Use of parenteral nutrition in the pediatric ICU: should we panic because of PEPaNIC?

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The conditions of using PN in patients in an intensive care unit (ICU) are the subject of controversial discussions, after studies in adult patients have raised questions regarding benefits and safety [1–4]. Recently, a large randomized multicenter trial in infants and children in intensive care, the PEPaNIC trial, was published by Fivez et al.[5], which was interpreted as showing that parenteral nutrition should generally be withheld for 1 week in pediatric ICU patients. Some colleagues have reacted almost with panic and have markedly restricted the use of parenteral nutrition in pediatric ICU patients. We have previously questioned whether such a general conclusion is justified [6]. Here we wish to summarize comments on the trial and its possible limitations (Table 1) and suggest alternative conclusions.
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