Association between enteral formula type and nutritional failure in critically ill children: A single-center...

Enteral nutrition is a fundamental component of care in critically ill children, yet uncertainty remains about the most appropriate formula. The aim of this study is to compare peptide-based formulas (PBF) and fiber-enriched polymeric formulas (FEF) with respect to feeding failure, intolerance, and progression toward nutritional goals in a PICU population. This study summarizes a single-center experience in a tertiary Pediatric Intensive Care Unit in Türkiye and included 225 children, aged 1-18 years, who received enteral nutrition for at least 48 h between 2021 and 2024. A total of 116 patients were started on PBF and 109 on FEF. Feeding failure was defined as discontinuation of enteral nutrition, switching formula, or failure to achieve ≥ 66% of prescribed caloric targets by day 7. Feeding intolerance rates were similar between groups. However, feeding failure occurred more frequently in the FEF group compared to the PBF group (43.1% vs. 29.3%, p = 0.037). After adjustment for relevant clinical variables, initiation with FEF remained independently associated with feeding failure (OR 2.18; 95% CI 1.22-3.88; p = 0.009). Nutritional risk scores improved earlier over the first 14 days in the PBF group. Patients receiving PBF also demonstrated higher protein delivery and reached caloric targets sooner.

Our results showed that peptide-based formula was associated with lower rates of feeding failure and faster achievement of nutritional targets. While causality cannot be inferred from this retrospective design, formula selection may represent an important, potentially modifiable factor in nutritional management during the PICU stay.

• Enteral nutrition is a fundamental component of care for critically ill children, yet achieving optimal gastrointestinal tolerance and meeting nutritional goals remains a significant clinical challenge. • Although specialized enteral formulas are developed to improve feeding tolerance, evidence directly comparing the efficacy of peptide-based versus fiber-enriched polymeric formulas in pediatric intensive care units is limited.

• Initiation of enteral nutrition with a peptide-based formula is associated with a significantly lower rate of feeding failure compared to fiber-enriched polymeric formulas in critically ill children. • Patients receiving peptide-based formulas demonstrate earlier improvement in nutritional risk scores and achieve their prescribed caloric and protein targets more rapidly.