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Published on: September 20, 2019
Evidence for the use of parenteral nutrition in the pediatric intensive care unit
Tom Fivez1, Dorian Kerklaan2, Dieter Mesotten1
1Clinical Division and Laboratory of Intensive Care Medicine, Department Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium.
Insights
Parenteral nutrition in pediatric intensive care units (PICU) may improve surrogate markers in critically ill children. However, current evidence from randomized controlled trials (RCTs) is limited, necessitating larger studies for clinical conclusions.
Area of Science:
- Pediatric Intensive Care
- Clinical Nutrition
- Critical Care Medicine
Background:
- Critically ill children in the pediatric intensive care unit (PICU) often require artificial nutrition.
- Enteral feeding frequently fails to meet caloric targets in this population.
- Parenteral nutrition is commonly utilized when enteral routes are insufficient.
Purpose of the Study:
- To review evidence from randomized controlled trials (RCTs) on the use of parenteral nutrition in critically ill children.
- To assess the impact of different parenteral nutrition dosing and compositions on clinical outcomes.
Main Methods:
- A systematic search of Ovid MEDLINE and Ovid EMBASE was conducted.
- Trial registries were screened to identify relevant RCTs.
- Studies involving pediatric patients in PICU comparing parenteral nutrition strategies were included; reviews and descriptive studies were excluded.
Main Results:
- Six small RCTs were identified, comparing different parenteral nutrition strategies.
- Improvements in surrogate endpoints were observed with increased calories or added glutamine/fish oil.
- No significant effects on hard clinical endpoints were reported.
Conclusions:
- Current RCTs suggest parenteral nutrition can influence surrogate endpoints in critically ill children.
- The existing studies lack the statistical power for definitive clinical conclusions.
- Larger RCTs focusing on clinically relevant outcomes are essential to validate current PICU nutritional guidelines.
Background And Aims:
During hospitalization in a pediatric intensive care unit (PICU), critically ill children are fed artificially. Administered via the preferred enteral route, caloric targets are often not reached. Hence, parenteral nutrition is given to this patient population. In this review we analyzed the available evidence from randomized controlled trials (RCTs) that supports the use of parenteral nutrition in children during critical illness.
Methods:
A search strategy in Ovid MEDLINE and Ovid EMBASE was created and trial registries were screened to identify the relevant RCTs. Studies were included if they were randomized controlled trials, involved pediatric patients admitted to PICU, and compared different dosing/compositions of parenteral nutrition. Descriptive studies and reviews were excluded.
Results:
Of the 584 articles identified by the search strategy, only 114 articles were retained after title screening. Further abstract and full text screening identified 6 small RCTs that compared two dosing/composition strategies of parenteral nutrition. These trials reported differences in surrogate endpoints without an effect on hard clinical endpoints. The RCTs observed improvements in these surrogate endpoints with the use of more calories or when parenteral glutamine or fish oil was added.
Conclusions:
The few RCTs suggest that surrogate endpoints can be affected by providing parenteral nutrition to critically ill children, but the studies were not statistically powered to draw meaningful clinical conclusions. Large RCTs with clinically relevant outcome measures are urgently needed to support the current nutritional guidelines that advise the use of parenteral nutrition in the PICU.
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