ESPGHAN/ESPEN/ESPR/CSPEN guidelines on pediatric parenteral nutrition: Energy

Embleton, Nicholas D.; Braegger, Christian; Bronský, Jiří; Cai, Wei; Campoy, Cristina; Carnielli, Virgilio P.; Darmaun, Dominique; Décsi, Támas; Domellöf, Magnus; Embleton, Nicholas; Fewtrell, Mary; Mis, Nataša Fidler; Franz, Axel; Goulet, Olivier; Hartman, Corina; Hill, Susan; Hojsak, Iva; Iacobelli, Simona; Jochum, Frank; Joosten, Koen; Kolaček, Sanja; Koletzko, Berthold; Książyk, Janusz; Lapillonne, Alexandre; Lohner, Szimonetta; Mesotten, Dieter; Mihályi, Krisztina; Mihatsch, Walter A.; Mimouni, Francis; Mølgaard, Christian; Moltu, Sissel J.; Nomayo, Antonia; Picaud, Jean Charles; Prell, Christine; Puntis, John; Riskin, Arieh; Pipaón, Miguel Sáenz de; Senterre, Thibault; Shamir, Raanan; Simchowitz, Venetia; Szitányi, Peter; Tabbers, Merit M.; Akker, Chris H.B. Van Den; Goudoever, Johannes B. van; Kempen, Anne A. M. W. van; Verbruggen, Sascha; Wu, Jiang; Yan, Wei

doi:10.1016/j.clnu.2018.06.944

Cited by 162 publications

(178 citation statements)

References 57 publications

Supporting

Mentioning

155

Contrasting

Unclassified

Order By: Relevance

“…The Schofield equation or Talbot's tables are least inaccurate for predicting REE in critically ill children when IC is not available . Both ASPEN and the latest European Society for Clinical Nutrition and Metabolism guidelines recommend the Schofield equations (Table ), but these are not validated during CRRT. Metabolic activity during CRRT could intrinsically be altered because the extracorporeal circuit induces immunologic activation and heat loss (the so‐called “dialytrauma” hypothesis) .…”

Section: Resultsmentioning

confidence: 99%

Modification of Nutrition Therapy During Continuous Renal Replacement Therapy in Critically Ill Pediatric Patients: A Narrative Review and Recommendations

Jonckheer¹,

Vergaelen²,

Spapen³

et al. 2018

Nut in Clin Prac

View full text Add to dashboard Cite

Introduction Nutrition is an important part of treatment in critically ill children. Clinical guidelines for nutrition adaptations during continuous renal replacement therapy (CRRT) are lacking. We collected and evaluated current knowledge on this topic and provide recommendations. Methods Questions were produced to guide the literature search in the PubMed database. Results Evidence is scarce and extrapolation from adult data was often required. CRRT has a direct and substantial impact on metabolism. Indirect calorimetry is the preferred method to assess resting energy expenditure (REE). Moderate underestimation of REE is common but not clinically relevant. Formula‐based calculation of REE is inaccurate and not validated in critically ill children on CRRT. The nutrition impact of nonintentional calories delivered as citrate, lactate, and glucose during CRRT must be considered. Quantifying nitrogen balance is not feasible during CRRT. Protein delivery should be increased by 25% to compensate for losses in the effluent. Fats are not removed by CRRT and should not be adapted during CRRT. Electrolyte disturbances are frequently present and should be treated accordingly. Vitamins B1, B6, B9, and C are lost in the effluent and should be adapted to the effluent dose. Trace elements, with the exception of selenium, are not cleared in relevant quantities. Manganese accumulation is of concern because of potential neurotoxicity. Conclusion Current recommendations regarding nutrition support in pediatric CRRT must be extrapolated from adult studies. Recommendations are provided, based on the weak level of evidence. Additional research on this topic is warranted.

show abstract

Section: Resultsmentioning

confidence: 99%

Modification of Nutrition Therapy During Continuous Renal Replacement Therapy in Critically Ill Pediatric Patients: A Narrative Review and Recommendations

Jonckheer¹,

Vergaelen²,

Spapen³

et al. 2018

Nut in Clin Prac

View full text Add to dashboard Cite

show abstract

“…When the survey was distributed, the most recent international guidelines were developed in 2005 and 2009. In the meantime, these guidelines have been updated by the leading expert nutrition societies [27,28], which means that the time between previous and current versions of the guidelines was 8 to 13 years. The fact that updated guidelines were awaited by a significant proportion of respondents stresses the importance of up-to-date guidelines.…”

Section: Discussionmentioning

confidence: 99%

International survey of De-implementation of initiating parenteral nutrition early in Paediatric intensive care units

Puffelen

Jacobs

Verdoorn

et al. 2019

BMC Health Serv Res

View full text Add to dashboard Cite

Background: Initiating parenteral nutrition (PN) within 24 h in critically ill children is inferior to withholding PN during the first week, as was found in the PEPaNIC study. The aims of this study were to investigate deimplementation of early initiation of PN at PICUs worldwide, and to identify factors influencing de-implementation. Methods: A cross-sectional online survey was conducted (May-October 2017), consisting of 41 questions addressing current PN practices, the degree of de-implementation, and factors affecting de-implementation. Results: We analysed 81 responses from 39 countries. Of these 81 respondents, 53 (65%) were aware of the findings of the PEPaNIC study, and 43 (53%) have read the article. In these 43 PICUs, PN was completely withheld during the first week in 10 PICUs, of which 5 already withheld PN (12%), and 5 de-implemented early initiation of PN (12%). Partial de-implementation was reported by 17 (40%) and no de-implementation by 16 (37%). Higher deimplementation rates were observed when the interpreted level of evidence and grade of recommendation of PEPaNIC was high. Predominant reasons for retaining early initiation of PN were concerns on withholding amino acids, the safety in undernourished children and neonates, and the long-term consequences. Furthermore, the respondents were waiting for updated guidelines. Conclusions: One year after the publication of the PEPaNIC trial, only two-thirds of the respondents was aware of the study results. Within this group, early initiation of PN was de-implemented completely in 12% of the PICUs, while 40% asserted partial de-implementation. Increasing the awareness, addressing the intervention-specific questions and more frequently revising international guidelines might help to accelerate de-implementation of ineffective, unproven or harmful healthcare.

show abstract

“…The aim of PN in preterm born is to achieve a regular postnatal growth rate. In detail, on the first postnatal day, the AA supply should be at least 1.5 g/Kg BW/day [31], with an energy intake of 45-55 Kcal/Kg BW/day [72]. From the second day of life on, the AA supply should be 2.5 to 3.5 g/Kg BW/day [31] with an energy intake of 90 to 120 Kcal/Kg BW/day [72].…”

Section: Pediatric Patientsmentioning

confidence: 99%

Macronutrients in Parenteral Nutrition: Amino Acids

et al. 2020

View full text Add to dashboard Cite

The right amount and quality of amino acids (AAs) supplied to patients on parenteral nutrition (PN) reduces muscle mass loss, may preserve or even increase it, with significant clinical benefits. Several industrial PN mixtures are available so that nutrition specialists can choose the product closest to the patient’s needs. In selected cases, there is the possibility of personalizing compounded mixtures in a hospital pharmacy that completely meets the individual nutritional needs of PN patients. This narrative review deals with the AA solutions used in PN mixtures. The physiology, the methods to calculate the AA needs, and the AA and energy requirements suggested by scientific guidelines for each patient type are also reported.

show abstract

ESPGHAN/ESPEN/ESPR/CSPEN guidelines on pediatric parenteral nutrition: Energy

Cited by 162 publications

References 57 publications

Modification of Nutrition Therapy During Continuous Renal Replacement Therapy in Critically Ill Pediatric Patients: A Narrative Review and Recommendations

Modification of Nutrition Therapy During Continuous Renal Replacement Therapy in Critically Ill Pediatric Patients: A Narrative Review and Recommendations

International survey of De-implementation of initiating parenteral nutrition early in Paediatric intensive care units

Macronutrients in Parenteral Nutrition: Amino Acids

Contact Info

Product

Resources

About