• Lyvonne N Tume, Frederic V Valla, Koen Joosten, Jotterand ChaparroCorinneCGeneva School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Delémont, Switzerland.Pediatric Intensive Care Unit, University Hospital of Lausanne, Lausanne, Switzerland., Lynne Latten, Luise V Marino, Isobel Macleod, Clémence Moullet, Nazima Pathan, Shancy Rooze, Joost van Rosmalen, and VerbruggenSascha C A TSCATIntensive Care, Department of Pediatrics and Pediatric Surgery, Erasmus Medical Centre, Sophia Children's Hospital, Rotterdam, The Netherlands..
• Faculty of Health and Society, University of Salford, Manchester, M6 6PU, UK. lyvonnetume@gmail.com.
• Intensive Care Med. 2020 Mar 1; 46 (3): 411-425.

BackgroundNutritional support is considered essential for the outcome of paediatric critical illness. There is a lack of methodologically sound trials to provide evidence-based guidelines leading to diverse practices in PICUs worldwide. Acknowledging these limitations, we aimed to summarize the available literature and provide practical guidance for the paediatric critical care clinicians around important clinical questions many of which are not covered by previous guidelines.ObjectiveTo provide an ESPNIC position statement and make clinical recommendations for the assessment and nutritional support in critically ill infants and children.DesignThe metabolism, endocrine and nutrition (MEN) section of the European Society of Pediatric and Neonatal Intensive Care (ESPNIC) generated 15 clinical questions regarding different aspects of nutrition in critically ill children. After a systematic literature search, the Scottish Intercollegiate Guidelines Network (SIGN) grading system was applied to assess the quality of the evidence, conducting meta-analyses where possible, to generate statements and clinical recommendations, which were then voted on electronically. Strong consensus (> 95% agreement) and consensus (> 75% agreement) on these statements and recommendations was measured through modified Delphi voting rounds.ResultsThe final 15 clinical questions generated a total of 7261 abstracts, of which 142 publications were identified relevant to develop 32 recommendations. A strong consensus was reached in 21 (66%) and consensus was reached in 11 (34%) of the recommendations. Only 11 meta-analyses could be performed on 5 questions.ConclusionsWe present a position statement and clinical practice recommendations. The general level of evidence of the available literature was low. We have summarised this and provided a practical guidance for the paediatric critical care clinicians around important clinical questions.

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