Abstract

Parenteral nutrition is used to treat children that cannot be fully fed by the enteral route. While the revised ESPGHAN/ESPEN/ESPR/CSPEN pediatric parenteral nutrition guidelines provide clear guidance on the use of parenteral nutrition in neonates, infants, and children based on current available evidence, they have helped to crystallize areas where research is lacking or more studies are needed in order to refine recommendations. This paper collates and discusses the research gaps identified by the authors of each section of the guidelines and considers each nutrient or group of nutrients in turn, together with aspects around delivery and organization. The 99 research priorities identified were then ranked in order of importance by clinicians and researchers working in the field using a survey methodology. The highest ranked priority was the need to understand the relationship between total energy intake, rapid catch-up growth, later metabolic function, and neurocognitive outcomes. Research into the optimal intakes of macronutrients needed in order to achieve optimal outcomes also featured prominently. Identifying research priorities in PN should enable research to be focussed on addressing key issues. Multicentre trials, better definition of exposure and outcome variables, and long-term metabolic and developmental follow-up will be key to achieving this.

Impact

• The recent ESPGHAN/ESPEN/ESPR/CSPEN guidelines for pediatric parenteral nutrition provided updated guidance for providing parenteral nutrition to infants and children, including recommendations for practice.

• However, in several areas there was a lack of evidence to guide practice, or research questions that remained unanswered. This paper summarizes the key priorities for research in pediatric parenteral nutrition, and ranks them in order of importance according to expert opinion.

中文翻译：

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儿科肠外营养的研究重点：ESPGHAN/ESPEN/ESPR/CSPEN 的共识和观点

摘要

肠外营养用于治疗无法通过肠内途径完全喂养的儿童。虽然修订后的 ESPGHAN/ESPEN/ESPR/CSPEN 儿科肠外营养指南根据现有证据为新生儿、婴儿和儿童的肠外营养使用提供了明确的指导，但它们有助于明确研究缺乏或更多研究的领域需要以完善建议。本文整理并讨论了指南每个部分的作者确定的研究差距，并依次考虑了每种营养素或营养素组，以及围绕交付和组织的方面。然后，在该领域工作的临床医生和研究人员使用调查方法按重要性顺序对确定的 99 个研究重点进行排序。排名最高的优先事项是需要了解总能量摄入、快速追赶增长、后期代谢功能和神经认知结果之间的关系。对实现最佳结果所需的常量营养素的最佳摄入量的研究也很重要。确定 PN 中的研究重点应该使研究能够专注于解决关键问题。多中心试验、更好地定义暴露和结果变量以及长期代谢和发育随访将是实现这一目标的关键。确定 PN 中的研究重点应该使研究能够专注于解决关键问题。多中心试验、更好地定义暴露和结果变量以及长期代谢和发育随访将是实现这一目标的关键。确定 PN 中的研究重点应该使研究能够专注于解决关键问题。多中心试验、更好地定义暴露和结果变量以及长期代谢和发育随访将是实现这一目标的关键。

影响

• 最近的 ESPGHAN/ESPEN/ESPR/CSPEN 儿科肠外营养指南提供了为婴儿和儿童提供肠外营养的最新指南，包括实践建议。

• 然而，在一些领域，缺乏指导实践的证据，或研究问题仍未得到解答。本文总结了儿科肠外营养研究的重点，并根据专家意见按重要性排序。