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Evaluation on the Time to Start Parenteral Nutrition in Pediatric Intensive Care Unit
J. Kor. Soc. Health-syst. Pharm. 2019;36:353-365
Published online August 31, 2019;
© 2019 Korean Society of Health-System Pharmacists

So Yeon Hana, Min Jae Junga, Jung Inn Yoona, Jae Song Kima, Kyung Won Kimb and Eun Sun Sona,†

Department of Pharmacy, Severance Hospital, Yonsei University Health Systema, Department of Pediatrics, Yonsei University College of Medicineb 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
Correspondence to: 손은선 Tel:02-2228-6888
Received February 25, 2019; Revised April 5, 2019; Accepted June 26, 2019.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Background : Optimal nutritional support for hospitalized pediatric patients is important because malnutrition is a risk factor impacting on clinical outcomes and inflammation. Parenteral Nutrition (PN) is necessary to pediatric patients supplied insufficiency or impossible gastric feeding, but it has risk of complication. The purpose of this study is to correlate the timing of PN of hospitalized patients with their nutritional status and clinical outcomes.
Methods : Retrospective analysis was carried out on the electronic Medical Record for patients admitted to a pediatric intensive care unit (PICU) and received PN support from September 2016 to April 2018. PN was initiated within 24~72 hours after PICU admission in early PN group, whereas PN was not provided until 72 hours after PICU admission in late PN group. The primary endpoint was assessment of nutrition status while the secondary endpoints were variations of biochemical indices for evaluating nutrition status, clinical effectiveness and risks associated with PN support.
Results : 22 patients (46.8%) received early PN while 25 patients (53.2%) received late PN. There was no significant difference in the basic characteristics between the two groups. Although changes of body weight (p=0.276), BMI (p=0.358) and % IBW (p=0.358) were not statistically significant in both groups, increase in serum total protein and albumin level were statistically higher in the early PN group (p=0.009, p=0.043). The duration of PICU stay was 7 days in the early PN group as compared to 13 days in the late PN group (p=0.026). Early PN group was associated with a shorter duration of mechanical ventilatory support as compared to late PN group (p=0.002). The duration of hospital stay was shorter in late PN group, although was not statistically significant (p=0.628).
Conclusions : Providing PN support within 24~72 hours after PICU admission was associated with better clinical outcomes as compared with withholding PN for 72 hours. Future research is necessary to establish the guideline of optimal timing for the initiation of PN in PICU.
Keywords : Parenteral nutrition, Pediatrics, Pediatric intensive care unit

August 2019, 36 (3)