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Chapter 8
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or as a bolus once a day (children >30 kg), until EN provides ≥80% of preset caloric goals, PICU discharge,
or up to day 8 of PICU stay, whichever comes first.
On the morning of day 8 after admission, if still present in the PICU, children receiving <80% of caloric
goals by the enteral route, will be switched to regular PN solutions containing lipids and amino acids with
a composition based on the ESPEN/ESPGHAN guidelines
2
. After discharge from the PICU, the nutritional
management is at the discretion of the physicians on the regular wards.
Table 1.
Suggested energy and macronutrient intake during the different phases of critical illness
Acute phase
Stable phase
Recovery phase
Enteral nutrition
(Preferred route)
Energy
Start as soon as possible to match REE
and gradually increase if tolerated
2xREE and higher if
necessary to enable
growth
Protein
(g/kg/day)
1-2
2-3
3-4
Parenteral nutrition
Energy
<REE
1.3-1.5xREE
2xREE
Carbohydrates
(mg/kg/min)
Newborn
28d-10 kg
11-30 kg
31-45 kg
>45 kg
2.5-5
2-4
1.5-2.5
1-1.5
0.5-1
5-10
4-6
2-4
1.5-3
1-2
5-10
6-10
3-6
3-4
2-3
Protein
(g/kg/day)
0
1-2
2-3
Lipids
(g/kg/day)
0
1-1.5
1.5-3
REE= Resting Energy Expenditure
From: Nutritional support and the role of the stress response in critically ill children, K. Joosten, D. Kerklaan,
S. Verbruggen. Curr Opin Clin Nutr Metab Care 2016
83
. Copyright©. Reprinted with permission.