Impact of enteral nutrition interruption in critically ill children: A systematic review and meta‐analysis

Children in pediatric intensive care units (PICUs) often experience forced interruptions of enteral nutrition (EN), which can worsen malnutrition. This systematic review aims to assess the prevalence, causes, and clinical consequences of EN interruptions (ENIs) in critically ill children admitted to the PICU. For this review, literature searches were performed in the Web of Science, PubMed, Embase, Cochrane Library, Medline, CNKI, and WanFang Data databases. Studies included those that were cohort, case-control, or cross-sectional designs and were published from the inception of each database to February 2025. Sixteen studies were included, including 14 cohort and 2 cross-sectional studies, involving 4325 children. Thirteen studies reported on the prevalence of ENI, with an overall prevalence of 52.8% (95% CI, 0.415-0.638) for the random-effects combination and high heterogeneity (I² = 94.64%, P < 0.001). Twelve studies detailed the reasons for interruptions, and the three most common reasons were intra-PICU procedures, surgery, and feeding intolerance, with median prevalences of 34.4%, 23.2%, and 19.8%, respectively. Six studies described the impact on clinical outcomes for children. Some results showed that ENI may be associated with a longer PICU stay for critically ill children by 7.02 days (95% CI, 1.16-12.88), with high heterogeneity (I2 = 87.7%; P < 0.001). More than half of PICU children experience ENIs; however, the extreme heterogeneity hinders the meaningful interpretation of the pooled indices. We therefore recommend standardizing the methodology to conduct future internationally representative studies, providing data support for future systematic reviews.