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Early Parenteral Nutrition in Critically Ill Children Not Receiving Early Enteral Nutrition Is Associated With Significantly Higher Mortality
Author(s) -
Goday Praveen S.,
Kuhn Evelyn M.,
Mikhailov Theresa A.
Publication year - 2020
Publication title -
journal of parenteral and enteral nutrition
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.935
H-Index - 98
eISSN - 1941-2444
pISSN - 0148-6071
DOI - 10.1002/jpen.1731
Subject(s) - medicine , parenteral nutrition , mechanical ventilation , odds ratio , enteral administration , logistic regression , propensity score matching , retrospective cohort study , critically ill , pediatrics
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.