Feasibility and safety of a modified volume‐based feeding protocol in critically ill children: A pilot study

OBJECTIVES: Enteral nutrition interruptions (ENIs) are common in critically ill children and may cause underfeeding. Volume-based feeding practices (VBFPs) mitigate ENIs, but their use has not been reported in pediatric critical care. We analyzed whether a modified VBFP (MVBFP), based on compensatory feeding over the subsequent 24 h, is feasible and safe. METHODS: Prospective longitudinal study of critically ill children aged 1 month-18 years receiving enteral nutrition in whom an MVBFP was applied. Compensatory increased enteral feeding goal rates (CIEFGR) were defined as instances in which the volume lost due to an ENI was replaced gradually over the subsequent 24 h by increasing the infusion rate. Data included demographics, ENI characteristics, volume and rate during compensatory feeding, caloric and protein intake, and gastrointestinal or metabolic adverse effects. We also recorded pre-existing gastrointestinal conditions and formula type. RESULTS: Twenty-eight CIEFGR were recorded in 21 children. The median compensatory period was 24 h (interquartile range [IQR]: 17.5-24), with a median additional volume of 20 mL/kg (IQR: 10.5-33.1), corresponding to increases of 18.8 kcal/kg (IQR: 9.8-27.8) and 0.5 g/kg protein (IQR: 0.23-0.8). The infusion rate rose from 21 to 27 mL/h (IQR: 20-33). Gastrointestinal signs (increased gastric residual volume, abdominal distension, nausea) occurred in 10.7% of episodes, were mild, and required no intervention. No significant metabolic alterations were observed. CONCLUSIONS: An MVBFP using compensatory feeding in critically ill children appears feasible and safe, improving caloric and protein delivery without increasing gastrointestinal side effects.