Long-term developmental effects of withholding parenteral nutrition for 1 week in the paediatric intensive care unit: a 2-year follow-up of the PEPaNIC international, randomised, controlled trial

Verstraete, Sören; Verbruggen, Sascha; Hordijk, José; Vanhorebeek, Ilse; Dulfer, Karolijn; Güiza, Fabian; Puffelen, Esther van; Jacobs, An; Leys, Sandra; Durt, Astrid; Cleemput, Hanna Van; Eveleens, Renate; Guerra, Gonzalo Garcia; Wouters, Pieter; Joosten, Koen; Berghe, Greet Van den

doi:10.1016/s2213-2600(18)30334-5

Cited by 66 publications

(124 citation statements)

References 22 publications

(23 reference statements)

Supporting

Mentioning

116

Contrasting

Order By: Relevance

“…14.1: Withholding parenteral nutrition for up to one week can be considered in critically ill term neonates and children, independent of nutritional status, while providing micronutrients B Consensus [8,9,22,[25][26][27]156] In critically ill children, does the use of a feeding protocols impact on clinical outcomes? 15…”

Section: Discussionmentioning

confidence: 99%

“…The post-pyloric or small intestinal site for EN may be used in patients unable to tolerate gastric feeding or those at high risk for aspiration. Existing data are insufficient to make recommendations regarding the use of continuous vs intermittent gastric feeding R11.2: Gastric feeding is not inferior to post pyloric feeding in the majority of critically ill children outcome in critically ill children [26,27]. Despite the lack of effect shown of protocols on mortality and NEC in the meta-analysis, as the level of this evidence was low, all individual studies did show positive effect on other variables such as time to initiate feeding and achievement of energy goals, but it was not possible to pool these in a meta-analysis.…”

Section: Q8 What Is the Role Of Immunonutrition In Critically Ill Chmentioning

confidence: 99%

See 1 more Smart Citation

Nutritional support for children during critical illness: European Society of Pediatric and Neonatal Intensive Care (ESPNIC) metabolism, endocrine and nutrition section position statement and clinical recommendations

et al. 2020

View full text Add to dashboard Cite

Background: Nutritional support is considered essential for the outcome of paediatric critical illness. There is a lack of methodologically sound trials to provide evidence-based guidelines leading to diverse practices in PICUs worldwide. Acknowledging these limitations, we aimed to summarize the available literature and provide practical guidance for the paediatric critical care clinicians around important clinical questions many of which are not covered by previous guidelines. Objective:To provide an ESPNIC position statement and make clinical recommendations for the assessment and nutritional support in critically ill infants and children. Design: The metabolism, endocrine and nutrition (MEN) section of the European Society of Pediatric and NeonatalIntensive Care (ESPNIC) generated 15 clinical questions regarding different aspects of nutrition in critically ill children. After a systematic literature search, the Scottish Intercollegiate Guidelines Network (SIGN) grading system was applied to assess the quality of the evidence, conducting meta-analyses where possible, to generate statements and clinical recommendations, which were then voted on electronically. Strong consensus (> 95% agreement) and consensus (> 75% agreement) on these statements and recommendations was measured through modified Delphi voting rounds. Results:The final 15 clinical questions generated a total of 7261 abstracts, of which 142 publications were identified relevant to develop 32 recommendations. A strong consensus was reached in 21 (66%) and consensus was reached in 11 (34%) of the recommendations. Only 11 meta-analyses could be performed on 5 questions. Conclusions:We present a position statement and clinical practice recommendations. The general level of evidence of the available literature was low. We have summarised this and provided a practical guidance for the paediatric critical care clinicians around important clinical questions.There is a lack of high-quality evidence to guide nutrition in paediatric critical illness. This position statement and clinical recommendations summarise the existing evidence around 15 of the most important clinical questions, and where no evidence is available, suggest good clinical practice.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Q8 What Is the Role Of Immunonutrition In Critically Ill Chmentioning

confidence: 99%

Nutritional support for children during critical illness: European Society of Pediatric and Neonatal Intensive Care (ESPNIC) metabolism, endocrine and nutrition section position statement and clinical recommendations

et al. 2020

View full text Add to dashboard Cite

show abstract

“…Secondary analyses of the PEPaNIC trial showed that withholding PN was also beneficial in term neonates and children who were undernourished at admission [373,374], although withholding parenteral nutrition in term neonates was also associated with increased risk of severe hypoglycemia [373]. A long-term follow-up 2 years after PICU admission showed that withholding parenteral nutrition for 1 week did not affect survival, anthropometrics, or health status, but did improve certain domains of neurocognitive development [375]. Although the results of the PEP-aNIC trial corroborated the findings from adult RCTs, the optimal timing of parenteral nutrition in the critically ill child with sepsis is still not clear [371,[376][377][378].…”

mentioning

confidence: 99%

Surviving sepsis campaign international guidelines for the management of septic shock and sepsis-associated organ dysfunction in children

et al. 2020

View full text Add to dashboard Cite

Objectives: To develop evidence-based recommendations for clinicians caring for children (including infants, school-aged children, and adolescents) with septic shock and other sepsis-associated organ dysfunction.Design: A panel of 49 international experts, representing 12 international organizations, as well as three methodologists and three public members was convened. Panel members assembled at key international meetings (for those The Society of Critical Care Medicine guidelines are intended for general information only, are not medical advice, and do not replace professional advice, which should be sought for any medical condition. The full disclaimer for guidelines can be accessed at https ://www.sccm.org/Resea rch/Guide lines /Guide lines . panel members attending the conference), and a stand-alone meeting was held for all panel members in November 2018. A formal conflict-of-interest policy was developed at the onset of the process and enforced throughout. Teleconferences and electronic-based discussion among the chairs, co-chairs, methodologists, and group heads, as well as within subgroups, served as an integral part of the guideline development process. Methods:The panel consisted of six subgroups: recognition and management of infection, hemodynamics and resuscitation, ventilation, endocrine and metabolic therapies, adjunctive therapies, and research priorities. We conducted a systematic review for each Population, Intervention, Control, and Outcomes question to identify the best available evidence, statistically summarized the evidence, and then assessed the quality of evidence using the Grading of Recommendations Assessment, Development, and Evaluation approach. We used the evidence-to-decision framework to formulate recommendations as strong or weak, or as a best practice statement. In addition, "in our practice" statements were included when evidence was inconclusive to issue a recommendation, but the panel felt that some guidance based on practice patterns may be appropriate. Results:The panel provided 77 statements on the management and resuscitation of children with septic shock and other sepsis-associated organ dysfunction. Overall, six were strong recommendations, 49 were weak recommendations, and nine were best-practice statements. For 13 questions, no recommendations could be made; but, for 10 of these, "in our practice" statements were provided. In addition, 52 research priorities were identified. Conclusions:A large cohort of international experts was able to achieve consensus regarding many recommendations for the best care of children with sepsis, acknowledging that most aspects of care had relatively low quality of evidence resulting in the frequent issuance of weak recommendations. Despite this challenge, these recommendations regarding the management of children with septic shock and other sepsis-associated organ dysfunction provide a foundation for consistent care to improve outcomes and inform future research. S14 the group heads, panel members, and methodologists. Searches utilized ...

show abstract

“…Furthermore, the concerns on the efficacy and safety of stopping the intervention (in our case withholding PN) should be addressed if possible. Since the launch of this survey, several secondary analyses have investigated the main concerns, such as the harm associated with administration of amino acids [29], the efficacy and safety of withholding PN in undernourished children [21] and neonates [20], the long-term effects on physical and neuropsychological functions [30], and the cost-effectiveness of withholding PN [31]. All these new findings were supportive for de-implementation of early-PN.…”

Section: Discussionmentioning

confidence: 95%

International survey of De-implementation of initiating parenteral nutrition early in Paediatric intensive care units

Puffelen

Jacobs

Verdoorn

et al. 2019

BMC Health Serv Res

Self Cite

View full text Add to dashboard Cite

Background: Initiating parenteral nutrition (PN) within 24 h in critically ill children is inferior to withholding PN during the first week, as was found in the PEPaNIC study. The aims of this study were to investigate deimplementation of early initiation of PN at PICUs worldwide, and to identify factors influencing de-implementation. Methods: A cross-sectional online survey was conducted (May-October 2017), consisting of 41 questions addressing current PN practices, the degree of de-implementation, and factors affecting de-implementation. Results: We analysed 81 responses from 39 countries. Of these 81 respondents, 53 (65%) were aware of the findings of the PEPaNIC study, and 43 (53%) have read the article. In these 43 PICUs, PN was completely withheld during the first week in 10 PICUs, of which 5 already withheld PN (12%), and 5 de-implemented early initiation of PN (12%). Partial de-implementation was reported by 17 (40%) and no de-implementation by 16 (37%). Higher deimplementation rates were observed when the interpreted level of evidence and grade of recommendation of PEPaNIC was high. Predominant reasons for retaining early initiation of PN were concerns on withholding amino acids, the safety in undernourished children and neonates, and the long-term consequences. Furthermore, the respondents were waiting for updated guidelines. Conclusions: One year after the publication of the PEPaNIC trial, only two-thirds of the respondents was aware of the study results. Within this group, early initiation of PN was de-implemented completely in 12% of the PICUs, while 40% asserted partial de-implementation. Increasing the awareness, addressing the intervention-specific questions and more frequently revising international guidelines might help to accelerate de-implementation of ineffective, unproven or harmful healthcare.

show abstract

Long-term developmental effects of withholding parenteral nutrition for 1 week in the paediatric intensive care unit: a 2-year follow-up of the PEPaNIC international, randomised, controlled trial

Cited by 66 publications

References 22 publications

Nutritional support for children during critical illness: European Society of Pediatric and Neonatal Intensive Care (ESPNIC) metabolism, endocrine and nutrition section position statement and clinical recommendations

Nutritional support for children during critical illness: European Society of Pediatric and Neonatal Intensive Care (ESPNIC) metabolism, endocrine and nutrition section position statement and clinical recommendations

Surviving sepsis campaign international guidelines for the management of septic shock and sepsis-associated organ dysfunction in children

International survey of De-implementation of initiating parenteral nutrition early in Paediatric intensive care units

Contact Info

Product

Resources

About