Background/Objectives: Nutrition is essential to outcomes in critically ill children; however, optimal timing, route, and composition of feeding remain uncertain. Prior studies demonstrate considerable variability in study design, patient populations, and outcome measures, limiting comparability. This review synthesizes international pediatric intensive care unit (PICU) nutrition studies evaluating timing, route, and content of nutritional interventions and summarizes associated clinical outcomes and nutritional adequacy. Methods: A comprehensive scoping review was conducted using the PICOS framework. PubMed and Embase databases were searched for studies published between 2015 and 2025 enrolling critically ill children ≤21 years old admitted to PICUs. Eligible studies assessed timing (early vs. late enteral nutrition), nutritional composition, or feeding route (enteral vs. parenteral). Screening and full-text review were performed independently by two reviewers using Covidence, with discrepancies resolved by a third reviewer. Quality assessment used STROBE. The protocol was registered with PROSPERO. Results: Of 652 identified records, 30 studies met inclusion criteria. Studies were conducted primarily in the United States (27%), with additional contributions from Spain and Brazil (10% each) and several other countries. Study designs included randomized controlled trials (27%) and observational studies (73%). Interventions examined feeding route (14%), nutritional content (38%), and timing (48%). Frequently reported outcomes included feeding intolerance or adverse events, duration of mechanical ventilation, time to nutrition goals, PICU length of stay, mortality, and nutritional adequacy. Conclusions: The contemporary PICU nutrition literature demonstrates persistent heterogeneity in practice and outcomes. This review identifies ongoing gaps in timing, delivery, and adequacy of nutritional support.
Purosky et al. (Sat,) studied this question.