Supplementation of vitamins, trace elements and electrolytes in the PEPaNIC Randomised Controlled Trial:: Composition and preparation of the prescription

Renate D. Eveleens; Bregje C. M. Witjes; Michael P. Casaer; Ilse Vanhorebeek; Gonzalo Garcia Guerra; Karlien Veldscholte; Lidwien M. Hanff; Katrien Cosaert; Lars Desmet; Dirk Vlasselaers; Britney Bernard; Greet van den Berghe; Sascha C. A. T. Verbruggen; Koen F. M. Joosten

doi:10.1016/j.clnesp.2021.01.028

Supplementation of vitamins, trace elements and electrolytes in the PEPaNIC Randomised Controlled Trial: Composition and preparation of the prescription

Renate D. Eveleens
, Bregje C. M. Witjes
, Michael P. Casaer
, Ilse Vanhorebeek
, Gonzalo Garcia Guerra
, Karlien Veldscholte
, Lidwien M. Hanff
, Katrien Cosaert
, Lars Desmet
, Dirk Vlasselaers
, Britney Bernard
, Greet van den Berghe
, Sascha C. A. T. Verbruggen
, Koen F. M. Joosten^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

15 Citations (Scopus)

Abstract

Background and aims
Following the results of the paediatric early versus late parenteral nutrition in critical illness (PEPaNIC) multicentre, randomised, controlled trial, the new ESPGHAN/ESPEN/ESPR/CSPEN and ESPNIC guidelines recommend to consider withholding parenteral macronutrients for 1 week, while providing micronutrients, in critically ill children if enteral nutrition is insufficient. Critically ill children are suspected to be vulnerable to micronutrient deficiencies due to inadequate enteral nutrition, increased body's demands and excessive losses. Hitherto, micronutrient requirements in PICU are estimated based on recommended daily intakes for healthy children and expert opinion. We aimed to provide an overview of the current practice of micronutrient administration and practical considerations in the three participating centres of the PEPaNIC study, and compare these therapies with the recommendations in the new ESPGHAN/ESPEN/ESPR/CSPEN guidelines.
Methods
We describe the current composition and preparation of the prescribed parenteral micronutrients (consisting of vitamins, trace elements and electrolytes) in the three centres (Leuven, Rotterdam and Edmonton) that participated in the PEPaNIC RCT, and compare this per micronutrient with the ESPGHAN/ESPEN/ESPR/CSPEN guidelines recommendations.
Results
The three centres use a different micronutrient supplementation protocol during the first week of critical illness in children, with substantial differences regarding the amounts administered. Leuven administers commercial vitamins, trace elements and electrolytes in separate infusions both in 4 h. Rotterdam provides commercial vitamins and trace elements simultaneously via 8-h infusion and electrolytes continuously over 24 h. Lastly, Edmonton administers commercial vitamins and institutionally prepared trace elements solutions in 1 h and electrolytes on demand. Comparison with the ESPGHAN/ESPEN/ESPR/CSPEN guidelines yields in differences between the recommendations and the administered amounts, which are most substantial for vitamins.
Conclusion
The practice of intravenous micronutrient administration differs substantially between the three PEPaNIC centres and in comparison with the current guideline recommendations. This deviation is at least partially explained by the inability to provide all recommended amounts with the currently available commercial products and by the lack of strong evidence supporting these recommendations.

Original language	English
Pages (from-to)	244-251
Number of pages	8
Journal	Clinical Nutrition ESPEN
Volume	42
DOIs	https://doi.org/10.1016/j.clnesp.2021.01.028
Publication status	Published - 4 Feb 2021

Bibliographical note

Funding sources
This study was supported by the Flemish Agency for Innovation through Science and Technology ( IWT-TBM110685 ) to dr Van den Berghe; a private donation by an anonymous Dutch family via the Leuven University Hospitals to dr Van den Berghe and dr Casaer; the Methusalem Programme funded by the Flemish Government via KU Leuven ( METH/08/07 to dr Van den Berghe and METH/14/06 to dr Van den Berghe and Vanhorebeek); the European Research Council under the European Union's Seventh Framework Programme ( FP7 /2013–2018 )/ERC Advanced Grant Agreement no. 321670 to dr Van den Berghe; Fonds NutsOhra to dr Verbruggen; Smoking Research Foundation to dr Verbruggen; Stichting Agis Zorginnovatie to dr Verbruggen; Nutricia Research B.V to dr Verbruggen, post-doctoral funding to dr Casaer by FWO Flanders . The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

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EMC OR-02-54-06

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10.1016/j.clnesp.2021.01.028

Cite this

Eveleens, R. D., Witjes, B. C. M., Casaer, M. P., Vanhorebeek, I., Guerra, G. G., Veldscholte, K., Hanff, L. M., Cosaert, K., Desmet, L., Vlasselaers, D., Bernard, B., van den Berghe, G., Verbruggen, S. C. A. T., & Joosten, K. F. M. (2021). Supplementation of vitamins, trace elements and electrolytes in the PEPaNIC Randomised Controlled Trial: Composition and preparation of the prescription. Clinical Nutrition ESPEN, 42, 244-251. https://doi.org/10.1016/j.clnesp.2021.01.028

@article{3ef628c4181e46bbbed04feece86b5d3,

title = "Supplementation of vitamins, trace elements and electrolytes in the PEPaNIC Randomised Controlled Trial:: Composition and preparation of the prescription",

abstract = "Background and aims Following the results of the paediatric early versus late parenteral nutrition in critical illness (PEPaNIC) multicentre, randomised, controlled trial, the new ESPGHAN/ESPEN/ESPR/CSPEN and ESPNIC guidelines recommend to consider withholding parenteral macronutrients for 1 week, while providing micronutrients, in critically ill children if enteral nutrition is insufficient. Critically ill children are suspected to be vulnerable to micronutrient deficiencies due to inadequate enteral nutrition, increased body's demands and excessive losses. Hitherto, micronutrient requirements in PICU are estimated based on recommended daily intakes for healthy children and expert opinion. We aimed to provide an overview of the current practice of micronutrient administration and practical considerations in the three participating centres of the PEPaNIC study, and compare these therapies with the recommendations in the new ESPGHAN/ESPEN/ESPR/CSPEN guidelines. Methods We describe the current composition and preparation of the prescribed parenteral micronutrients (consisting of vitamins, trace elements and electrolytes) in the three centres (Leuven, Rotterdam and Edmonton) that participated in the PEPaNIC RCT, and compare this per micronutrient with the ESPGHAN/ESPEN/ESPR/CSPEN guidelines recommendations. Results The three centres use a different micronutrient supplementation protocol during the first week of critical illness in children, with substantial differences regarding the amounts administered. Leuven administers commercial vitamins, trace elements and electrolytes in separate infusions both in 4 h. Rotterdam provides commercial vitamins and trace elements simultaneously via 8-h infusion and electrolytes continuously over 24 h. Lastly, Edmonton administers commercial vitamins and institutionally prepared trace elements solutions in 1 h and electrolytes on demand. Comparison with the ESPGHAN/ESPEN/ESPR/CSPEN guidelines yields in differences between the recommendations and the administered amounts, which are most substantial for vitamins. Conclusion The practice of intravenous micronutrient administration differs substantially between the three PEPaNIC centres and in comparison with the current guideline recommendations. This deviation is at least partially explained by the inability to provide all recommended amounts with the currently available commercial products and by the lack of strong evidence supporting these recommendations.",

author = "Eveleens, \{Renate D.\} and Witjes, \{Bregje C. M.\} and Casaer, \{Michael P.\} and Ilse Vanhorebeek and Guerra, \{Gonzalo Garcia\} and Karlien Veldscholte and Hanff, \{Lidwien M.\} and Katrien Cosaert and Lars Desmet and Dirk Vlasselaers and Britney Bernard and \{van den Berghe\}, Greet and Verbruggen, \{Sascha C. A. T.\} and Joosten, \{Koen F. M.\}",

note = "Funding sources This study was supported by the Flemish Agency for Innovation through Science and Technology ( IWT-TBM110685 ) to dr Van den Berghe; a private donation by an anonymous Dutch family via the Leuven University Hospitals to dr Van den Berghe and dr Casaer; the Methusalem Programme funded by the Flemish Government via KU Leuven ( METH/08/07 to dr Van den Berghe and METH/14/06 to dr Van den Berghe and Vanhorebeek); the European Research Council under the European Union's Seventh Framework Programme ( FP7 /2013–2018 )/ERC Advanced Grant Agreement no. 321670 to dr Van den Berghe; Fonds NutsOhra to dr Verbruggen; Smoking Research Foundation to dr Verbruggen; Stichting Agis Zorginnovatie to dr Verbruggen; Nutricia Research B.V to dr Verbruggen, post-doctoral funding to dr Casaer by FWO Flanders . The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.",

year = "2021",

month = feb,

day = "4",

doi = "10.1016/j.clnesp.2021.01.028",

language = "English",

volume = "42",

pages = "244--251",

journal = "Clinical Nutrition ESPEN",

issn = "2405-4577",

publisher = "Elsevier Ltd.",

}

Eveleens, RD, Witjes, BCM, Casaer, MP, Vanhorebeek, I, Guerra, GG, Veldscholte, K, Hanff, LM, Cosaert, K, Desmet, L, Vlasselaers, D, Bernard, B, van den Berghe, G, Verbruggen, SCAT & Joosten, KFM 2021, 'Supplementation of vitamins, trace elements and electrolytes in the PEPaNIC Randomised Controlled Trial: Composition and preparation of the prescription', Clinical Nutrition ESPEN, vol. 42, pp. 244-251. https://doi.org/10.1016/j.clnesp.2021.01.028

TY - JOUR

T1 - Supplementation of vitamins, trace elements and electrolytes in the PEPaNIC Randomised Controlled Trial:

T2 - Composition and preparation of the prescription

AU - Eveleens, Renate D.

AU - Witjes, Bregje C. M.

AU - Casaer, Michael P.

AU - Vanhorebeek, Ilse

AU - Guerra, Gonzalo Garcia

AU - Veldscholte, Karlien

AU - Hanff, Lidwien M.

AU - Cosaert, Katrien

AU - Desmet, Lars

AU - Vlasselaers, Dirk

AU - Bernard, Britney

AU - van den Berghe, Greet

AU - Verbruggen, Sascha C. A. T.

AU - Joosten, Koen F. M.

N1 - Funding sources This study was supported by the Flemish Agency for Innovation through Science and Technology ( IWT-TBM110685 ) to dr Van den Berghe; a private donation by an anonymous Dutch family via the Leuven University Hospitals to dr Van den Berghe and dr Casaer; the Methusalem Programme funded by the Flemish Government via KU Leuven ( METH/08/07 to dr Van den Berghe and METH/14/06 to dr Van den Berghe and Vanhorebeek); the European Research Council under the European Union's Seventh Framework Programme ( FP7 /2013–2018 )/ERC Advanced Grant Agreement no. 321670 to dr Van den Berghe; Fonds NutsOhra to dr Verbruggen; Smoking Research Foundation to dr Verbruggen; Stichting Agis Zorginnovatie to dr Verbruggen; Nutricia Research B.V to dr Verbruggen, post-doctoral funding to dr Casaer by FWO Flanders . The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

PY - 2021/2/4

Y1 - 2021/2/4

N2 - Background and aims Following the results of the paediatric early versus late parenteral nutrition in critical illness (PEPaNIC) multicentre, randomised, controlled trial, the new ESPGHAN/ESPEN/ESPR/CSPEN and ESPNIC guidelines recommend to consider withholding parenteral macronutrients for 1 week, while providing micronutrients, in critically ill children if enteral nutrition is insufficient. Critically ill children are suspected to be vulnerable to micronutrient deficiencies due to inadequate enteral nutrition, increased body's demands and excessive losses. Hitherto, micronutrient requirements in PICU are estimated based on recommended daily intakes for healthy children and expert opinion. We aimed to provide an overview of the current practice of micronutrient administration and practical considerations in the three participating centres of the PEPaNIC study, and compare these therapies with the recommendations in the new ESPGHAN/ESPEN/ESPR/CSPEN guidelines. Methods We describe the current composition and preparation of the prescribed parenteral micronutrients (consisting of vitamins, trace elements and electrolytes) in the three centres (Leuven, Rotterdam and Edmonton) that participated in the PEPaNIC RCT, and compare this per micronutrient with the ESPGHAN/ESPEN/ESPR/CSPEN guidelines recommendations. Results The three centres use a different micronutrient supplementation protocol during the first week of critical illness in children, with substantial differences regarding the amounts administered. Leuven administers commercial vitamins, trace elements and electrolytes in separate infusions both in 4 h. Rotterdam provides commercial vitamins and trace elements simultaneously via 8-h infusion and electrolytes continuously over 24 h. Lastly, Edmonton administers commercial vitamins and institutionally prepared trace elements solutions in 1 h and electrolytes on demand. Comparison with the ESPGHAN/ESPEN/ESPR/CSPEN guidelines yields in differences between the recommendations and the administered amounts, which are most substantial for vitamins. Conclusion The practice of intravenous micronutrient administration differs substantially between the three PEPaNIC centres and in comparison with the current guideline recommendations. This deviation is at least partially explained by the inability to provide all recommended amounts with the currently available commercial products and by the lack of strong evidence supporting these recommendations.

AB - Background and aims Following the results of the paediatric early versus late parenteral nutrition in critical illness (PEPaNIC) multicentre, randomised, controlled trial, the new ESPGHAN/ESPEN/ESPR/CSPEN and ESPNIC guidelines recommend to consider withholding parenteral macronutrients for 1 week, while providing micronutrients, in critically ill children if enteral nutrition is insufficient. Critically ill children are suspected to be vulnerable to micronutrient deficiencies due to inadequate enteral nutrition, increased body's demands and excessive losses. Hitherto, micronutrient requirements in PICU are estimated based on recommended daily intakes for healthy children and expert opinion. We aimed to provide an overview of the current practice of micronutrient administration and practical considerations in the three participating centres of the PEPaNIC study, and compare these therapies with the recommendations in the new ESPGHAN/ESPEN/ESPR/CSPEN guidelines. Methods We describe the current composition and preparation of the prescribed parenteral micronutrients (consisting of vitamins, trace elements and electrolytes) in the three centres (Leuven, Rotterdam and Edmonton) that participated in the PEPaNIC RCT, and compare this per micronutrient with the ESPGHAN/ESPEN/ESPR/CSPEN guidelines recommendations. Results The three centres use a different micronutrient supplementation protocol during the first week of critical illness in children, with substantial differences regarding the amounts administered. Leuven administers commercial vitamins, trace elements and electrolytes in separate infusions both in 4 h. Rotterdam provides commercial vitamins and trace elements simultaneously via 8-h infusion and electrolytes continuously over 24 h. Lastly, Edmonton administers commercial vitamins and institutionally prepared trace elements solutions in 1 h and electrolytes on demand. Comparison with the ESPGHAN/ESPEN/ESPR/CSPEN guidelines yields in differences between the recommendations and the administered amounts, which are most substantial for vitamins. Conclusion The practice of intravenous micronutrient administration differs substantially between the three PEPaNIC centres and in comparison with the current guideline recommendations. This deviation is at least partially explained by the inability to provide all recommended amounts with the currently available commercial products and by the lack of strong evidence supporting these recommendations.

UR - https://www.scopus.com/pages/publications/85101663603

U2 - 10.1016/j.clnesp.2021.01.028

DO - 10.1016/j.clnesp.2021.01.028

M3 - Article

C2 - 33745587

SN - 2405-4577

VL - 42

SP - 244

EP - 251

JO - Clinical Nutrition ESPEN

JF - Clinical Nutrition ESPEN

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