Nutritional needs in critically ill children

Abstract

In critically ill children, nutritional support must satisfy nutritional needs in order to avoid both under- and overfeeding. However, most recommendations remain unclear, often concluding that data is missing. Due to their metabolic perturbations during critically illness and specific physiologic requirements, prescription in children cannot be simply based on studies conducted in critically ill adults or on the well-known nutritional needs of healthy children.

For the last twenty years, studies measuring energy expenditure have shown that critically ill children on mechanical ventilation were not hypermetabolic and that their energy expenditure was lower or close to the basal metabolism. The determination of caloric goal remains problematic because predictive equations used in children are imprecise. Ideally, indirect calorimetry measurements should be performed, but they are rarely available. Moreover, the prescription of nutrition is limited on the first days by fluid restriction and medications that use a large part of available fluid intake, resulting in a mandatory caloric debt. If enteral nutrition should be the preferred mode of nutrient provision in the presence of a functional gastrointestinal tract, its use is frequently associated with often not justified interruptions which may further impede caloric delivery.

Numerous other fields of nutrition, like needs in proteins or amino-acids remain poorly investigated. During acute critically illness, the optimal amount of antioxidant micronutrients to provide or to supplement, is still unsolved.