title: Evidence for the use of parenteral nutrition in the pediatric intensive care unit.
abstract: During hospitalization in a pediatric intensive care unit (PICU), critically ill children are fed artificially. Administered via the preferred enteral route, caloric targets are often not reached. Hence, parenteral nutrition is given to this patient population. In this review we analyzed the available evidence from randomized controlled trials (RCTs) that supports the use of parenteral nutrition in children during critical illness.
  
  
  
  A search strategy in Ovid MEDLINE and Ovid EMBASE was created and trial registries were screened to identify the relevant RCTs. Studies were included if they were randomized controlled trials, involved pediatric patients admitted to PICU, and compared different dosing/compositions of parenteral nutrition. Descriptive studies and reviews were excluded.
  
  
  
  Of the 584 articles identified by the search strategy, only 114 articles were retained after title screening. Further abstract and full text screening identified 6 small RCTs that compared two dosing/composition strategies of parenteral nutrition. These trials reported differences in surrogate endpoints without an effect on hard clinical endpoints. The RCTs observed improvements in these surrogate endpoints with the use of more calories or when parenteral glutamine or fish oil was added.
  
  
  
  The few RCTs suggest that surrogate endpoints can be affected by providing parenteral nutrition to critically ill children, but the studies were not statistically powered to draw meaningful clinical conclusions. Large RCTs with clinically relevant outcome measures are urgently needed to support the current nutritional guidelines that advise the use of parenteral nutrition in the PICU.
authors.affiliation: Clinical Division and Laboratory of Intensive Care Medicine, Department Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium. Electronic address: tom.fivez@med.kuleuven.be.
authors.forename: Tom
authors.initials: T
authors.lastname: Fivez
authors.affiliation: Intensive Care Unit, Department of Paediatrics and Pediatric Surgery, Erasmus Medical Centre, Sophia Children's Hospital, Rotterdam, The Netherlands. Electronic address: d.kerklaan@erasmusmc.nl.
authors.forename: Dorian
authors.initials: D
authors.lastname: Kerklaan
authors.affiliation: Clinical Division and Laboratory of Intensive Care Medicine, Department Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium. Electronic address: dieter.mesotten@med.kuleuven.be.
authors.forename: Dieter
authors.initials: D
authors.lastname: Mesotten
authors.affiliation: Intensive Care Unit, Department of Paediatrics and Pediatric Surgery, Erasmus Medical Centre, Sophia Children's Hospital, Rotterdam, The Netherlands. Electronic address: s.verbruggen@erasmusmc.nl.
authors.forename: Sascha
authors.initials: S
authors.lastname: Verbruggen
authors.affiliation: Intensive Care Unit, Department of Paediatrics and Pediatric Surgery, Erasmus Medical Centre, Sophia Children's Hospital, Rotterdam, The Netherlands. Electronic address: k.joosten@erasmusmc.nl.
authors.forename: Koen
authors.initials: K
authors.lastname: Joosten
authors.affiliation: Clinical Division and Laboratory of Intensive Care Medicine, Department Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium. Electronic address: greet.vandenberghe@med.kuleuven.be.
authors.forename: Greet
authors.initials: G
authors.lastname: Van den Berghe
mesh_terms: D002648:Child; D016638:Critical Illness / Q000628:therapy; D023381:Endpoint Determination; D019317:Evidence-Based Medicine; D006760:Hospitalization; D006801:Humans; D015278:Intensive Care Units, Pediatric; D010288:Parenteral Nutrition; D016032:Randomized Controlled Trials as Topic
keywords: Children; Critical Illness; Intensive Care; Nutrition; Sepsis