Division of Pediatric Gastroenterology and Nutrition, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
Children's Hospital of Wisconsin, Milwaukee, Wisconsin, USA.
JPEN J Parenter Enteral Nutr. 2020 Aug;44(6):1096-1103. doi: 10.1002/jpen.1731. Epub 2019 Oct 26.
To determine whether early parenteral nutrition (PN) (25% of goal energy within 48 hours of PICU admission) is associated with poorer outcomes in children receiving no enteral nutrition (EN).
Multicenter retrospective study of patients aged 1 month to 18 years who had a PICU length of stay (PLOS) >96 hours. We obtained weight, sex, pediatric index of mortality 2 score (PIM-2), PLOS, duration of mechanical ventilation (DMV), mortality data, and nutrition intake data. Logistic and mixed model regression analysis were used to compare data.
2069 patients (53.2% male, median age 6.61 years) received no EN in the first 4 days. Children receiving early PN were more likely to die than those who did not when adjusted for PIM-2, propensity score, and center (odds ratio = 2.10 [1.41-3.13], median [IQR]; P = 0.0003). The unadjusted PLOS (9.48 [5.94-18.19], and unadjusted DMV (6.73 [3.48-13.98]) for patients receiving early PN were both significantly longer than those who did not (6.75 [4.95-11.65]; P < 0.0001 and 4.9 [1.88-10.19]; P = 0.009, respectively). When adjusted for PIM-2, center, percentage of energy from protein, and age, the PLOS and DMV for those receiving early PN did not differ from those who did not (P = 0.14 and P = 0.76, respectively).
In children with PLOS >96 hours receiving no EN for 4 days, early PN is strongly associated with higher mortality but not with differences in PLOS or DMV.
为了确定在 PICu 入院后 48 小时内接受早期肠外营养（PN）（目标能量的 25%）是否与未接受肠内营养（EN）的患儿预后较差有关。
这是一项多中心回顾性研究，纳入了年龄在 1 个月至 18 岁之间、PICu 住院时间（PLOS）>96 小时的患者。我们获得了体重、性别、儿童死亡率 2 评分（PIM-2）、PLOS、机械通气时间（DMV）、死亡率和营养摄入数据。使用逻辑回归和混合模型回归分析来比较数据。
2069 名患者（53.2%为男性，中位年龄 6.61 岁）在最初的 4 天内未接受 EN。在校正 PIM-2、倾向评分和中心后，接受早期 PN 的患儿死亡的可能性高于未接受者（比值比=2.10[1.41-3.13]，中位数[IQR]；P=0.0003）。与未接受早期 PN 的患者相比，接受早期 PN 的患者的未调整 PLOS（9.48[5.94-18.19]）和未调整 DMV（6.73[3.48-13.98]）均显著更长（P<0.0001 和 4.9[1.88-10.19]；P=0.009）。在校正 PIM-2、中心、蛋白质供能百分比和年龄后，接受早期 PN 和未接受早期 PN 的患者的 PLOS 和 DMV 无差异（P=0.14 和 P=0.76）。
在 PLOS>96 小时且 4 天内未接受 EN 的患儿中，早期 PN 与死亡率升高密切相关，但与 PLOS 或 DMV 无差异。
