Enteral nutrition usage in critically ill children: A descriptive cohort study

Children admitted to pediatric intensive care units requiring nutrition support receive enteral nutrition formula. Guidelines recommend concentrated formula in fluid restriction, meet 2/3 estimated energy need, a minimum 1.5 g/kg/day dietary protein and dietary recommended intakes for micronutrients. The objective of this retrospective cohort study was to compare nutrition delivery in critically ill children 1-18 years against current guidelines.

Three years of charts were included over two cohorts: September 2018 to December 2020 and February 2022 to March 2023. The first cohort included demographics and nutrient intake, while the second included feeding interruption details. Logistic and linear regression models were employed to assess associations of macro-nutrient and micro-nutrient intake with age and formula type. Pearson correlations examined relationship between interruption hours and energy goal.

Children (n = 86) that were included spanned 459 nutrition support days. Concentrated formula was provided in 34% of nutrition support days, goal of 2/3 estimated energy need met in 43.9% and 24.9% met minimum protein intake. Micronutrients were mostly met with prescribed volumes; however, vitamin D and selenium intakes were inadequate in pediatric formula products. Length of interruptions was 5 h per day with an average of two interruptions.

Nutrient intake recommendations are unable to be met in critically ill children when comparing one enteral nutrition formula product against multiple different age group recommendations. The age ranges for formula use needs to be reviewed on an institutional basis with strong consideration of concentrate products.