Moving towards optimal nutrition in critically children

Nutrition plays an essential role in the treatment of paediatric critical illness, as energy is a prerequisite for the functioning of the human body. However, reaching nutritional targets is difficult in critically ill children. One of the most well-known strategies to prevent feeding intolerance and to achieve reaching nutritional targets has been to spread the nutritional load by providing nutrition continuously. However, there is no solid evidence for this strategy. Moreover, this strategy disregards the possible beneficial effects of a fasting response, which recently have gained attention. This thesis reviews the mechanisms behind intermittent feeding and the potential beneficial effects in critically ill children. Furthermore, a randomised controlled trial (RCT) investigating intermittent feeding with an overnight fast in critically ill children was designed and conducted. The results of this RCT are described in this thesis. Furthermore, this thesis aims to provide insight into the two “great unknowns” of nutritional therapy in critically ill children, feeding intolerance and mineral disturbances. The course of several gastrointestinal biomarkers from pathways deemed involved in feeding intolerance and their association with enteral nutrition advancement in the first week of paediatric intensive care unit (PICU) stay was investigated. Moreover, the occurrence of early refeeding hypophosphatemia in critically ill children, its association with clinical outcomes and the impact of early parenteral nutrition hereon was investigated. Lastly, the course and depletions of zinc, copper, selenium and magnesium in plasma and red blood cells in the first week of PICU stay were investigated.