A recent article published in Pediatric Medicine discussed thatthe goal of nutritional support during critical illness is to provide the stipulated amount of nutrition required for acute, stable and recovery phases in order to accelerate recovery and to improve short- and long-term outcomes. Although the enteral route is preferred for critically ill pediatric patients, reaching target intakes is often difficult due to (perceived) feeding intolerance, fluid restriction and interruptions around procedures. 

As undernourishment in these children renderspoor prognosis, parenteral nutrition (PN) is deemed as an optimal alternative for reaching early and high nutritional targets. However, PN recommendations regarding timing, dose and composition vary widely. 

Here, the authors informed that thepediatric early versus late PN in critically ill children (PEPaNIC) study showed that omitting supplemental PN during the first week of pediatric intensive care unit (PICU) admission reduced new acquired infections and accelerated recovery. Additionally, provision of amino acids was negatively associated with short-term outcomes.

Meanwhile, results of the long-term PEPaNIC follow-up study showed that withholding early PN did not negatively affect anthropometrics and health status, but improved neurocognitive and psychosocial development—after two and four years. 

Therefore, the current guidelines suggest withholding parenteral macronutrients for the first week of PICU admission, while providing micronutrients. Although parenteral restriction during the first week of critical illness has been found beneficial, further research beyond the acute phase is warranted to determine the best role of PN in terms of optimal timing, dose and composition in order to improve short-term recovery and long-term developmental outcomes.

This article summarized that enteral intake is frequently insufficient in critically ill children; thus, PNmay be essential. Understanding the course of metabolic needs during the acute stress response is essential before providing PN. It was stated that further research is required to obtain the optimal timing, dose and composition of PN during stable and recovery phase.

Source: Pediatric Medicine. 2020 Nov; Vol 20. Available from:https://pm.amegroups.com/article/view/5804