Nutritional therapy in children with sepsis and septic shock: unresolved questions and the need for an individualized approach

The aim. This review provides a meta-analysis of current guidelines on nutrition in critically ill patients, including SCCM–ASPEN (2017), SSC (2012, 2021), ESPNIC (2020), and SSC (2020) pediatric sepsis guidelines. While the ESPNIC (2020) guidance complements the existing ASPEN (2017) guidelines for critical paediatrics, the Children's SSC (2020) did not find sufficient direct evidence to develop strong nutritional recommendations for children with sepsis/septic shock. Materials and methods. Looking for publications on nutritional assessment and nutritional support in children with sepsis have been keywords sepsis in children, nutrition, and critical conditions. Literature searched and analyzed from PubMed, Google Scholar and ScienceDirect databases. Revealed under-a sufficient amount of work on pediatric sepsis (an exception is neonatal sepsis), there are no protocols for assessing nutritional status and its correction in children diagnosed with sepsis/SS. Results. Despite ongoing research in this area, many questions remain unresolved and require systematic study. While some small and large pediatric studies have recommended nutritional therapy, the heterogeneity of children's ICUs in terms of age, pathology, disease severity, comorbidities, and nutritional status precludes a one-size-fits-all approach to nutrition in critically ill children. Therefore, an individualized approach to nutrition is necessary, considering the patient's unique circumstances and the risk/benefit ratio of different nutritional therapies. Conclusions. An extensive literature review did not reveal strong nutritional recommendations for children with sepsis/SS, underscoring the need for future research on the assessment and correction of protein-energy malnutrition in this population. Overall, this review highlights the importance of tailoring nutritional therapy to the individual needs of critically ill children with sepsis/ septic shock to optimize outcomes