Nutritional Goals in Mechanically Ventilated Children: Impact of a Standardized Enteral Protocol in a Tertiary Pediatric Intensive Care Unit
Abstract
Background & aims: Optimizing nutrition remains challenging in pediatric intensive care units (PICUs), particularly for children requiring prolonged mechanical ventilation. In 2020, our PICU adopted a standardized enteral nutrition protocol emphasizing early energy delivery. We evaluated its impact and identified predictors of early enteral feeding shortfalls. Methods: This retrospective cohort study (2016–2023) included children <18 years, weighing ≥10 kg and intubated ≥48 h in a tertiary PICU. Daily enteral and total (enteral and parenteral) caloric intakes expressed as percentage of Schofield-estimated resting energy expenditure (REE) were compared between pre-protocol period (2016–2019, n = 83) and post-protocol (2020–2023, n = 58) periods. Multivariate linear regression analyses assessed factors linked to suboptimal enteral intake on day 2 and 3. Results: Of 141 patients (median age 7.4 [3.6–11.3] years; 60 % boys), enteral and total intakes did not differ significantly between periods. By day 2, 60 % received enteral nutrition (median 26 [0–93] % of REE); by day 3, 81 % did (median 75 [31–122] % of REE). Protein targets (1.5 g/kg/day) were met infrequently. On day 2, independent predictors of lower enteral intake included vasoactive agent use, higher body weight, and non-neurological/respiratory admission diagnoses; on day 3, vasoactive support and atypical diagnoses persisted as risk factors. Conclusion: PICU nutritional practices aligned with international guidelines but struggled to meet targets in critically ill subgroups, underscoring the value of personalized strategies, potentially incorporating indirect calorimetry, for this vulnerable population
Related
- Reply-Letter to the editor. Nutritional Goals in Mechanically Ventilated Children: Impact of a Standardized Enteral Protocol in a Tertiary Pediatric Intensive Care Unit
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BibTeX
@article{ceci2026nutritional,
title = {{Nutritional Goals in Mechanically Ventilated Children: Impact of a Standardized Enteral Protocol in a Tertiary Pediatric Intensive Care Unit}},
author = {Cyril Ceci and Julien Baleine and Héléna Huguet and Gilles Cambonie and Marie-Christine Picot and Claire Morice and Angelo Polito and Arthur Gaudaire and Christophe Milesi and Arthur Gavotto},
journal = {Clinical Nutrition ESPEN},
year = {2026},
month = oct,
doi = {10.1016/j.clnesp.2026.102985},
url = {https://hal.science/hal-05531500v1},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Nutritional Goals in Mechanically Ventilated Children: Impact of a Standardized Enteral Protocol in a Tertiary Pediatric Intensive Care Unit
AU - Cyril Ceci
AU - Julien Baleine
AU - Héléna Huguet
AU - Gilles Cambonie
AU - Marie-Christine Picot
AU - Claire Morice
AU - Angelo Polito
AU - Arthur Gaudaire
AU - Christophe Milesi
AU - Arthur Gavotto
PY - 2026
DA - 2026/10/15
JO - Clinical Nutrition ESPEN
DO - 10.1016/j.clnesp.2026.102985
UR - https://hal.science/hal-05531500v1
AB - Background & aims: Optimizing nutrition remains challenging in pediatric intensive care units (PICUs), particularly for children requiring prolonged mechanical ventilation. In 2020, our PICU adopted a standardized enteral nutrition protocol emphasizing early energy delivery. We evaluated its impact and identified predictors of early enteral feeding shortfalls. Methods: This retrospective cohort study (2016–2023) included children <18 years, weighing ≥10 kg and intubated ≥48 h in a tertiary PICU. Daily enteral and total (enteral and parenteral) caloric intakes expressed as percentage of Schofield-estimated resting energy expenditure (REE) were compared between pre-protocol period (2016–2019, n = 83) and post-protocol (2020–2023, n = 58) periods. Multivariate linear regression analyses assessed factors linked to suboptimal enteral intake on day 2 and 3. Results: Of 141 patients (median age 7.4 [3.6–11.3] years; 60 % boys), enteral and total intakes did not differ significantly between periods. By day 2, 60 % received enteral nutrition (median 26 [0–93] % of REE); by day 3, 81 % did (median 75 [31–122] % of REE). Protein targets (1.5 g/kg/day) were met infrequently. On day 2, independent predictors of lower enteral intake included vasoactive agent use, higher body weight, and non-neurological/respiratory admission diagnoses; on day 3, vasoactive support and atypical diagnoses persisted as risk factors. Conclusion: PICU nutritional practices aligned with international guidelines but struggled to meet targets in critically ill subgroups, underscoring the value of personalized strategies, potentially incorporating indirect calorimetry, for this vulnerable population
SN - 2405-4577
ER -