title: Optimal nutrition therapy in paediatric critical care in the Asia-Pacific and Middle East: a consensus.
abstract: OBJECTIVE
  Current practices and available resources for nutrition therapy in paediatric intensive care units (PICUs) in the Asia Pacific-Middle East region are expected to differ from western countries. Existing guidelines for nutrition management in critically ill children may not be directly applicable in this region. This paper outlines consensus statements developed by the Asia Pacific-Middle East Consensus Working Group on Nutrition Therapy in the Paediatric Critical Care Environment. Challenges and recommendations unique to the region are described.
  
  
  METHODS
  Following a systematic literature search from 2004-2014, consensus statements were developed for key areas of nutrient delivery in the PICU. This review focused on evidence applicable to the Asia Pacific-Middle East region. Quality of evidence and strength of recommendations were rated according to the Grading of Recommendation Assessment, Development and Evaluation approach.
  
  
  RESULTS
  Enteral nutrition (EN) is the preferred mode of nutritional support. Feeding algorithms that optimize EN should be encouraged and must include: assessment and monitoring of nutritional status, selection of feeding route, time to initiate and advance EN, management strategies for EN intolerance and indications for using parenteral nutrition (PN). Despite heterogeneity in nutritional status of patients, availability of resources and diversity of cultures, PICUs in the region should consider involvement of dieticians and/or nutritional support teams.
  
  
  CONCLUSIONS
  Robust evidence for several aspects of optimal nutrition therapy in PICUs is lacking. Nutritional assessment must be implemented to document prevalence and impact of malnutrition. Nutritional support must be given greater priority in PICUs, with particular emphasis in optimizing EN delivery.
authors.affiliation: Children's Intensive Care Unit, KK Women's and Children's Hospital, and Office of Clinical Sciences, Duke-NUS School of Medicine, Singapore. Email: lee.jan.hau@singhealth.com.sg.
authors.forename: Jan Hau
authors.initials: JH
authors.lastname: Lee
authors.affiliation: Department of Nutrition and Food Services, Royal Children's Hospital, Melbourne, Australia.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Rogers
authors.affiliation: Sarawak General Hospital, Malaysia.
authors.forename: Yek Kee
authors.initials: YK
authors.lastname: Chor
authors.affiliation: Division of Paediatric Pulmonary and Critical Care, King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
authors.forename: Rujipat
authors.initials: R
authors.lastname: Samransamruajkit
authors.affiliation: Paediatric Critical Care and Paediatric Haematology- Oncology Divisions of Department of Paediatrics, Khoo Teck Puat- National University Children's Medical Institute, National University Hospital, Singapore.
authors.forename: Pei Lin
authors.initials: PL
authors.lastname: Koh
authors.affiliation: Paediatric Gastroenterology, Hepatology and Nutrition, Sheikh Khalifa Medical City, United Arab Emirates.
authors.forename: Mohamad
authors.initials: M
authors.lastname: Miqdady
authors.affiliation: Paediatric Gastroenterology and Nutrition, Department of Paediatrics, King Faisal Specialist Hospital and Research Center, Riyadh, Kingdom of Saudi Arabia.
authors.forename: Ali Ibrahim
authors.initials: AI
authors.lastname: Al-Mehaidib
authors.affiliation: Paediatric Critical Care Division, Department of Child Health, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia.
authors.forename: Antonius
authors.initials: A
authors.lastname: Pudjiadi
authors.affiliation: Department of Paediatrics, Advanced Paediatrics Center, Postgraduate Institute of Medical Education and Research, India.
authors.forename: Sunit
authors.initials: S
authors.lastname: Singhi
authors.affiliation: Division of Critical Care Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital Boston, United States.
authors.forename: Nilesh M
authors.initials: NM
authors.lastname: Mehta
mesh_terms: D000465:Algorithms; D001315:Australia; D002675:Child, Preschool; D032921:Consensus; D003422:Critical Care / Q000379:methods*; D016638:Critical Illness / Q000628:therapy; D004044:Dietary Proteins / Q000008:administration & dosage; D004750:Enteral Nutrition; D006801:Humans; D007194:India; D007214:Indonesia; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric; D008296:Malaysia; D015596:Nutrition Assessment; D044623:Nutrition Therapy / Q000379:methods*; D009752:Nutritional Status; D018529:Nutritional Support; D064686:Nutritionists; D010372:Pediatrics; D012529:Saudi Arabia; D012846:Singapore; D013785:Thailand; D014479:United Arab Emirates
chemical_list: D004044:Dietary Proteins