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Long-term outcomes related to timing of parenteral nutrition in critically ill children.
The Lancet Respiratory Medicine ( IF 38.7 ) Pub Date : 2020-02-18 , DOI: 10.1016/s2213-2600(20)30061-8 Nilesh M Mehta 1
The Lancet Respiratory Medicine ( IF 38.7 ) Pub Date : 2020-02-18 , DOI: 10.1016/s2213-2600(20)30061-8 Nilesh M Mehta 1
Affiliation
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Optimal nutrition is required to support the metabolic demands of the stress response, prevent nutritional deterioration, and improve outcomes in critically ill children. However, there is a paucity of high-quality trials on the topic, and important questions about the optimal dose, timing, and route of nutritional interventions in the paediatric intensive care unit (PICU) remain unanswered. In 2017, the PEPaNIC trial described the benefits of a late parenteral nutrition strategy (delayed until day 8) in patients admitted to the PICU who were unable to achieve at least 80% energy intake via enteral nutrition, compared with early parenteral nutrition (started within 24 h of admission). In 2019, the trial investigators reported significantly better inhibitory control at 2-year follow-up among patients in the late parenteral nutrition group, compared with early parenteral nutrition. In a pre-planned secondary analysis of the PEPaNIC trial in The Lancet Respiratory Medicine, Fabian Güiza and colleagues propose differential DNA methylation as a potential mechanism to explain, at least in part, the improved neurocognitive outcomes in the late parenteral nutrition group. The PEPaNIC studies continue to enrich the field with new information that has challenged dogma, presented interesting hypotheses, and generated some controversy.
中文翻译：
与危重儿童肠胃外营养时机有关的长期结果。
需要最佳营养来支持应激反应的代谢需求，防止营养恶化并改善危重儿童的结局。但是，关于该主题的高质量试验很少，关于小儿重症监护病房（PICU）的最佳剂量，时机和营养干预途径的重要问题仍未得到解答。2017年，PEPaNIC试验描述了晚期肠胃外营养策略（推迟到第8天）对于PICU入院患者无法通过肠内营养实现至少80％的能量摄入的益处，而早期肠胃外营养（从入场24小时）。在2019年，试验研究者报告了晚期肠胃外营养组患者在2年随访中的抑制控制明显改善，与早期肠胃外营养相比。在预先计划的PEPaNIC试验的二级分析中《柳叶刀》呼吸医学杂志（FabianGüiza）及其同事提出，差异DNA甲基化是潜在的机制，至少部分地解释了晚期肠胃外营养组神经认知功能改善的原因。PEPaNIC研究继续通过挑战信条，提出有趣的假设并引起一些争议的新信息来丰富该领域。
更新日期：2020-03-03
中文翻译：
与危重儿童肠胃外营养时机有关的长期结果。
需要最佳营养来支持应激反应的代谢需求，防止营养恶化并改善危重儿童的结局。但是，关于该主题的高质量试验很少，关于小儿重症监护病房（PICU）的最佳剂量，时机和营养干预途径的重要问题仍未得到解答。2017年，PEPaNIC试验描述了晚期肠胃外营养策略（推迟到第8天）对于PICU入院患者无法通过肠内营养实现至少80％的能量摄入的益处，而早期肠胃外营养（从入场24小时）。在2019年，试验研究者报告了晚期肠胃外营养组患者在2年随访中的抑制控制明显改善，与早期肠胃外营养相比。在预先计划的PEPaNIC试验的二级分析中《柳叶刀》呼吸医学杂志（FabianGüiza）及其同事提出，差异DNA甲基化是潜在的机制，至少部分地解释了晚期肠胃外营养组神经认知功能改善的原因。PEPaNIC研究继续通过挑战信条，提出有趣的假设并引起一些争议的新信息来丰富该领域。
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