Clinical Research Directory

Inclusion Criteria: 1. Between 28 days and 18 years of age 2. Have a BMI z-score \< 0 on PICU admission 3. Requires respiratory support in the form of invasive or non-invasive mechanical ventilation (CPAP or BiPAP) within 24-48 hours of PICU admission, and the attending physician expects the child to require any respiratory support for at least 48 hours of PICU admission 4. Requires enteral nutrition support for feeding (e.g., oro-gastric, nasogastric, gastrostomy, naso-jejunal, oro-jejunal) 5. Have an expected PICU stay of \> 48 hours Exclusion Criteria: 1. Are not expected to survive this PICU admission because of palliative care (e.g., do-not-resuscitate status) or limited life support 2. Progressive neuromuscular disease (e.g., spinal muscular atrophy, Duchenne or other muscular dystrophy, multiple sclerosis, amyotrophic lateral sclerosis) 3. Medical conditions where increased or decreased protein intake is required, including acute kidney injury (stage 3 KDIGO criteria), chronic kidney disease (stage 4 and 5), inborn errors of metabolism, fulminant liver failure, severe burn injury 4. Contraindications to enteral nutrition (e.g., gut hemorrhage, post-gastrointestinal surgery etc.) 5. Diagnosed cow's milk protein allergy 6. Parenteral nutrition 7. Premature infants who are less than corrected gestational age of 44 weeks (gestational age + weeks after birth) 8. Were previously enrolled in this trial 9. Are currently enrolled in a potentially confounding trial 10. Diagnosis of anorexia nervosa and other eating disorders 11. On extra-corporeal membrane oxygenation (ECMO) support 12. Conditions that required significant fluid restriction (≤75% of maintenance fluid) (e.g., post cardiac surgery etc.)