Nutrition therapy in the critically ill child.
OBJECTIVE
Malnutrition and obesity are prevalent in children admitted to the pediatric intensive care unit. Nutritional deterioration secondary to suboptimal nutrient delivery can adversely affect outcomes during pediatric critical illness. This review highlights the recent investigations of nutrition assessment, energy balance, indirect calorimetry, nutrition therapy, barriers to nutrient delivery, monitoring during enteral feeding, and the role of nutrition guidelines in critically ill children.


RESULTS
Critically ill children are at high risk for energy and protein imbalance. Indirect calorimetry remains the only accurate method to assess energy requirements in this population. Intensive insulin therapy to achieve glycemic control may reduce morbidity and mortality in adults, but risks hypoglycemia in critically ill children. Early enteral nutrition improves nutrition outcomes and adherence to nutrition guidelines can overcome barriers to optimal nutrition therapy.


CONCLUSIONS
Timely and adequate nutrition therapy is essential to improve nutrition outcomes in critically ill children. Further research is required to determine clinical outcome benefits with indirect calorimetry and enteral nutrition guidelines, and to identify optimal glucose targets.
Department of Clinical Nutrition, Children's Hospital Colorado, Aurora, Colorado, USA.
Heather E
HE
Skillman
Nilesh M
NM
Mehta
D000293:Adolescent; D002153:Calorimetry, Indirect; D002648:Child; D002675:Child, Preschool; D016638:Critical Illness / Q000401:mortality / Q000628:therapy*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric; D008297:Male; D044342:Malnutrition / Q000178:diet therapy* / Q000401:mortality; D044623:Nutrition Therapy / Q000379:methods*; D009765:Obesity / Q000178:diet therapy* / Q000401:mortality