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Published on: September 20, 2019
Timing of parenteral nutrition initiation in critically ill children: a randomized clinical trial
Nagwan Y Saleh1, Hesham M Aboelghar1, Nehad B Abdelaty2
1Department of Pediatrics, Faculty of Medicine, Menoufia University, Shebin Elkom, Egypt.
Insights
Early parenteral nutrition (PN) in critically ill children improves outcomes. Starting PN on admission day reduces mechanical ventilation needs and shortens pediatric intensive care unit (PICU) stays, enhancing clinical recovery.
Area of Science:
- Pediatric Critical Care Medicine
- Nutritional Support
- Clinical Trial Research
Background:
- The optimal timing for initiating parenteral nutrition (PN) in critically ill pediatric patients is not well-established.
- This uncertainty impacts clinical decision-making regarding nutritional support in pediatric intensive care units (PICUs).
Purpose of the Study:
- To determine the optimal timing for initiating parenteral nutrition (PN) in critically ill children.
- To evaluate the impact of early versus late PN initiation on clinical outcomes in a pediatric intensive care setting.
Main Methods:
- A randomized clinical trial involving 140 critically ill children in a pediatric intensive care unit (PICU).
- Patients were randomized to receive either early PN (day 1 of admission) or late PN (day 4 or 7).
- Primary outcome was mechanical ventilation (MV) requirement; secondary outcomes included PICU length of stay and mortality.
Main Results:
- Early PN initiation led to significantly earlier enteral feeding (median 6 vs. 12 days) and reduced feeding intolerance (5.6% vs. 18.8%).
- Patients receiving early PN had a shorter median PICU length of stay (P<0.001) and a reduced likelihood of requiring mechanical ventilation (P=0.018).
- The time to achieve full enteral caloric intake was significantly shorter in the early PN group (P=0.004).
Conclusions:
- Initiating parenteral nutrition (PN) early in critically ill children is associated with improved clinical outcomes.
- Early PN reduces the need for and duration of mechanical ventilation (MV) compared to later PN administration.
- Early PN demonstrates more favorable morbidity profiles, supporting its use in pediatric critical care.
Background:
The optimal timing of parenteral nutrition (PN) initiation in critically ill children remains controversial.
Purpose:
To identify the optimal timing of PN initiation in critically ill children.
Methods:
This randomized clinical trial was conducted in the pediatric intensive care unit (PICU) of Menoufia University Hospital. A total of 140 patients were randomized to receive early or late PN. The early PN group consisted of 71 well-nourished and malnourished patients who received PN on the first day of PICU admission. Malnourished (42%) and well-nourished children randomized to the late PN group (42%) started PN on the fourth versus seventh day after admission, respectively. Mechanical ventilation (MV) was the primary outcome, while PICU length of stay and mortality were secondary outcomes.
Results:
Patients who received early PN started enteral feeding significantly earlier (median, 6 days; interquartile range, 2-20 days) than those not provided early PN (median, 12 days; interquartile range, 3-30 days; P<0.001) and had a significantly lower risk of feeding intolerance (5.6% vs.18.8%, P=0.035). The median time required to obtain full calories enterally was shorter in the early versus late PN group (P=0.004). Furthermore, patients in the early versus late PN group had a significantly shorter median PICU stay (P<0.001) and were less likely to require MV (P=0.018).
Conclusion:
Patients who received early PN had a lower MV need and duration than those who received later PN and had more favorable clinical outcomes in terms of morbidity.
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