Document Type : original article

Authors

1 Department of Nutrition, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

2 Department of Pediatrics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

3 Department of Pediatrics, Mashhad University of Medical Sciences, Mashhad, Iran

10.22038/jpp.2025.84169.5507

Abstract

Background: Nutritional support in the pediatric intensive care unit (PICU) is critical for promoting recovery and reducing complications in critically ill children. Although guidelines exist, variability in enteral nutrition (EN) practices underscores the need for standardized protocols tailored to the unique needs of PICU patients. This study aimed to develop a standardized enteral feeding protocol for PICU patients, informed by current evidence and expert consensus, to improve feeding tolerance and clinical outcomes.

Methods: A two-phase study was conducted. Phase 1 involved a systematic review of global guidelines and evidence-based practices for EN in PICUs to identify key variables in EN delivery. In Phase 2, a multidisciplinary panel of PICU experts, including nutritionists and pediatric intensivists, used a structured focus group approach to develop a consensus on feeding initiation, volume advancement, prokinetic use, and complication management.

Results: The resulting protocol recommends initiating EN within 24 hours for hemodynamically stable patients, with gradual, weight-based volume advancement tailored to patient tolerance. Prokinetic agents (metoclopramide, domperidone, erythromycin) were incorporated to improve feeding tolerance, and guidelines for managing potential complications, such as refeeding syndrome, gastrointestinal issues, and electrolyte imbalances, were established.

Conclusion: This protocol provides a comprehensive, evidence-based framework for EN in PICUs, offering structured guidance to support the nutritional needs of critically ill pediatric patients. While rigorous development ensures relevance and adaptability, further clinical evaluation is necessary to assess its impact across diverse PICU settings.

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