Early enteral protein intake and respiratory support requirements in critically ill children: a retrospective cohort study.

BACKGROUND: Optimal protein provision during pediatric critical illness remains uncertain, and its relationship with clinically meaningful outcomes is incompletely defined. We aimed to evaluate the association between early enteral protein intake and short-term clinical outcomes, with particular focus on respiratory support requirements, in critically ill children. METHODS: In this retrospective cohort study, children aged 1 month to 18 years who received enteral nutrition for at least three consecutive days in a tertiary pediatric intensive care unit between September 2020 and December 2021 were included. Mean protein intake during the first 72 hours was analyzed both relative to age-based Recommended Dietary Allowance (RDA) thresholds and as a continuous variable. Multivariable linear and logistic regression models were constructed to assess associations between early protein intake and pediatric intensive care unit (PICU) length of stay, duration of invasive mechanical ventilation (IMV), 28-day ventilator-free days, and requirement for IMV, adjusting for age, illness severity (PRISM III, PELOD), malnutrition status, and energy intake. RESULTS: A total of 117 children were included (42.7% female; median age 46 months). Mean early protein intake was 0.85 ± 0.50 g/kg/day. In adjusted linear regression models, early protein intake was not associated with PICU length of stay, duration of IMV, or ventilator-free days at 28 days (all P > 0.05). However, in multivariable logistic regression analysis, higher early protein intake was associated with lower odds of requiring invasive mechanical ventilation (adjusted odds ratio 0.31, 95% CI 0.10-0.93; P = 0.036), independent of illness severity and energy intake. CONCLUSION: In this single-center cohort of critically ill children, early enteral protein intake was not associated with shorter PICU stay or ventilation duration. However, multivariable analysis demonstrated that higher early protein intake, modeled as a continuous variable, was independently associated with lower odds of requiring invasive mechanical ventilation. These findings suggest a possible association between higher early protein intake and reduced respiratory support requirements. Given the observational design and uncertainty surrounding the effect estimate, the results should be considered hypothesis-generating and require confirmation in prospective multicenter studies.