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Early enteral nutrition (EEN) in critically ill children was associated with lower adjusted mortality (aOR 0.36; 95% CI 0.14–0.91) in pooled analyses of studies that adjusted for illness severity. Across 18 studies (n≈9,829), EEN was also associated with shorter ventilator and ICU length of stay, fewer infections, better nutrition adequacy, and lower organ dysfunction scores. However, the certainty of evidence is very low because most data are from observational cohorts, adjustment for confounding was limited, definitions of EEN varied, and between-study heterogeneity was substantial (I2=78.6% for mortality in adjusted pooled analysis). Clinicians should continue guideline-aligned early enteral feeding when feasible but recognize the limitations of current evidence and the need for high-quality randomized studies with standardized outcomes.
