Abstract
There are reports of children COVID-19 or COVID-19 like symptoms with hyperinflammatory multisystem syndrome, ARDS, gastrointestinal and atypical Kawasaki disease presenting to PICU worldwide temporally associated with COVID-19, for which there are important nutrition support considerations. As a result, the European Society of Pediatric and Neonatal Intensive Care – Metabolism, Endocrine and Nutrition group (ESPNIC-MEN) and paediatric nutritionists working in PICUs are being consulted regarding nutrition management of critically ill children with COVID-19 or COVID-19 like symptoms. Therefore, the aim of this short report is to provide a summary of nutrition support recommendations for critically ill children with COVID-19. They are based on the ESPNIC-MEN section recommendations published in January 2020 and surviving sepsis recommendations from February 2020.
Highlights
The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was first identified in Wuhan, China, December 2019 [2]
The aim of this editorial is to provide an adaptation of nutrition support recommendations for the overall population of critically ill children, to provide further refined recommendations for critically ill children presenting with COVID-19 or paediatric hyper-inflammatory syndrome temporally associated with COVID
Energy intake provided to critically ill children should not exceed resting energy expenditure
Summary
The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was first identified in Wuhan, China, December 2019 [2]. For critically ill children with severe COVID-19 and COVID-19 like symptoms there are a number of different nutritional considerations including; 1) severe gastrointestinal or cardiac manifestations and inotrope resistance shock may mean usual early gastric enteral feeding is not be possible, in these instances it may be possible to consider providing enteral feeds via a post-pyloric tube, 2) the placement of naso-enteric tube is considered aerosol producing and as such appropriate personal protective equipment should be worn, 3) children who are nursed prone or in a medically induced coma may tolerated post-pyloric feeds better, 4) measurement of GRV is not recommended unless there is repeated vomiting and no possibility to increase gastric enteral feeding (measured additional care should be taken using personal protective equipment (PPE) as SARS-COV 2 virus has been found in the gastrointestinal lumen, 5) there is no evidence to support supra-physiological doses of micronutrient supplementation, including zinc during the acute phase [17], and 6) as children may have undergone a prolonged admission to PICU, nutrition support may be required well into the. Recovery period to ensure adequate and appropriate nutrition recovery (Table 2)
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