Early hypophosphatemia in critically ill children and the effect of parenteral nutrition: A secondary analysis of the PEPaNIC RCT

Veldscholte, Karlien; Veen, M.A.N.; Eveleens, Renate; Jonge, Rogier C. J. de; Vanhorebeek, Ilse; Gunst, Jan; Casaer, Michaël P; Wouters, Pieter; Guerra, Gonzalo Garcia; Berghe, Greet Van den; Joosten, K.F.; Verbruggen, Sascha

doi:10.1016/j.clnu.2022.09.001

Cited by 4 publications

(2 citation statements)

References 35 publications

(46 reference statements)

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“…The PEPaNIC randomized controlled trial, several of the preplanned secondary analyses, and other studies evaluating the timing of PN initiation on outcomes are summarized in Table 3. Outcomes reported with late vs early PN in the PEPaNIC secondary analyses include cost reduction, 42 decreased infections in patients diagnosed with malnutrition by anthropometric measurements, 43 less refeeding hypophosphatemia, 32 decreased total thyroxine levels, 39 and no difference in weight‐for‐age Z score deterioration 38 . An association of increased infections and prolonged mechanical ventilation requirement was found with early exposure to PN amino acids but not with lipid or dextrose 45 .…”

Section: Timing Of Pn Initiation Without Contraindications To Enmentioning

confidence: 99%

Timing of enteral nutrition and parenteral nutrition in the PICU

Fell,

Bitetto,

Skillman

2023

Nut in Clin Prac

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The timing of nutrition support initiation has the potential to positively impact nutrition and clinical outcomes in infants and children with critical illness. Early enteral nutrition within 24–48 h and attainment of both a 60% energy and protein goal by the end of the first week of pediatric intensive care unit admission are reported to be significantly associated with improved survival in large observational studies. The results of one randomized controlled trial demonstrated increased morbidity in infants and children with critical illness assigned to early vs delayed supplemental parenteral nutrition. Observational studies in this population also suggest increased mortality with exclusive parenteral nutrition and worse nutrition outcomes when parenteral nutrition is delayed. Subsequently, current nutrition support guidelines recommend early enteral nutrition and avoidance of early parenteral nutrition, although the available evidence used to create the guidelines was inadequate to inform bedside nutrition support practice to improve outcomes. These guidelines are limited by the included studies with small numbers and heterogeneity of patients and research design that confound study outcomes and interpretation. This article provides a narrative review of the timing of nutrition support on outcomes in infants and children with critical illness, strategies to optimize timing and adequacy of nutrition support, and literature gaps, including the timing of parenteral nutrition initiation for children with malnutrition and those with contraindications to enteral nutrition and accurate measurement of energy requirements.

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Section: Timing Of Pn Initiation Without Contraindications To Enmentioning

confidence: 99%

Timing of enteral nutrition and parenteral nutrition in the PICU

Fell,

Bitetto,

Skillman

2023

Nut in Clin Prac

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“…Many physiological pathways require phosphate, including skeletal development and mineralization, membrane composition, nucleotide structure, cellular signaling, energy storage, and acid-base balance [3,4]. Nutritional deficiencies, refeeding syndrome, insulin therapy for diabetic ketoacidosis, increased catecholamine secretion, acute respiratory alkalosis, diuretics, glucocorticoids, and antacids are all known to be associated with hypophosphatemia [3,[5][6][7][8][9][10][11][12][13][14][15][16]. Hypophosphatasia is common in adult and pediatric intensive care units (ICUs).…”

Section: Introductionmentioning

confidence: 99%

Nomogram for predicting early hypophosphatemia in term infants

Tao,

Zhan,

Shen

et al. 2024

BMC Pediatr

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Background Physiological processes rely on phosphate, which is an essential component of adenosine triphosphate (ATP). Hypophosphatasia can affect nearly every organ system in the body. It is crucial to monitor newborns with risk factors for hypophosphatemia and provide them with the proper supplements. We aimed to evaluate the risk factors and develop a nomogram for early hypophosphatemia in term infants. Methods We conducted a retrospective study involving 416 term infants measured serum phosphorus within three days of birth. The study included 82 term infants with hypophosphatemia (HP group) and 334 term infants without hypophosphatemia (NHP group). We collected data on the characteristics of mothers, newborn babies, and childbirth. Furthermore, univariate and multivariate logistic regression analyses were performed to identify independent risk factors for hypophosphatemia in term infants, and a nomogram was developed and validated based on the final independent risk factors. Results According to our analysis, the multivariate logistic regression analysis showed that male, maternal diabetes, cesarean delivery, lower serum magnesium, and lower birth weight were independent risk factors for early hypophosphatemia in term infants. In addition, the C-index of the developed nomogram was 0.732 (95% CI = 0.668–0.796). Moreover, the calibration curve indicated good consistency between the hypophosphatemia diagnosis and the predicted probability, and a decision curve analysis (DCA) confirmed the clinical utility of the nomogram. Conclusions The analysis revealed that we successfully developed and validated a nomogram for predicting early hypophosphatemia in term infants.

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Side effects of vitamins, amino acids, nutrition, and complementary and alternative medicine

Waller

2023

Side Effects of Drugs Annual

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Early hypophosphatemia in critically ill children and the effect of parenteral nutrition: A secondary analysis of the PEPaNIC RCT

Cited by 4 publications

References 35 publications

Timing of enteral nutrition and parenteral nutrition in the PICU

Timing of enteral nutrition and parenteral nutrition in the PICU

Nomogram for predicting early hypophosphatemia in term infants

Side effects of vitamins, amino acids, nutrition, and complementary and alternative medicine

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