Delivery of enteral nutrition for critically ill children


  • Z. Abdul Manaf, PhD, Associate Professor
  • N. Kassim, MSc, Dietitian
  • N.H. Hamzaid, MSc, Lecturer
  • NH. Razali, BSc, Tutor
  • Authors' contribution: Zahara Abdul Manaf designed the study, developed the protocol, interpreted the data and improved the manuscript. Norasimah Kassim conducted data collection and data entry. Nur Hana Hamzaid and Nurul Huda Razali wrote the first draft of the manuscript. All authors contributed to and have approved the final manuscript.

Correspondence: Z. Abdul Manaf, Dietetic Programme, School of Healthcare Sciences, Faculty of Health Sciences, National University of Malaysia, 50300 Kuala Lumpur, Malaysia. Email:;



Optimal nutrition support is important in the care of critically ill children as they are at higher risk of malnutrition and have a higher incidence of complications and mortality. The aim of this study was to review the delivery of enteral feeding to critically ill paediatric patients in the Paediatric Intensive Care Unit in a tertiary hospital in Malaysia.


This cross-sectional study was conducted in 53 subjects (30 males and 23 females) who were recruited on the day of admission and remained in the study until they were discharged, deceased or for a maximum of 14 days of Paediatric Intensive Care Unit stay. The median age of subjects was 10.2 (interquartile range 5.1–50.5) months old.


Enteral nutrition was initiated within 21.0 (interquartile range 5.3–33.8) hours after admission and was interrupted in 66% of patients during the study, with a median duration of 11.5 (interquartile range 6.1–28.3) hours for each patient. The overall duration of enteral feeding interruptions was 20% of the total feeding time. The main reasons for interruptions were medical procedures (55%) and non-gastrointestinal complications (27%). Twenty-two (43.2%) of the patients were malnourished when admitted to the Paediatric Intensive Care Unit. The feeding initiation time, referral to the dietitian, and the frequency and duration of feeding interruptions were all positively associated with cumulative energy and protein deficits.


Malnutrition among critically ill children in the Paediatric Intensive Care Unit was prevalent; energy and protein deficits were substantial. Strategies to improve the delivery of nutritional support to this group of patients should be planned and implemented by multidisciplinary clinical teams.