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Nutritional support in the recovery phase of critically ill children

Joosten, Koen F.M.; Eveleens, Renate D.; Verbruggen, Sascha C.A.T.

Current Opinion in Clinical Nutrition & Metabolic Care: March 2019 - Volume 22 - Issue 2 - p 152–158
doi: 10.1097/MCO.0000000000000549
NUTRITION AND THE INTENSIVE CARE UNIT: Edited by Peter J.M. Weijs and Stephen A. McClave

Purpose of review The metabolic stress response of a critically ill child evolves over time and thus it seems reasonable that nutritional requirements change during their course of illness as well. This review proposes strategies and considerations for nutritional support during the recovery phase to gain optimal (catch-up) growth with preservation of lean body mass.

Recent findings Critical illness impairs nutritional status, muscle mass and function, and neurocognition, but early and high intakes of artificial nutrition during the acute phase cannot resolve this. Although (parenteral) nutrient restriction during the acute phase appears to be beneficial, persistent nutrient restriction, when the metabolic stress response resolves, has short-term and long-term detrimental consequences. Requirements increase markedly during the recovery phase to enable recovery and catch-up growth. Such large amounts of intake demand for alternate approach, especially when intestinal problems constitute a barrier for full enteral feeding. As part of the nutritional recovery, mobilization and exercise are essential to achieve catch-up growth with an optimal body composition.

Summary During the recovery phase of paediatric critical illness (catch-up) growth and muscle recovery require nutritional intakes at least two times the resting energy expenditure.

Paediatric Intensive Care, Department of Paediatrics and Paediatric Surgery, Erasmus MC – Sophia Children's Hospital, Rotterdam, the Netherlands

Correspondence to Koen F.M. Joosten, MD, PhD, Department Paediatric Intensive Care, Erasmus MC – Sophia Children's Hospital, Rotterdam, P.O. Box 2060, 3000 CB Rotterdam, the Netherlands. Tel: +31 10 7037029; e-mail:

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