{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T11:17:41Z","timestamp":1790162261351,"version":"4.1.0"},"reference-count":53,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T00:00:00Z","timestamp":1786665600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Nutr."],"abstract":"<jats:p>Acute gastrointestinal injury (AGI) affects 41\u201365% of children admitted to pediatric intensive care units (PICUs) and is associated with prolonged mechanical ventilation, extended hospital stays, multiple organ dysfunction, and increased mortality. Although the 2012 European Society of Intensive Care Medicine (ESICM) AGI grading system provides standardized gastrointestinal assessment for adults, no validated pediatric-specific tool currently exists. This narrative review critically synthesizes the prognostic and nutritional relevance of AGI severity assessment in critically ill children. A structured literature search of PubMed, Embase, Web of Science, Google Scholar, Cochrane Library, CINAHL, CNKI, and Wanfang Data through December 2025 yielded 78 peer-reviewed articles, guidelines, and consensus statements. Two reviewers independently screened records; evidence was appraised narratively with explicit attention to study design and methodological quality, assigning greater weight to multicenter prospective studies, pediatric guidelines, and meta-analyses (level I\u2013II evidence). No formal quality assessment, consensus methodology, or systematic evidence synthesis was performed, consistent with narrative review methodology. Existing pediatric adaptations of adult AGI criteria have been reported in single-center and observational studies and include reported thresholds for gastric residual volume (&amp;gt;5\u202fmL\/kg), intra-abdominal pressure gradations, and feeding intolerance definitions. Higher AGI severity is consistently associated with increased mortality, prolonged mechanical ventilation, and greater multiple organ dysfunction syndrome. Synthesis of AGI severity concepts with pediatric nutrition guidelines suggests that early enteral nutrition appears feasible in mild dysfunction, whereas severe grades may warrant cautious parenteral supplementation with dynamic reassessment. This review identifies critical gaps: the absence of multicenter validation, the subjective nature of grading variables, and the lack of age-stratified nutritional trials. In conclusion, AGI severity assessment holds conceptual promise for risk stratification and nutritional guidance in pediatric intensive care, but requires formal consensus methodology, systematic evidence synthesis, and prospective validation before clinical adoption.<\/jats:p>","DOI":"10.3389\/fnut.2026.1911973","type":"journal-article","created":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T04:23:31Z","timestamp":1786681411000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Acute gastrointestinal injury severity assessment informs nutritional support and prognostic evaluation in critically ill children: a narrative review"],"prefix":"10.3389","volume":"13","author":[{"given":"Cizheng","family":"Zeng","sequence":"first","affiliation":[{"name":"Pediatric Intensive Care Unit, Affiliated Hospital of Guangdong Medical University","place":["Zhanjiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tufeng","family":"Li","sequence":"additional","affiliation":[{"name":"Pediatric Intensive Care Unit, Affiliated Hospital of Guangdong Medical University","place":["Zhanjiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiayuan","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Scientific Research, Affiliated Hospital of Guangdong Medical University","place":["Zhanjiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shiwen","family":"Rong","sequence":"additional","affiliation":[{"name":"Pediatric Intensive Care Unit, Affiliated Hospital of Guangdong Medical University","place":["Zhanjiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaohua","family":"Liu","sequence":"additional","affiliation":[{"name":"Pediatric Intensive Care Unit, Affiliated Hospital of Guangdong Medical University","place":["Zhanjiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yinhui","family":"Chen","sequence":"additional","affiliation":[{"name":"Pediatric Intensive Care Unit, Affiliated Hospital of Guangdong Medical University","place":["Zhanjiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nali","family":"Cai","sequence":"additional","affiliation":[{"name":"Pediatric Intensive Care Unit, Affiliated Hospital of Guangdong Medical University","place":["Zhanjiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Limei","family":"Zhang","sequence":"additional","affiliation":[{"name":"Pediatric Intensive Care Unit, Affiliated Hospital of Guangdong Medical University","place":["Zhanjiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wen","family":"Li","sequence":"additional","affiliation":[{"name":"Pediatric Intensive Care Unit, Affiliated Hospital of Guangdong Medical University","place":["Zhanjiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ling","family":"Liu","sequence":"additional","affiliation":[{"name":"Pediatric Intensive Care Unit, Affiliated Hospital of Guangdong Medical University","place":["Zhanjiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,14]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"384","DOI":"10.1007\/s00134-011-2459-y","article-title":"Gastrointestinal function in intensive care patients: terminology, definitions and management. Recommendations of the ESICM working group on abdominal problems","volume":"38","author":"Reintam Blaser","year":"2012","journal-title":"Intensive Care Med"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"S53","DOI":"10.1542\/peds.2021-052888H","article-title":"Gastrointestinal dysfunction criteria in critically ill children: the PODIUM consensus conference","volume":"149","author":"Typpo","year":"2022","journal-title":"Pediatrics"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"S1","DOI":"10.1542\/peds.2021-052888B","article-title":"Pediatric organ dysfunction information update mandate (PODIUM) contemporary organ dysfunction criteria: executive summary","volume":"149","author":"Bembea","year":"2022","journal-title":"Pediatrics"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"78","DOI":"10.21304\/2018.0506.00463","article-title":"Acute gut injury: prevalence and impact on outcome in critically ill children","volume":"5","author":"Dhochak","year":"2018","journal-title":"J Pediatr Crit Care"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"649","DOI":"10.1111\/jpc.15804","article-title":"Acute gastrointestinal injury in critically ill children: impact on clinical outcome","volume":"58","author":"Dhochak","year":"2022","journal-title":"J Paediatrics Child Health"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"470","DOI":"10.1186\/s12887-024-04947-0","article-title":"Trajectories of acute gastrointestinal injury grade in critically ill children","volume":"24","author":"Lin","year":"2024","journal-title":"BMC Pediatr"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"188","DOI":"10.1186\/s13054-017-1780-4","article-title":"Severity of acute gastrointestinal injury grade is a predictor of all-cause mortality in critically ill patients: a multicenter, prospective, observational study","volume":"21","author":"Hu","year":"2017","journal-title":"Crit Care"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"514","DOI":"10.3748\/wjg.v26.i5.514","article-title":"Severity of acute gastrointestinal injury grade is a good predictor of mortality in critically ill patients with acute pancreatitis","volume":"26","author":"Ding","year":"2020","journal-title":"WJG"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"3523","DOI":"10.3390\/nu16203523","article-title":"Personalized nutrition in the pediatric ICU: steering the shift from acute stress to metabolic recovery and rehabilitation","volume":"16","author":"Briassoulis","year":"2024","journal-title":"Nutrients"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"217","DOI":"10.1016\/j.clnu.2020.05.011","article-title":"Association between nutrition support and acute gastrointestinal injury in critically ill patients during the first 72 hours","volume":"40","author":"Li","year":"2021","journal-title":"Clin Nutr"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"21614","DOI":"10.1038\/s41598-023-49050-z","article-title":"Improving enteral nutrition tolerance and protein intake maybe beneficial to intensive care unit patients","volume":"13","author":"Zhong","year":"2023","journal-title":"Sci Rep"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"685","DOI":"10.1016\/j.clnu.2019.03.026","article-title":"Definitions, predictors and outcomes of feeding intolerance in critically ill children: a systematic review","volume":"39","author":"Eveleens","year":"2020","journal-title":"Clin Nutr"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"1675","DOI":"10.1007\/s00431-018-3229-4","article-title":"A review of feeding intolerance in critically ill children","volume":"177","author":"Tume","year":"2018","journal-title":"Eur J Pediatr"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"1441171","DOI":"10.3389\/fped.2024.1441171","article-title":"Measurements of enteral feeding intolerance in critically ill children: a scoping review","volume":"12","author":"Li","year":"2024","journal-title":"Front Pediatr"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"411","DOI":"10.1007\/s00134-019-05922-5","article-title":"Nutritional support for children during critical illness: European Society of Pediatric and Neonatal Intensive Care (ESPNIC) metabolism, endocrine and nutrition section position statement and clinical recommendations","volume":"46","author":"Tume","year":"2020","journal-title":"Intensive Care Med"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"706","DOI":"10.1177\/0148607117711387","article-title":"Guidelines for the provision and assessment of nutrition support therapy in the pediatric critically ill patient: Society of Critical Care Medicine and American Society for Parenteral and Enteral Nutrition","volume":"41","author":"Mehta","year":"2017","journal-title":"JPEN J Parenter Enteral Nutr"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"e2610639","DOI":"10.1001\/jama.2026.10639","article-title":"Gastric residual volume assessment in critically ill children: the GASTRIC-PICU randomized clinical trial","author":"Tume","year":"2026","journal-title":"JAMA"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"203","DOI":"10.1016\/j.ccc.2015.11.004","article-title":"The gut as the Motor of Multiple Organ Dysfunction in critical illness","volume":"32","author":"Klingensmith","year":"2016","journal-title":"Crit Care Clin"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"91","DOI":"10.1186\/s13054-025-05309-7","article-title":"A review of gut failure as a cause and consequence of critical illness","volume":"29","author":"Soranno","year":"2025","journal-title":"Crit Care"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"e70136","DOI":"10.1002\/ctm2.70136","article-title":"Intestinal oxygen utilisation and cellular adaptation during intestinal ischaemia\u2013reperfusion injury","volume":"15","author":"Archontakis-Barakakis","year":"2025","journal-title":"Clin Transl Med"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"8398","DOI":"10.3390\/ijms26178398","article-title":"Oxygen-mediated molecular mechanisms involved in intestinal ischemia and reperfusion injury","volume":"26","author":"Archontakis-Barakakis","year":"2025","journal-title":"IJMS"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"617","DOI":"10.1002\/ncp.10928","article-title":"Acute gastrointestinal failure is associated with worse hemodynamic and perfusion parameters over 48 h after admission in patients with septic shock: retrospective cohort study","volume":"38","author":"Klanovicz","year":"2023","journal-title":"Nutr Clin Pract"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"751","DOI":"10.1007\/s15010-018-1178-5","article-title":"Gut-origin sepsis in the critically ill patient: pathophysiology and treatment","volume":"46","author":"Assimakopoulos","year":"2018","journal-title":"Infection"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"2028","DOI":"10.3390\/ijms26052028","article-title":"Intestinal microbiota Dysbiosis role and bacterial translocation as a factor for septic risk","volume":"26","author":"Charitos","year":"2025","journal-title":"IJMS"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"462","DOI":"10.1038\/s41467-020-20746-4","article-title":"Clostridioides difficile exploits toxin-mediated inflammation to alter the host nutritional landscape and exclude competitors from the gut microbiota","volume":"12","author":"Fletcher","year":"2021","journal-title":"Nat Commun"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"e01444-24","DOI":"10.1128\/msystems.01444-24","article-title":"Comparative metagenome-associated analysis of gut microbiota and antibiotic resistance genes in acute gastrointestinal injury patients with the risk of in-hospital mortality","volume":"10","author":"Bai","year":"2025","journal-title":"mSystems"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"4491","DOI":"10.1113\/JP281951","article-title":"The impact of acute and chronic stress on gastrointestinal physiology and function: a microbiota\u2013gut\u2013brain axis perspective","volume":"601","author":"Leigh","year":"2023","journal-title":"J Physiol"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"472","DOI":"10.1002\/jpen.1678","article-title":"Gastrointestinal hormone profiles associated with enteral nutrition tolerance and gastric emptying in pediatric critical illness: a pilot study","volume":"44","author":"Martinez","year":"2020","journal-title":"J Parenter Enter Nutr"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"S201","DOI":"10.5005\/jp-journals-10071-23637","article-title":"Gastrointestinal issues in critically ill children","volume":"24","author":"Khilnani","year":"2020","journal-title":"Indian J Crit Care Med"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"1","DOI":"10.3310\/hta24230","article-title":"Routine gastric residual volume measurement to guide enteral feeding in mechanically ventilated infants and children: the GASTRIC feasibility study","volume":"24","author":"Tume","year":"2020","journal-title":"Health Technol Assess"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"707","DOI":"10.1097\/PCC.0000000000001944","article-title":"Gastric residual volume measurement in U.K. PICUs: a survey of practice","volume":"20","author":"Tume","year":"2019","journal-title":"Pediatr Crit Care Med"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"1049746","DOI":"10.1155\/ccrp\/1049746","article-title":"Prediction of gastric residual volume by ultrasonography in critically ill children undergoing enteral nutrition","volume":"2025","author":"Hu","year":"2025","journal-title":"Crit Care Res Pract"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"97","DOI":"10.1186\/s13054-020-2782-1","article-title":"A clinician\u2019s guide to Management of Intra-abdominal Hypertension and Abdominal Compartment Syndrome in critically ill patients","volume":"24","author":"De Laet","year":"2020","journal-title":"Crit Care"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"1190","DOI":"10.1007\/s00134-013-2906-z","article-title":"Intra-abdominal hypertension and the abdominal compartment syndrome: updated consensus definitions and clinical practice guidelines from the world Society of the Abdominal Compartment Syndrome","volume":"39","author":"Kirkpatrick","year":"2013","journal-title":"Intensive Care Med"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"63","DOI":"10.21304\/2016.0304.00146","article-title":"An update on intra-abdominal hypertension and abdominal compartment syndrome in children","volume":"3","author":"Raghunathan","year":"2016","journal-title":"J Pediatr Crit Care"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"20251244","DOI":"10.1515\/med-2025-1244","article-title":"Intra-abdominal hypertension\/abdominal compartment syndrome of pediatric patients in critical care settings","volume":"20","author":"Marjanovic","year":"2025","journal-title":"Open Medicine"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"920","DOI":"10.1002\/jpen.1025","article-title":"Early enteral nutrition is associated with significantly lower hospital charges in critically ill children","volume":"42","author":"Mikhailov","year":"2018","journal-title":"J Parenter Enter Nutr"},{"key":"ref38","doi-asserted-by":"publisher","first-page":"459","DOI":"10.1177\/0148607113517903","article-title":"Early enteral nutrition is associated with lower mortality in critically ill children","volume":"38","author":"Mikhailov","year":"2014","journal-title":"JPEN J Parenter Enteral Nutr"},{"key":"ref39","doi-asserted-by":"publisher","first-page":"e12970","DOI":"10.1097\/MD.0000000000012970","article-title":"Prevalence and outcome of acute gastrointestinal injury in critically ill patients: a systematic review and meta-analysis","volume":"97","author":"Zhang","year":"2018","journal-title":"Medicine"},{"key":"ref40","doi-asserted-by":"publisher","first-page":"219","DOI":"10.1186\/s12887-021-02673-5","article-title":"Gastrointestinal failure score in children with traumatic brain injury","volume":"21","author":"Zhou","year":"2021","journal-title":"BMC Pediatr"},{"key":"ref41","doi-asserted-by":"publisher","first-page":"181","DOI":"10.1007\/s11605-021-05015-z","article-title":"Acute gastrointestinal injury and feeding intolerance as prognostic factors in critically ill COVID-19 patients","volume":"26","author":"Drakos","year":"2022","journal-title":"J Gastrointest Surg"},{"key":"ref42","doi-asserted-by":"publisher","first-page":"1906","DOI":"10.3760\/cma.j.cn112150-20250810-00778","article-title":"Clinical features and prognostic risk assessment of pediatric sepsis","volume":"59","author":"Li","year":"2025","journal-title":"Zhonghua Yu Fang Yi Xue Za Zhi"},{"key":"ref43","doi-asserted-by":"publisher","first-page":"4125","DOI":"10.2147\/IJGM.S305209","article-title":"The serum Citrulline and D-lactate are associated with gastrointestinal dysfunction and failure in critically ill patients","volume":"14","author":"Teng","year":"2021","journal-title":"IJGM"},{"key":"ref44","doi-asserted-by":"publisher","first-page":"999","DOI":"10.3760\/cma.j.issn.2095-4352.2017.11.008","article-title":"Diagnostic value of citrulline and intestinal fatty acid binding protein on acute gastrointestinal injury in critical patients: a prospective study of 530 patients","volume":"29","author":"Wang","year":"2017","journal-title":"Zhonghua Wei Zhong Bing Ji Jiu Yi Xue"},{"key":"ref45","doi-asserted-by":"publisher","first-page":"811","DOI":"10.1097\/MPG.0000000000003950","article-title":"Gastrointestinal biomarkers and their association with feeding in the first five days of pediatric critical illness","volume":"77","author":"Veldscholte","year":"2023","journal-title":"J Pediatr Gastroenterol Nutr"},{"key":"ref46","doi-asserted-by":"publisher","first-page":"903944","DOI":"10.3389\/fped.2022.903944","article-title":"Point-of-care gastric ultrasound confirms the inaccuracy of gastric residual volume measurement by aspiration in critically ill children: GastriPed study","volume":"10","author":"Valla","year":"2022","journal-title":"Front Pediatr"},{"key":"ref47","doi-asserted-by":"publisher","first-page":"112255","DOI":"10.1016\/j.nut.2023.112255","article-title":"Enteral feeding strategies in patients with acute gastrointestinal injury: from limited to progressive to open feeding","volume":"117","author":"Wang","year":"2024","journal-title":"Nutrition"},{"key":"ref48","doi-asserted-by":"publisher","first-page":"99","DOI":"10.1186\/s13613-025-01509-0","article-title":"Expert consensus-based clinical practice guidelines for nutritional support in the intensive care unit: the French Intensive Care Society (SRLF) and the French-speaking Group of Pediatric Emergency Physicians and Intensivists (GFRUP)","volume":"15","author":"Reignier","year":"2025","journal-title":"Ann Intensive Care"},{"key":"ref49","doi-asserted-by":"publisher","first-page":"213","DOI":"10.1097\/PCC.0000000000002135","article-title":"Early enteral nutrition is associated with improved clinical outcomes in critically ill children: a secondary analysis of nutrition support in the heart and lung failure-pediatric insulin titration trial","volume":"21","author":"Srinivasan","year":"2020","journal-title":"Pediatr Crit Care Med"},{"key":"ref50","doi-asserted-by":"publisher","first-page":"2204","DOI":"10.1097\/CCM.0b013e31824e18a8","article-title":"Nutritional practices and their relationship to clinical outcomes in critically ill children--an international multicenter cohort study","volume":"40","author":"Mehta","year":"2012","journal-title":"Crit Care Med"},{"key":"ref51","doi-asserted-by":"publisher","first-page":"1911","DOI":"10.1016\/j.clnu.2020.09.005","article-title":"Achieving enteral nutrition during the acute phase in critically ill children: associations with patient characteristics and clinical outcome","volume":"40","author":"Eveleens","year":"2021","journal-title":"Clin Nutr"},{"key":"ref52","doi-asserted-by":"publisher","first-page":"e1010050","DOI":"10.1371\/journal.pcbi.1010050","article-title":"Microbiome-based disease prediction with multimodal variational information bottlenecks","volume":"18","author":"Grazioli","year":"2022","journal-title":"PLoS Comput Biol"},{"key":"ref53","doi-asserted-by":"publisher","first-page":"1819","DOI":"10.1152\/physrev.00035.2018","article-title":"Metabolomics for investigating physiological and pathophysiological processes","volume":"99","author":"Wishart","year":"2019","journal-title":"Physiol Rev"}],"updated-by":[{"DOI":"10.3389\/fnut.2026.1989398","type":"correction","label":"Correction","source":"publisher","updated":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T00:00:00Z","timestamp":1790121600000}}],"container-title":["Frontiers in Nutrition"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fnut.2026.1911973\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T10:28:47Z","timestamp":1790159327000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fnut.2026.1911973\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,14]]},"references-count":53,"alternative-id":["10.3389\/fnut.2026.1911973"],"URL":"https:\/\/doi.org\/10.3389\/fnut.2026.1911973","relation":{},"ISSN":["2296-861X"],"issn-type":[{"value":"2296-861X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,14]]},"article-number":"1911973"}}