Background: Malnutrition may be a significant problem in Pediatric Intensive Care Unit (PICU) patients and could adversely affect outcome.Objectives: To investigate the feasibility, safety and value of early nasogastric tube feeding in critically ill children (CIC).Design: A prospective randomized controlled trial involving 38 consecutively enrolled CIC fulfilling inclusion criteria.Interventions: Nasogastric tube feeding initiated within 24 hrs of admission (group A) compared to that initiated on or after the 3rd day (group B). Enteral feeding were advanced to a target volume of energy intake = 0.3; 0.6; 0.9; 1.2 and 1.5 of the predicted basal metabolic rate on days 1−5, respectively. Prokinetic agents were added.Measurements and main results: Initial clinical, anthropometric and laboratory [Albumin, Prealbumin (PA) and transferrin (TRF)] nutritional assessment and outcome assessment using achievement of caloric and protein goals by D5, laboratory indicators, length of stay and survival.Prior malnutrition was prevalent, low PA being the most sensitive marker of malnutrition. Intolerance wasn't common. The outcome assessment showed better achievement of caloric (p=0.02) and protein goals (p=0.002) by D5 in group A. Day 5 TRF and % change of PA were significantly higher in survivors (p=0.02; p=0.004, respectively).Group A had better survival to discharge than group B, significantly in those < than 12 mo (p=0.02).Conclusions: The implementation of an early feeding protocol encouraged the initiation of enteral feeding (EF) and proved to be safe and effective in improving the outcome.