Considerations for nutrition support in critically ill children with COVID-19 and paediatric inflammatory multisystem syndrome temporally associated with COVID-19

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.

COVID-19: Lessons on malnutrition, nutritional care and public health from the ESPEN-WHO Europe call for papers

“…ESPEN also specifically addressed the issue of obesity [2], with largely similar recommendations. Guidance for pediatric patients is also available [114] for specific needs of this age group [115]. Despite early availability of guidance documents, several hurdles may however impair implementation of nutritional care in routine clinical practice.…”

Gastrointestinal involvement in paediatric COVID-19 — from pathogenesis to clinical management: A comprehensive review

“…In children with severe GI COVID-19 and MIS-C, enteral nutrition support may be continued for a long time into the recovery phase until sufficient oral intake is consistently achieved to support physical and nutritional rehabilitation[ 32 ]. Enteral nutrition is also recommended in critically ill children on hemodynamic support with a stable clinical condition; parenteral nutrition has to be withheld during the first 7 d of admission[ 12 , 31 ].…”

“…Enteral nutrition is also recommended in critically ill children on hemodynamic support with a stable clinical condition; parenteral nutrition has to be withheld during the first 7 d of admission[ 12 , 31 ]. However, in children who continue to require fluid resuscitation or escalating doses of vasoactive agents with evidence of severe GI dysfunction and MIS-C, enteral nutrition may be withheld for up to 7 d[ 32 ].…”

“…It may be useful to consider providing enteral feeds via a post-pyloric tube in critically ill children with COVID-19 with severe GI symptoms or cardiac manifestations or inotrope resistance shock in which early gastric enteral feeding is not possible[ 12 , 32 ].…”

“…There is no evidence to support supra-physiological doses of micronutrients supplementation, including zinc during the acute phase[ 32 ].…”