Early Parenteral Nutrition in Critically Ill Children Not Receiving Early Enteral Nutrition Is Associated With Significantly Higher Mortality. JPEN J Parenter Enteral Nutr 2020 Aug;44(6):1096-1103
Date
10/28/2019Pubmed ID
31654448DOI
10.1002/jpen.1731Scopus ID
2-s2.0-85074554263 (requires institutional sign-in at Scopus site) 10 CitationsAbstract
BACKGROUND: To determine whether early parenteral nutrition (PN) (25% of goal energy within 48 hours of PICU admission) is associated with poorer outcomes in children receiving no enteral nutrition (EN).
METHODS: Multicenter retrospective study of patients aged 1 month to 18 years who had a PICU length of stay (PLOS) >96 hours. We obtained weight, sex, pediatric index of mortality 2 score (PIM-2), PLOS, duration of mechanical ventilation (DMV), mortality data, and nutrition intake data. Logistic and mixed model regression analysis were used to compare data.
RESULTS: 2069 patients (53.2% male, median age 6.61 years) received no EN in the first 4 days. Children receiving early PN were more likely to die than those who did not when adjusted for PIM-2, propensity score, and center (odds ratio = 2.10 [1.41-3.13], median [IQR]; P = 0.0003). The unadjusted PLOS (9.48 [5.94-18.19], and unadjusted DMV (6.73 [3.48-13.98]) for patients receiving early PN were both significantly longer than those who did not (6.75 [4.95-11.65]; P < 0.0001 and 4.9 [1.88-10.19]; P = 0.009, respectively). When adjusted for PIM-2, center, percentage of energy from protein, and age, the PLOS and DMV for those receiving early PN did not differ from those who did not (P = 0.14 and P = 0.76, respectively).
CONCLUSION: In children with PLOS >96 hours receiving no EN for 4 days, early PN is strongly associated with higher mortality but not with differences in PLOS or DMV.
Author List
Goday PS, Kuhn EM, Mikhailov TAAuthor
Theresa A. Mikhailov MD, PhD Professor in the Pediatrics department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
ChildCritical Illness
Enteral Nutrition
Female
Humans
Infant
Length of Stay
Male
Parenteral Nutrition
Respiration, Artificial
Retrospective Studies
