Early enteral nutritional support and clinical outcomes in critically ill children: A scoping review

Abstract

Background and aims

Pediatric malnutrition, is defined as an imbalance between nutrient intake and requirements leading to cumulative energy, protein, or micronutrient deficits, is highly prevalent among critically ill children and negatively affects growth and recovery. Early enteral nutrition (EEN) is increasingly recognized as a key strategy to prevent or address malnutrition in pediatric intensive care units (PICUs). Although emerging evidence suggests that EEN improves clinical outcomes, uncertainty persists regarding its feasibility and impact in this population. This scoping review aimed to map existing evidence on the use of EEN in critically ill children, evaluate its effects on key clinical outcomes including mechanical ventilation duration, length of stay, and infection risk; and identify barriers and facilitators to its implementation in pediatric intensive care settings.

Methods

A scoping review was conducted following Joanna Briggs Institute methodology and PRISMA-ScR guidelines. Searches were performed in PubMed, Embase, Scopus, CINAHL, and the Cochrane Library. Studies were eligible if they involved children aged 1 month to 18 years and initiated enteral nutrition within 48 h of PICU admission. Keywords included child, critical illness, enteral nutrition, intensive care units, and pediatrics. Studies in English or Italian were included without date restrictions.

Results

Sixteen thousand seven hundred ninety-nine records were identified; 15,556 were screened after duplicates were removed, and 14 studies met inclusion criteria (USA n = 6; Asia n = 4; Africa n = 3; Europe n = 1). Most were cohort studies, with one randomized trial. EEN was consistently associated with shorter mechanical ventilation duration (5.86 ± 3.63 vs 11.96 ± 9.17 days, p = 0.002), reduced PICU and hospital length of stay (4 vs 11.5 days, p < 0.001), and lower infection rates (16.7 % vs 41.1 %, p = 0.001). Barriers to EEN included hemodynamic instability, gastrointestinal intolerance, and procedural interruptions, while facilitators included multidisciplinary teamwork, nurse-led feeding protocols, and standardized nutritional guidelines.

Conclusion

EEN initiated within 24–48 h was generally associated with favorable clinical outcomes; however, evidence on feasibility and safety remains limited and heterogeneous. Strengthening nursing autonomy and implementing standardized feeding pathways may enhance timely nutrition delivery and support recovery in pediatric intensive care.

Implications for clinical practice

Pediatric intensive care nurses play a pivotal role in initiating and monitoring EEN. Empowering nurses through evidence-based feeding protocols and multidisciplinary education can promote timely nutrition delivery and improve recovery in critically ill children.