We found eight trials of an immune-enhancing formula versus a standard formula for feeding critically ill children, which did not show consistent benefit in terms of clinically important outcomes. This was, however, not a systematic review of immune-enhancing formulae in critically ill children. It would be of interest to conduct a systematic review of immune-enhancing formulae in paediatric critical illness. The immune-enhancing components may best be considered as pharmacological interventions, rather than nutritional support, in which case they should be studied separately from the need for nutritional support (Heyland 2006). One trial of gastric versus small bowel feeding found that more calories
were provided in the small bowel-fed group, with trends toward increased mortality, ventilator days, intensive care unit days, and hospital days in the small bowel-fed group (Meert 2004).