Relationship between acute nutritional goal achievement and outcomes in critically ill pediatric patients: A single‐center retrospective cohort study

Background Although malnutrition in critically ill children is linked to poor outcomes, the impact of achieving guideline‐recommended nutritional goals remains unclear. We examined the association between achievement of American Society for Parenteral and Enteral Nutrition (ASPEN) goals via enteral nutrition (EN) and clinical outcomes in a Japanese pediatric intensive care unit (PICU). Methods This single‐center, retrospective cohort study included patients aged <16 years admitted between July 2022 and December 2024 who required mechanical ventilation and had a PICU/high care unit (HCU) stay of ≥7 days. We compared patients who achieved the ASPEN goal (≥2/3 of resting energy expenditure and ≥1.5 g/kg/day protein via EN) within 7 days with those who did not. Multivariable Cox proportional hazards models were used to evaluate the association between nutritional goal achievement and the primary outcome of total length of stay (LOS). Results Of the 110 patients, 80 (72.7%) achieved their nutritional goals. The achievement group had a significantly shorter total LOS (median 12 vs 20 days; P < 0.001). After multivariable adjustment, meeting the nutritional target was independently associated with a higher likelihood of discharge (adjusted hazard ratio: 2.41; 95% confidence interval: 1.45–4.02; P < 0.001). The achievement group also had fewer new‐onset infections (8.8% vs 40%) and more ventilator‐free days. Conclusion Achievement of ASPEN‐recommended nutritional targets through EN within the first week is strongly associated with short LOS and reduced complications in critically ill children. Although early EN is a potential marker of better prognosis, our findings support its optimization in this vulnerable population.