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Review
. 2020 Mar;46(3):411-425.
doi: 10.1007/s00134-019-05922-5. Epub 2020 Feb 20.

Nutritional support for children during critical illness: European Society of Pediatric and Neonatal Intensive Care (ESPNIC) metabolism, endocrine and nutrition section position statement and clinical recommendations

Lyvonne N Tume  1   2 , Frederic V Valla  3 , Koen Joosten  4 , Corinne Jotterand Chaparro  5   6 , Lynne Latten  7 , Luise V Marino  8 , Isobel Macleod  9 , Clémence Moullet  5   6 , Nazima Pathan  10 , Shancy Rooze  11 , Joost van Rosmalen  12 , Sascha C A T Verbruggen  4
Affiliations
Review

Nutritional support for children during critical illness: European Society of Pediatric and Neonatal Intensive Care (ESPNIC) metabolism, endocrine and nutrition section position statement and clinical recommendations

Lyvonne N Tume et al. Intensive Care Med. 2020 Mar.

Abstract

Background: Nutritional support is considered essential for the outcome of paediatric critical illness. There is a lack of methodologically sound trials to provide evidence-based guidelines leading to diverse practices in PICUs worldwide. Acknowledging these limitations, we aimed to summarize the available literature and provide practical guidance for the paediatric critical care clinicians around important clinical questions many of which are not covered by previous guidelines.

Objective: To provide an ESPNIC position statement and make clinical recommendations for the assessment and nutritional support in critically ill infants and children.

Design: The metabolism, endocrine and nutrition (MEN) section of the European Society of Pediatric and Neonatal Intensive Care (ESPNIC) generated 15 clinical questions regarding different aspects of nutrition in critically ill children. After a systematic literature search, the Scottish Intercollegiate Guidelines Network (SIGN) grading system was applied to assess the quality of the evidence, conducting meta-analyses where possible, to generate statements and clinical recommendations, which were then voted on electronically. Strong consensus (> 95% agreement) and consensus (> 75% agreement) on these statements and recommendations was measured through modified Delphi voting rounds.

Results: The final 15 clinical questions generated a total of 7261 abstracts, of which 142 publications were identified relevant to develop 32 recommendations. A strong consensus was reached in 21 (66%) and consensus was reached in 11 (34%) of the recommendations. Only 11 meta-analyses could be performed on 5 questions.

Conclusions: We present a position statement and clinical practice recommendations. The general level of evidence of the available literature was low. We have summarised this and provided a practical guidance for the paediatric critical care clinicians around important clinical questions.

Keywords: Child; Enteral nutrition; Guidelines; Intensive care; Paediatric; Parenteral nutrition.

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Conflict of interest statement

The authors of these guidelines have reported all potential conflicts or financial disclosures. For a complete overview of the potential conflicts and financial disclosures see below. No funding or contribution from industry was involved in the completion of these recommendations, nor were any industry representatives present at any of the committee meetings. LNT is a member of the NIHR. SCV is supported by Nutricia Advanced Medical Nutrition (unrestricted research grant). SCV has received speakers’ fees from Nutricia Advanced Medical Nutrition and Baxter in the past. KJ is supported by Nutricia Advanced Medical Nutrition (unrestricted research grant). FVV has received speaker fees from Fresenius Kabi and Nutricia (past) and consultant fees from Baxter (current). LVM is supported by a Health Education England/NIHR Clinical Lectureship (ICA-CL-2016-02-001) supported by the National Institute for Health Research. LVM has also received speaker’s fees from Abbott Laboratories and Nutricia in the past. NP is supported by research funding from the National Institute for Health Research. CJC is supported by the Marisa Sophie Foundation and has received travel fees from Nutricia and Baxter (past). CM is supported by the Marisa Sophie Foundation and has received travel fees from Nutricia and Baxter (past).

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