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A review of feeding intolerance in critically ill children

Tume, Lyvonne N; Valla, Frederic V

Authors

Lyvonne Tume Lyvonne.Tume@uwe.ac.uk
Associate Professor in Child Health

Frederic V Valla



Abstract

© 2018, The Author(s). Ensuring optimal nutrition is vital in critically ill children and enteral feeding is the main route of delivery in intensive care. Feeding intolerance is the most commonly cited reason amongst pediatric intensive care unit healthcare professionals for stopping or withholding enteral nutrition, yet the definition for this remains inconsistent, nebulous, and entirely arbitrary. Not only does this pose problems clinically, but research in this field frequently uses feeding intolerance as an endpoint and the heterogeneity in this definition makes the comparison of studies difficult and meta-analysis impossible. We reviewed the use of, and definitions of, the term feed intolerance in pediatric intensive care research papers in the last 20years. Gastric residual volume remains the most common factor used to define feed intolerance, despite the lack of evidence for this. Healthcare professionals would benefit from further education to improve their awareness of the limitations of the markers to define feeding intolerance, and the international PICU community needs to agree a consistent definition of this phenomenon to improve consistency in both practice and research. Conclusion: This paper will provide a narrative review of the definitions of, evidence for, and markers of feeding intolerance in critically ill children.What is Known?:• Feeding intolerance is a commonly cited reason amongst pediatric intensive care unit healthcare professionals for stopping or withholding enteral nutrition.• There is no agreed definition for feeding intolerance in critically ill children.What is New?:• This paper provides an up to date review of the definitions of, evidence for, and markers of feeding intolerance in critically ill children.• Despite no evidence, gastric residual volume continues to drive clinical bedside decisions about enteral feeding and feeding tolerance.

Citation

Tume, L. N., & Valla, F. V. (2018). A review of feeding intolerance in critically ill children. European Journal of Pediatrics, 177(11), 1675-1683. https://doi.org/10.1007/s00431-018-3229-4

Journal Article Type Article
Acceptance Date Aug 10, 2018
Online Publication Date Aug 17, 2018
Publication Date Nov 1, 2018
Journal European Journal of Pediatrics
Print ISSN 0340-6199
Electronic ISSN 1432-1076
Publisher Springer (part of Springer Nature)
Peer Reviewed Peer Reviewed
Volume 177
Issue 11
Pages 1675-1683
DOI https://doi.org/10.1007/s00431-018-3229-4
Keywords pediatric, intensive care, nutrition, infant
Public URL https://uwe-repository.worktribe.com/output/856672
Publisher URL http://dx.doi.org/10.1007/s00431-018-3229-4

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