Early Enteral Nutrition Versus Late Enteral Nutrition in Pediatric Critically Ill Trauma Patients: A Systematic Review and Meta-Analysis

Trauma remains a leading cause of morbidity and mortality in the pediatric population, and critically ill pediatric trauma patients frequently develop a hypermetabolic state that increases the risk of malnutrition. Although early enteral nutrition (EEN) has demonstrated clinical benefits in adult trauma populations, evidence in children remains limited and inconsistent. This systematic review and meta-analysis evaluated the impact of EEN versus late enteral nutrition (LEN) on clinical outcomes in critically ill pediatric trauma patients admitted to the pediatric intensive care unit (PICU). A comprehensive search of major databases was conducted for studies published between 2005 and 2025 comparing EEN, defined as initiation within 72 hours of injury or admission, with LEN. Four studies, including 834 patients, met the inclusion criteria. The primary outcome was all-cause mortality, while secondary outcomes included ICU length of stay (LOS), hospital LOS, and functional outcomes. EEN was associated with a significantly lower risk of mortality (risk ratio = 0.20), shorter hospital LOS (mean difference = -5.19 days), shorter ICU LOS (MD = -4.13 days), and improved functional outcomes (OR = 4.79). However, substantial heterogeneity was observed across several outcomes. Early initiation of enteral nutrition within the first 72 hours of PICU admission was associated with improved clinical outcomes; nevertheless, given the predominance of observational evidence and the observed heterogeneity, these findings should be interpreted with caution, and high-quality randomized controlled trials are required to establish causality and guide standardized nutritional protocols.