Eveleens proposed a definition for enteral feeding intolerance in a critically-ill child. The authors are from Erasmus MC, Sophia Children's Hospital (Rotterdam), and the Hospital for Sick Children in Toronto.
Patient selection: critically-ill child (gestational age >= 35 weeks; age <= 21 years)
Criteria for enteral feeding intolerance:
(1) insufficient enteral intake (see below)
(2) presence of one or both of the following:
(2a) gastrointestinal symptoms (large gastric residual volume, vomiting, diarrhea)
(2b) severe gastrointestinal symptoms with concern for intestinal ischemia (abdominal distention, abdominal pain, melena, hematochezia)
Insufficient enteral intake is one or more of the following AND not because of an interruption for a procedure:
(1) enteral intake < 67% of prescribed daily target
(2) enteral nutrition withheld for >= 48 hours
(3) enteral nutrition not increased for >= 48 hours
A large gastric residual volume is >= 50% of enteral intake over the past 4 hours
