[ Vol. 10 No. 2 ] (May - August 2009 )
Nutritional management of the critically ill child - A holistic approach

Sarath Gopalan
Pushpawati Singhania Research Institute, and Center for Research on Nutrition Support Systems, New Delhi


In recent years, there have been major advances in critical care, which have contributed significantly to better salvage of very sick children. Unfortunately, nutrition support has never been considered a “glamorous” subject and this very important area in critical care has not received the importance it deserves.

Although there is tremendous paucity of data available on all aspects pertaining to nutritional management in the very sick child, there is increasing evidence that optimal nutritional support is related to a better overall outcome, improved survival, decreased morbidity and duration of stay in the ICU. It is important to recognize that the critically ill child might have metabolic and physiologic characteristics very different from a normal child and it is in this context that the practical approach to nutritional intervention in the critically ill child has undergone a major change over the past two decades – from hypercaloric to eucaloric or even “permissive hypocaloric” feeding. 

There are two important issues to be considered in the nutritional management of a critically ill child – an increased requirement of energy and nutrients, especially protein and at the same time inefficient utilization of energy and nutrients provided in the setting of stress and optimum nutritional support in the critically ill setting requires a judicious balance between these two factors, the latter being more important from the practical standpoint.

Critically ill children, including those in shock may present with glucose and lipid intolerance, extreme degrees of metabolic derangement in protein and energy metabolism characterized by increased protein breakdown which is not entirely suppressed by protein or energy intake – a reprioritization of protein synthesis resulting in a very high protein turnover. Optimal nutritional support in the critically ill child under these circumstances is a challenging endeavour.


PENSA 2009

“Energizing Nutrition Support Practice for Life”
June 5-7 2009, Shangri-La Hotel, Kuala Lumpur, Malaysia 
Page: 32