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Nutritional support for critically ill children

  1. Ari Joffe1,*,
  2. Natalie Anton1,
  3. Laurance Lequier1,
  4. Ben Vandermeer2,
  5. Lisa Tjosvold3,
  6. Bodil Larsen4,
  7. Lisa Hartling5

Editorial Group: Cochrane Anaesthesia, Critical and Emergency Care Group

Published Online: 15 APR 2009

Assessed as up-to-date: 15 FEB 2007

DOI: 10.1002/14651858.CD005144.pub2

How to Cite

Joffe A, Anton N, Lequier L, Vandermeer B, Tjosvold L, Larsen B, Hartling L. Nutritional support for critically ill children. Cochrane Database of Systematic Reviews 2009, Issue 2. Art. No.: CD005144. DOI: 10.1002/14651858.CD005144.pub2.

Author Information

  1. 1

    University of Alberta and Stollery Children's Hospital, Department of Pediatrics, Division of Pediatric Intensive Care, Edmonton, Alberta, Canada

  2. 2

    Alberta Research Centre for Child Health Evidence & University of Alberta Evidence-based Practice Centre, Department of Pediatrics, Edmonton, Alberta, Canada

  3. 3

    University of Alberta, Alberta Research Centre for Child Health Evidence, Edmonton, Alberta, Canada

  4. 4

    Stollery Children's Hospital, Nutrition Service , Edmonton, Alberta, Canada

  5. 5

    Evidence-based Practice Centre, University of Alberta, Edmonton, Alberta, Canada

*Ari Joffe, Department of Pediatrics, Division of Pediatric Intensive Care, University of Alberta and Stollery Children's Hospital, Office 3A3.07, 8440- 112 St, Edmonton, Alberta, T6G 2B7, Canada.

Publication History

  1. Publication Status: New
  2. Published Online: 15 APR 2009



References to studies included in this review

  1. References to studies included in this review
  2. References to studies excluded from this review
  3. Additional references
Gottschlich 2002 {published data only}
  • Gottschlich MM, Jenkins ME, Mayes T, Khoury J, Kagan RJ, Warden GD. An evaluation of the safety of early vs delayed enteral support and effects on clinical, nutritional, and endocrine outcomes after severe burns. The Journal of Burn Care & Rehabilitation 2002;23(6):401-15. [PUBMED: 12432317 ]

References to studies excluded from this review

  1. References to studies included in this review
  2. References to studies excluded from this review
  3. Additional references
Alberda 2005 {published data only}
  • Alberda C, Gramlich L, Field C, McCargar L, Meddings J, Madsen K. Effects of probiotic therapy in critically ill patients: a randomized, double-blind, placebo-controlled study [abstract]. Gastroenterology 2005;128 Suppl 2(4):281-2.
Albers 2005 {published data only}
  • Albers MJ, Steyerberg EW, Hazebroek FW, Mourik M, Borsboom GJ, et al. Glutamine supplementation of parenteral nutrition does not improve intestinal permeability, nitrogen balance, or outcome in newborns and infants undergoing digestive-tract surgery: results from a double-blind, randomized, controlled trial. Annals of Surgery 2005;241(4):599-606. [PUBMED: 15798461 ]
Alexander 1980 {published data only}
  • Alexander JW, Macmillan BG, Stinnett JD, Ogle C, Bozian RC, Fischer JE, et al. Beneficial effects of aggressive protein feeding in severely burned children. Annals of Surgery 1980;192:505-16. [PUBMED: 7425697 ]
Barbosa 1999 {published data only}
  • Barbosa E, Moreira EA, Goes JE, Faintuch J. Pilot study with a glutamine-supplemented enteral formula in critically ill infants. Revista do Hospital das Clínicas 1999;54(1):21-4. [PUBMED: 10488597]
Black 1981 {published data only}
  • Black DD, Suttle EA, Whitington PF, Whitington GL, Korones SD. The effect of short-term total parenteral nutrition on hepatic function in the human neonate: a prospective randomized study demonstrating alteration of hepatic canalicular function. The Journal of Pediatrics 1981;99:445-9. [PUBMED: 6115001]
Briassoulis 2005 {published data only}
  • Briassoulis G, Filippou O, Hatzi E, Papassotiriou I, Hatzis T. Early enteral administration of immunonutrition in critically ill children: results of a blinded randomized controlled clinical trial. Nutrition 2005;21(7-8):799-807. [PUBMED: 15975487]
Briassoulis 2005b {published data only}
  • Briassoulis G, Filippou O, Kanariou M, Hatzis T. Comparative effects of early randomized immune or non-immune-enhancing enteral nutrition on cytokine production in children with septic shock. Intensive Care Medicine 2005;31(6):851-8. [PUBMED: 15834703 ]
Briassoulis 2006 {published data only}
  • Briassoulis G, Filippou O, Kanariou M, Papassotiriou I, Hatzis T. Temporal nutritional and inflammatory changes in children with severe head injury fed a regular or an immune-enhancing diet: a randomized, controlled trial. Pediatric Critical Care Medicine 2006;7(1):56-62. [PUBMED: 16395076 ]
Chaloupecky 1994 {published data only}
  • Chaloupecky V, Vislocky I, Pachl J, Sprongl L, Svomova V. The effect of early parenteral nutrition on amino acid and protein metabolism in infants following congenital heart disease surgery in extracorporeal circulation. Cor et Vasa 1994;36:26-34.
Gottschlich 1990 {published data only}
  • Gottschlich MM, Jenkins M, Warden GD, Baumer T, Havens P, Snook JT, et al. Differential effects of three enteral dietary regimens on selected outcome variables in burn patients. JPEN. Journal of Parenteral and Enteral Nutrition 1990;14(3):225-36. [PUBMED: 2112634 ]
Hadley 1986 {published data only}
  • Hadley MN, Grahm TW, Harrington T, Schiller WR, McDermott MK, Posillico DB. Nutritional support and neurotrauma: a critical review of early nutrition in forty five acute head injury patients. Neurosurgery 1986;19:367-73. [PUBMED: 3093915 ]
Hausmann 1985 {published data only}
  • Hausmann D, Mosebach KO, Caspari R, Rommelsheim K. Combined enteral-parenteral nutrition versus total parenteral nutrition in brain-injured patients. Intensive Care Medicine 1985;11:80-4. [PUBMED: 3921583]
Horn 2003 {published data only}
  • Horn D, Chaboyer W. Gastric feeding in critically ill children: a randomized controlled trial. American Journal of Critical Care 2003;12(5):461-8. [PUBMED: 14503430 ]
Kolacinski 1993 {published data only}
Marin 1999 {published data only}
  • Marín VB, Rebollo MG, Castillo-Duran CD, López MT, Sanabria MS, Morage FM, et al. Controlled study of early postoperative parenteral nutrition in children. Journal of Pediatric Surgery 1999;34:1330-5. [PUBMED: 10507423]
Marin 2006 {published data only}
  • Marin VB, Rodriguez-Osiac L, Schlessinger L, Villegas J, Lopez M, Castillo-Duran C. Controlled study of enteral arginine supplementation in burned children: impact on immunologic and metabolic status. Nutrition 2006;22(7-8):705-12. [PUBMED: 16815485 ]
Meert 2004 {published data only}
  • Meert KL, Daphtary KM, Metheny NA. Gastric vs small-bowel feeding in critically ill children receiving mechanical ventilation: a randomized controlled trial. Chest 2004;126(3):872-8. [PUBMED: 15364769]
Papadopoulou 2000 {published data only}
  • Papadopoulou A, Papazoglou K, Tsoutsou A, Papadatos J. Prospective, randomised trial on the efficacy of glutamine- versus placebo-enriched peptide based feeds in critically ill children. Journal of Pediatric Gastroenterology and Nutrition 2000;31 Suppl 2:209-10.
Peng 2001 {published data only}
Pillo-Blocka 2004 {published data only}
  • Pillo-Blocka F, Adatia I, Sharieff W, McCrindle BW, Zlotkin S. Rapid advancement to more concentrated formula in infants after surgery for congenital heart disease reduces duration of hospital stay: a randomized clinical trial. The Journal of Pediatrics 2004;145(6):761-6. [PUBMED: 15580197 ]
Suchner 1996 {published data only}
  • Suchner U, Senftleben U, Eckart T, Scholz MR, Beck K, Murr R, et al. Enteral versus parenteral nutrition: effects on gastrointestinal function and metabolism. Nutrition 1996;12:12-22. [PUBMED: 8838831]
Tyson 2005 {published data only}
Young 1987 {published data only}

Additional references

  1. References to studies included in this review
  2. References to studies excluded from this review
  3. Additional references
Alexander 1989
  • Alexander JW, Gonce SJ, Miskell PW, Peck MD, Sax H. A new model for studying nutrition in peritonitis: the adverse effect of overfeeding. Annals of Surgery 1989;209(3):334-40. [PUBMED: 2493777]
Ash 2005
  • Ash JL, Gervasio JM, Zaloga GP, Rodman GH. Does the quantity of enteral nutrition affect outcomes in critically ill trauma patients. Nutrition in Clinical Practice 2005;29 Suppl(1):10-11.
ASPEN 2002
  • A.S.P.E.N. Board of directors and the clinical guidelines task force. Guidelines for the use of parenteral and enteral nutrition in adult and pediatric patients. JPEN. Journal of Parenteral and Enteral Nutrition 2002;26 Suppl:1-138SA. [PUBMED: 11841046 ]
Avitzur 2003
  • Avitzur Y, Singer P, Dagan O, Kozer E, Abramovitch D, Dinari G, et al. Resting energy expenditure in children with cyanotic and noncyanotic congential heart disease before and after open heart surgery. JPEN. Journal of Parenteral and Enteral Nutrition 2003;27:47-51. [PUBMED: 12549598]
Begg 1994
Boitano 2006
  • Boitano M. Hypocaloric feeding of the critically ill. Nutrition in Clinical Practice 2006;21:617-22. [PUBMED: 17119168]
Bordone 2005
Briassoulis 2000
Briassoulis 2001
Chwals 1994
  • Chwals WJ. Overfeeding the critically ill child: fact or fantasy?. New Horizons 1994;2:147-55. [PUBMED: 7922439]
Dhaliwal 2004
  • Dhaliwal R, Jurewitsch B, Harrietha D, Heyland DK. Combination enteral and parenteral nutrition in critically ill patients: harmful or beneficial?  A systematic review of the evidence. Intensive Care Medicine 2004;30:1666-71. [PUBMED: 15185069]
Dickerson 2002
Duval 2000
Egger 1997
Fink 2001
Framson 2007
  • Framson CM, LeLeiko NS, Dallal GE, Roubenoff R, Snelling LK, Dwyer JT. Energy expenditure in critically ill children. Pediatric Critical Care Medicine 2007;8:264-7. [PUBMED: 17417117]
Gramlich 2004
  • Gramlich L, Kichian K, Pinilla J, Rodych NJ, Dhaliwal R, Heyland DK. Does enteral nutrition compared to parenteral nutrition result in better outcomes in critically ill adult patients?  A systematic review of the literature. Nutrition 2004;20:843-8. [PUBMED: 15474870]
Hart 2002
  • Hart DW, Wolf SE, Herndon DN, Chinkes DL, Lal SO, Obeng MK, et al. Energy expenditure and caloric balance after burn: increased feeding leads to fat rather than lean mass accretion. Annals of Surgery 2002;235(1):152-61. [PUBMED: 11753055]
Heyland 1998a
Heyland 1998b
Heyland 2001
  • Heyland DK, Novak F, Drover JW, Jain M, Su X, Suchner U. Should immunonutrition become routine in critically ill patients? A systematic review of the evidence. JAMA 2001;286(8):944-53. [PUBMED: 11509059]
Heyland 2003
  • Heyland DK, Dhaliwal R, Drover JW, Gramlich L, Dodek P. Canadian clinical practice guidelines for nutrition support in mechanically ventilated, critically ill adult patients. JPEN. Journal of Parenteral and Enteral Nutrition 2003;27(5):355-73. [PUBMED: 12971736 ]
Heyland 2006
  • Heyland DK, Dhaliwal R. Oxidative stress in the critically ill: a preliminary look at the REDOXS study. Critical Care Rounds 2006;7(1):1-7.
Higgins 2002
Jacsik 2001
  • Jacsik T, Shew SB, Keshen TH, Dzakovic A, Jahoor F. Do critically ill surgical neonates have increased energy expenditure?. Journal of Pediatric Surgery 2001;36(1):63-7. [PUBMED: 11150439 ]
Jadad 1996
  • Jadad AR, Moore RA, Carroll D, Jenkinson C, Reynolds DJM, Gavaghan DJ, et al. Assessing the quality of reports of randomized clinical trials: Is blinding necessary?. Controlled Clinical Trials 1996;17:1-12. [PUBMED: 8721797]
Jeejeebhoy 2004
  • Jeejeebhoy KN. Permissive underfeeding of the critically ill patient. Nutrition in Clinical Practice 2004;19:477-80. [PUBMED: 16215142 ]
Joffe 2001
Klein 1997
  • Klein S, Kinney J, Jeejeebhoy K, Alpers D, Hellerstein M, Murray M, et al. Nutrition support in clinical practice: review of published data and recommendations for future research directions. Summary of a conference sponsored by the National Institutes of Health, American Society for Parenteral and Enteral Nutrition, and American Society for Clinical Nutrition. American Journal of Clinical Nutrition 1997;66(3):683-706. [PUBMED: 9280194]
Koretz 2005
  • Koretz RL. Nutrition society symposium on 'end points in clinical nutrition trials': death, morbidity and economics are the only end points for trials. Proceedings of the Nutrition Society 2005;64:277-84.
Koretz 2007
Koretz 2007a
  • Koretz RL, Avenell A, Lipman TO, Braunschweig CL, Milne AC. Does enteral nutrition affect clinical outcome? A systematic review of the randomized trials. The American Journal of Gastroenterology 2007;102:412-29. [PUBMED: 17311654 []
    Direct Link:
Koretz 2007b
Krishnan 2003
  • Krishnan JA, Parce PB, Martinez A, Diette GB, Brower RG. Caloric intake in medical ICU patients: consistency of care with guidelines and relationship to clinical outcomes. Chest 2003;124:297-305. [PUBMED: 12853537 ]
Letton 1995
  • Letton RW, Chwals WJ, Jamie A, Charles B. Early postoperative alterations in infant energy use increase the risk of overfeeding. Journal of Pediatric Surgery 1995;30(7):988-93. [PUBMED: 7472959]
Marik 2001
Martinez 2004
  • Martinez JLV, Matinez-romillo PD, Sebastian JD, Tarrio FR. Predicted versus measured energy expenditure by continuous online indirect calorimetry in ventilated, critically ill children during the early postinjury period. Pediatric Critical Care Medicine 2004;5(1):19-27.
Miles 2006
Mizock 1984
Oosterveld 2006
  • Oosterveld MJ, Kuip MV, Meer KD, Greef HJ, Gemke RJ. Energy expenditure and balance following pediatric intensive care unit admission: a longitudinal study of critically ill children. Pediatric Critical Care Medicine 2006;7(2):147-53.
Parmar 1998
Peter 2005
  • Peter JV, Moran JL, Phillips-Hughes J. A metaanalysis of treatment outcomes of early enteral versus early parenteral nutrition in hospitalized patients. Critical Care Medicine 2005;33:213-20. [PUBMED: 15644672]
Preiser 2003
  • Preiser JC, Chiolero R, Wernerman J. Nutrition papers in ICU patients: what lies between the lines?. Intensive Care Medicine 2003;29:156-66. [PUBMED: 12594580 ]
Protti 2006
  • Protti A, Singer M. Bench to bedside review: potential strategies to protect or reverse mitochondrial dysfunction in sepsis-induced organ failure. Critical Care 2006;10(228):1-7. [PUBMED: 16953900]
Schulz 1995
  • Schulz KF, Chalmers I, Hayes RJ, Altman DG. Empirical evidence of bias. Dimensions of methodological quality associated with estimates of treatment effects in controlled trials. JAMA 1995;273:408-12. [PUBMED: 7823387]
Shew 1999
  • Shew SB, Keshen TH, Jahoor F, Jaksic T. The determinants of protein catabolism in neonates on extracorporeal membrane oxygenation. Journal of Pediatric Surgery 1999;34:1086-90. [PUBMED: 10442596]
Simpson 2005
  • Simpson F, Doig GS. Parenteral vs. enteral nutrition in the critically ill patients: a meta-analysis of trials using the intention to treat principle. Intensive Care Medicine 2005;31:12-23. [PUBMED: 15592814]
Stroud 2007
van der Kuip 2004
  • van der Kuip M, Oosterveld MJ, van der Schueren MA, de Meer K, Lafeber HN, Gemke RJ. Nutritional support in 111 pediatric intensive care units: a European survey. Intensive Care Medicine 2004;30(9):1807-13.
Way 2007
White 2000
  • White MS, Shepherd RW, McEniery JA. Energy expenditure in 100 ventilated, critically ill children: improving the accuracy of predictive equations. Critical Care Medicine 2000;28:2307-12. [PUBMED: 10921557]
Yamazaki 1986
  • Yamazaki K, Maiz A, Moldawer LL, Bistrian BR, Blackburn GL. Complications associated with the overfeeding of infected animals. The Journal of Surgical Research 1986;40(2):152-8. [PUBMED: 3080640 ]
Zaloga 1994
  • Zaloga GP, Roberts P. Permissive underfeeding. New Horizons 1994;2:257-63. [PUBMED: 7922451]