Outcomes of Delaying Parenteral Nutrition for 1 Week vs Initiation Within 24 Hours Among Undernourished Children in Pediatric Intensive Care

Key Points Question What are the effects of withholding parenteral nutrition in undernourished critically ill children? Findings In a randomized clinical trial, compared with well-nourished pediatric intensive care unit patients, being acutely undernourished on admission to the pediatric intensive care unit was associated with prolonged intensive care dependency. In this subanalysis of 289 undernourished critically ill children with insufficient enteral nutritional intake, withholding supplemental parenteral nutrition for 1 week (late parenteral nutrition) reduced new infections and shortened intensive care dependency, as compared with early (<24 hours) supplemental parenteral nutrition. Meaning Withholding parenteral nutrition during the first week of pediatric critical illness is clinically superior to early initiation in undernourished critically ill children.