess the feasibility and safety of a modified VBFP (MVBFP) in critically ill children.
  • To evaluate if compensatory feeding over 24 hours can manage ENIs effectively.

Main Methods:

  • A prospective longitudinal study involving critically ill children (1 month-18 years) receiving enteral nutrition.
  • Implementation of MVBFP with compensatory increased enteral feeding goal rates (CIEFGR) to replace lost volume within 24 hours.
  • Data collection included demographics, ENI details, compensatory feeding parameters, intake, and adverse events.

Main Results:

  • Twenty-eight CIEFGR events occurred in 21 children, with a median compensatory period of 24 hours.
  • Significant increases in caloric (18.8 kcal/kg) and protein (0.5 g/kg) delivery were achieved.
  • Mild gastrointestinal signs occurred in 10.7% of episodes, requiring no intervention; no significant metabolic alterations were observed.

Conclusions:

  • A modified VBFP using compensatory feeding is a feasible and safe strategy for critically ill children.
  • This approach effectively improves caloric and protein delivery, mitigating underfeeding risks from ENIs.
  • The MVBFP strategy does not appear to increase gastrointestinal side effects in this population.
Abstract

Keywords:
critical careenteral nutrition interruptionsnutritionpediatric critical care

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