99 / 208
Evidence for the use of PN in the PICU
97
5
While the evidence from high quality RCTs no longer supports the early use of PN for critically
ill adult patients, and while the literature may suggest the opposite for preterm newborns,
there is currently no evidence to support any of the current PN practices for critically ill patients
from term neonates to adolescents. Although several observational studies of large cohorts
of critically children have shown a relation between the adequacy of feeding and of protein
intake during the first 10 days of admission and lower risk of death
4,41
, the adult literature
calls for caution in assuming that this association is causal. Hence, whether and for how long
the substantial macronutrient deficit that accumulates in critically ill infants and children on
enteral feeding only can be tolerated remains an open question.
Further research is therefore necessary to address this question and to determine the role of
PN in the PICU population. In order to answer this important question, the study should be
large enough to have enough statistical power to detect relevant differences in hard clinical
endpoints. The results of the currently ongoing multicenter randomized controlled PEPaNIC
trial (Clinical Trials.gov NCT 01536275), will hopefully elucidate some of the controversial
topics. The PEPaNIC trial is a study of 1440 critically ill infants and children, and compares
the effects of early PN with no PN for up to one week in PICU on several patient-centered
clinical endpoints such as new infections and the duration of PICU dependency, besides safety
endpoints including mortality
42
.