Timing of parenteral nutrition is associated with adequacy of nutrient delivery and anthropometry in critically ill children: A single‐center study

Abstract

Background The optimal timing of supplemental parenteral nutrition (PN) use in the pediatric intensive care unit (ICU) is unclear. We aimed to describe patterns of PN use in the ICU and the association between the timing of PN initiation and macronutrient delivery and anthropometry. Methods We enrolled patients (aged <18 years) with an ICU stay >3 days were started on PN in the ICU. Initiation within 48 hours of admission was deemed as early, and duration <5 days was deemed as short. We used multivariable analysis to examine the association between PN timing and macronutrient delivery adequacy (percentage of the prescribed target that was actually delivered) and weight‐for‐age z‐score (WAZ) over hospital stay. Results Ninety‐five patients were included. Median (interquartile range [IQR]) time to initiate PN was 4 (1, 6) days, and in 33%, PN was initiated early. Median (IQR) PN duration was 8 (5, 14) days, and in 16.8%, duration was short. Median (IQR) adequacies for total energy and protein delivery were 55% (40, 74) and 72% (44, 81) in the early PN group compared with 29% (3, 50) and 31% (4, 47), respectively, in the late PN group (P < .001). The late PN group had a 0.50‐unit greater decline in mean WAZ compared with the early PN group (95% CI, 0.11–0.89; P = .012). Conclusion Late PN initiation was associated with significantly lower adequacy of macronutrient delivery and greater decline in WAZ in critically ill children. The relationship between PN timing patient outcomes must be further examined.

Evaluation of nutritional status in pediatric intensive care unit patients: the results of a multicenter, prospective study in Turkey

“…The rate of infections, duration of mechanical ventilation and the length of stay in the intensive care unit were significantly lower in the late parenteral nutrition cohort (32,33). In a study evaluating nutritional status in 95 critically ill patients, the rate of parenteral nutrition was 7.7% and early parenteral nutrition was initiated in 33% of the patients in a mean duration of four days (1-6 days) (34).…”

Timing of enteral nutrition and parenteral nutrition in the PICU

“…Although changes in PN initiation before and after the change in practice were clinically and statistically significant, a much larger population may be necessary to demonstrate clinical outcome differences. A single‐center prospective study of PN initiation in the PICU including 95 children showed median time to PN initiation was 4 days 53 . Investigators found 33% of patients received early PN defined as within 48 h from admission to the PICU.…”

“…A single-center prospective study of PN initiation in the PICU including 95 children showed median time to PN initiation was 4 days. 53 Investigators found 33% of patients received early PN defined as within 48 h from admission to the PICU. Median PN duration was 8 days, and in 16.8% of children, PN was given for a short duration specified as <5 days.…”