# Nutrition Provision in Pediatric Extracorporeal Membrane Oxygenation: Evidence, Challenges, and Clinical Considerations

## TL;DR

This paper reviews how to best provide nutrition to children on ECMO, highlighting the challenges and the importance of early feeding.

## Contribution

The paper synthesizes current evidence on nutritional strategies for pediatric ECMO patients, emphasizing individualized assessment and structured feeding approaches.

## Key findings

- Malnutrition is a significant risk factor for poor outcomes in ECMO patients.
- Early enteral nutrition is associated with improved gut integrity and outcomes.
- Parenteral nutrition is essential but linked to hepatic dysfunction and metabolic imbalances.

## Abstract

Background/Objectives: Nutritional support is a critical yet challenging aspect of care for pediatric patients requiring extracorporeal membrane oxygenation (ECMO). Malnutrition is prevalent in this population and is associated with worse clinical outcomes. This review synthesizes current evidence on nutritional strategies for pediatric ECMO patients, emphasizing assessment methods, feeding routes, challenges, and clinical outcomes. Methods: A literature review was conducted using PubMed, Scopus, and Web of Science to identify relevant studies published between January 2010 and 2025. Keywords included “pediatric ECMO”, “nutrition”, “enteral feeding”, and “parenteral nutrition”. Studies addressing nutritional assessment, enteral and parenteral feeding practices, and their impact on clinical outcomes were included. Results: Malnutrition is a significant risk factor for morbidity and mortality in ECMO patients, yet nutritional support remains highly variable. While enteral nutrition (EN) is preferred, feeding intolerance and gastrointestinal dysfunction often necessitate parenteral nutrition (PN). Early EN initiation, even at trophic levels, is associated with improved gut integrity and outcomes. However, achieving full nutritional goals enterally remains a challenge, particularly in neonates. PN remains essential in cases of feeding intolerance but is linked to hepatic dysfunction and metabolic imbalances. Conclusions: Optimizing nutritional support in pediatric ECMO patients requires individualized assessment and a structured approach to enteral and parenteral feeding. Further research is needed to establish standardized feeding protocols and determine the optimal timing and composition of nutritional support to improve outcomes.