Impact of critical illness and withholding of early parenteral nutrition in the pediatric intensive care unit on long-term physical performance of children: a 4-year follow-up of the PEPaNIC randomized controlled trial

Ilse Vanhorebeek, An Jacobs, Liese Mebis, Karolijn Dulfer, Renate Eveleens, Hanna Van Cleemput, Pieter J. Wouters, Ines Verlinden, Koen Joosten, Sascha Verbruggen, Greet Van den Berghe*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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Abstract

Background: Many critically ill children face long-term developmental impairments. The PEPaNIC trial attributed part of the problems at the level of neurocognitive and emotional/behavioral development to early use of parenteral nutrition (early-PN) in the PICU, as compared with withholding it for 1 week (late-PN). Insight in long-term daily life physical functional capacity after critical illness is limited. Also, whether timing of initiating PN affects long-term physical function of these children remained unknown. Methods: This preplanned follow-up study of the multicenter PEPaNIC randomized controlled trial subjected 521 former critically ill children (253 early-PN, 268 late-PN) to quantitative physical function tests 4 years after PICU admission in Leuven or Rotterdam, in comparison with 346 age- and sex-matched healthy children. Tests included handgrip strength measurement, timed up-and-go test, 6-min walk test, and evaluation of everyday overall physical activity with an accelerometer. We compared these functional measures for the former critically ill and healthy children and for former critically ill children randomized to late-PN versus early-PN, with multivariable linear or logistic regression analyses adjusting for risk factors. Results: As compared with healthy children, former critically ill children showed less handgrip strength (p < 0.0001), completed the timed up-and-go test more slowly (p < 0.0001), walked a shorter distance in 6 min (p < 0.0001) during which they experienced a larger drop in peripheral oxygen saturation (p ≤ 0.026), showed a lower energy expenditure (p ≤ 0.024), performed more light and less moderate physical activity (p ≤ 0.047), and walked fewer steps per day (p = 0.0074). Late-PN as compared with early-PN did not significantly affect these outcomes. Conclusions: Four years after PICU admission, former critically ill children showed worse physical performance as compared with healthy children, without impact of timing of supplemental PN in the PICU. This study provides further support for de-implementing the early use of PN in the PICU. Trial registration ClinicalTrials.gov, NCT01536275; registered on February 22, 2012.

Original languageEnglish
Article number133
JournalCritical Care
Volume26
Issue number1
DOIs
Publication statusPublished - 12 May 2022

Bibliographical note

Funding Information:
This work was supported by European Research Council Advanced Grants (AdvG-2012-321670 from the Ideas Program of the European Union 7th framework program and AdvG-2017-785809 from the Horizon 2020 Program to GVdB); by the Methusalem Program of the Flemish government (through the University of Leuven to GVdB, METH/08/07, and to GVdB and IV, METH14/06); by the Institute for Science and Technology, Flanders, Belgium (through the University of Leuven to GVdB, IWT-TBM150181 and IWT-TBM110685); by the Sophia Research Foundation (SSWO to SV); by the Stichting Agis Zorginnovatie (to SV); Nutricia Research B.V (to SV); by the Erasmus Trustfonds (to SV); and by an European Society for Clinical Nutrition and Metabolism (ESPEN) research grant (to SV). The funders of the study had no role in the design of the study, the collection, analysis, and interpretation of data, or in the writing of the manuscript.

Publisher Copyright:
© 2022, The Author(s).

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