307 - Nutrition Management in Critically Ill Children: Current Practices and Outcomes in the Pediatric Intensive Care Unit

Publication Number: 3296.307

Purosky R. Isabella, Michigan State University College of Human Medicine, Muskegon, MI, United States; Terry Griggs, Michigan State University College of Human Medicine, Grand Rapids, MI, United States; Mara L. Leimanis-Laurens, Helen DeVos Children's Hospital, Grand Rapids_D Level, MI, United States; Chana Kraus-Friedberg, MIchigan State University, Lansing, MI, United States

Background: Nutrition is essential to outcomes for critically ill children, yet optimal timing, composition, and route of feeding remain uncertain. Prior studies show variability in design, outcome measures, and populations, limiting comparability.

Objective: To systematically review international pediatric intensive care unit (PICU) nutrition studies evaluating timing, route, and content of nutritional interventions and summarize their effects on clinical outcomes and nutritional adequacy.

Design/Methods: A state-of-the-art review was conducted using the PICOS framework (Population, Intervention, Comparison, Outcomes, Study design) to identify studies on nutritional interventions and prognosis in critically ill children. Comprehensive searches of PubMed, Embase, and WHO identified 567 studies published between 2015 and 2025. Of 567 titles and abstracts screened by two independent reviewers using Covidence, 330 were excluded, and 237 full-text articles were reviewed. After excluding 211 articles that did not meet criteria, 26 studies were included. Eligible studies enrolled critically ill patients ≤21 years old admitted to PICUs and assessed timing (early vs late enteral), content, or route (enteral vs parenteral) of nutritional interventions. Studies of cardiac intensive care, neonatal, or non-critically ill populations, micronutrient-only interventions, or lacking nutrition outcomes were excluded. Articles were screened by two independent reviewers using the STROBE guidelines (22-point checklist; IRR 88.5%), with average quality scores of 92.5%. The protocol was registered with PROSPERO.

Results: Of 26 included studies, 8 (31%) were conducted in the U.S. and 18 (69%) internationally, including Asia, Australia, Europe, and Latin America. Designs included 5 randomized controlled trials (19%) and 21 cohort or observational studies (81%). 4 (15%) examined the route of feeding, 10 (38%) content, and 11 (42%) timing. Reported outcomes included feeding intolerance or adverse events in 8 (31%) studies, ventilation duration in 9 (35%), time to nutrition goals in 11 (42%), PICU length of stay in 12 (46%), mortality in 13 (50%), and nutrition adequacy in 17 (65%). Median age of participants across studies was 9.5 months (1 month - 13.5 years), and median sample size was 99.5 (18 - 1844).

Conclusion(s): This state-of-the-art review will summarize global evidence on the timing, route, and composition of nutritional interventions in critically ill pediatric patients, emphasizing the persistent burden of malnutrition across income settings and countries by identifying nutrition gaps that influence recovery and length of stay.