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Both overfeeding and underfeeding critically ill children are problematic. This prospective pilot study evaluated the resting energy expenditure in infants and children requiring extracorporeal membrane oxygenation (ECMO) support. An indirect calorimeter was used to measure oxygen consumption (VO2) and carbon dioxide production (VCO2) from the mechanical ventilator. Blood gases were used to determine VO2 and VCO2 from the ECMO circuit.