Timing of parenteral nutrition initiation in critically ill children: a randomized clinical trial

BACKGROUND: The optimal timing of parenteral nutrition (PN) initiation in critically ill children remains controversial. PURPOSE: To identify the optimal timing of PN initiation in critically ill children. METHODS: This randomized clinical trial was conducted in the pediatric intensive care unit (PICU) of Menoufia University Hospital. A total of 140 patients were randomized to receive early or late PN. The early PN group consisted of 71 well-nourished and malnourished patients who received PN on the first day of PICU admission. Malnourished (42%) and well-nourished children randomized to the late PN group (42%) started PN on the fourth versus seventh day after admission, respectively. Mechanical ventilation (MV) was the primary outcome, while PICU length of stay and mortality were secondary outcomes. RESULTS: Patients who received early PN started enteral feeding significantly earlier (median, 6 days; interquartile range, 2–20 days) than those not provided early PN (median, 12 days; interquartile range, 3–30 days; P<0.001) and had a significantly lower risk of feeding intolerance (5.6% vs.18.8%, P=0.035). The median time required to obtain full calories enterally was shorter in the early versus late PN group (P=0.004). Furthermore, patients in the early versus late PN group had a significantly shorter median PICU stay (P<0.001) and were less likely to require MV (P=0.018). CONCLUSION: Patients who received early PN had a lower MV need and duration than those who received later PN and had more favorable clinical outcomes in terms of morbidity.