title: Nutritional support and the role of the stress response in critically ill children.
abstract: OBJECTIVE
  Nutrition impacts outcome in critically ill children. Based on evolving neuro-endocrine, immunologic and metabolic alterations, three different phases can be proposed during the course of illness. The different phases each demand for tailored macronutrient intakes in critically ill children.
  
  
  RESULTS
  Early enteral nutrition is associated with decreased morbidity and mortality, but several misconceptions concerning the provision of enteral nutrition prevent adequate intake. Parenteral nutrition in critically ill children is associated with potential disadvantages, as nosocomial infections, but evidence on the effect on clinical outcome is lacking. Nutrient restriction early during critical illness might be beneficial for short and long-term outcomes by decreasing the incidence of side-effects and possibly by amplifying the acute catabolic stress response and stimulating autophagy and muscle integrity. Higher caloric and protein intake via the enteral route are associated with higher 60-day survival, asking for a more aggressive feeding approach in subsequent phases.
  
  
  CONCLUSIONS
  Understanding the stress response to critical illness and its phases is essential for nutritional recommendations in critically ill children. Although parenteral nutrient restriction during the acute phase might be beneficial, inclining requirements ask for a more aggressive approach during the stable and recovery phase to enable recovery, growth and catch-up growth.
authors.affiliation: Paediatric Intensive Care, Department of Paediatrics and Paediatric Surgery, Erasmus MC - Sophia Children's Hospital, Rotterdam, The Netherlands.
authors.forename: Koen F M
authors.initials: KF
authors.lastname: Joosten
authors.forename: Dorian
authors.initials: D
authors.lastname: Kerklaan
authors.forename: Sascha C A T
authors.initials: SC
authors.lastname: Verbruggen
mesh_terms: D002648:Child; D002657:Child Development; D002664:Child Nutritional Physiological Phenomena; D003131:Combined Modality Therapy / Q000639:trends; D003422:Critical Care / Q000639:trends; D016638:Critical Illness / Q000534:rehabilitation / Q000628:therapy*; D018450:Disease Progression; D002149:Energy Intake; D004734:Energy Metabolism; D006801:Humans; D007107:Immune System / Q000276:immunology / Q000378:metabolism / Q000503:physiopathology; D015278:Intensive Care Units, Pediatric; D009490:Neurosecretory Systems / Q000276:immunology / Q000378:metabolism / Q000503:physiopathology; D009751:Nutritional Requirements; D018529:Nutritional Support / Q000639:trends; D057285:Precision Medicine; D013312:Stress, Physiological