Early Versus Late Parenteral Nutrition in the Pediatric Intensive Care Unit

NCT ID: NCT01536275

Last Updated: 2024-02-12

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

ACTIVE_NOT_RECRUITING

Clinical Phase

NA

Total Enrollment

1440 participants

Study Classification

INTERVENTIONAL

Study Start Date

2012-06-30

Study Completion Date

2026-12-31

Brief Summary

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In the PEPaNIC trial it is investigated whether withholding parenteral nutrition during the first week in critically ill children is beneficial, compared to the current standard of the early start of parenteral nutrition.

Detailed Description

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Conditions

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Critical Illness Children

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

SINGLE

Outcome Assessors

Study Groups

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Early parenteral nutrition

Parenteral nutrition supplements insufficient enteral nutrition from admission to ICU according to the current standard of care per center

Group Type NO_INTERVENTION

No interventions assigned to this group

Late parenteral nutrition

Parenteral nutrition will be withheld during the first 7 days of ICU stay

Group Type EXPERIMENTAL

Late parenteral nutrition

Intervention Type OTHER

Withholding parenteral nutrition during the first 7 days of ICU stay

Interventions

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Late parenteral nutrition

Withholding parenteral nutrition during the first 7 days of ICU stay

Intervention Type OTHER

Other Intervention Names

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Late PN

Eligibility Criteria

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Inclusion Criteria

* All patients admitted to the PICU with a STRONGkids score of 2 points or more upon ICU admission

Exclusion Criteria

* Age of 17 years or older
* Patients with a DNR code at the time of ICU admission.
* Patients expected to die within 12 hours (=moribund patients).
* Patient readmitted to ICU after randomization to the PEPaNIC trial, more than 48 hours after the initial discharge
* Patients transferred from another paediatric intensive care after a stay of more than 7 days
* Patients suffering from ketoacidotic or hyperosmolar coma on admission.
* Patients suffering from Short Bowel Syndrome on home PN or other conditions that require home PN
* Patients suspicious or established inborn metabolic diseases requiring specific diet
* STRONGkids score lower than 2 on ICU admission.
* Premature Newborns ( 37 weeks gestational age upon admission in the PICU)
* Prior inclusion in another randomized controlled outcome study
Maximum Eligible Age

17 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Sophia Kindergeneeskunde

OTHER

Sponsor Role collaborator

Stollery Children's Hospital

OTHER

Sponsor Role collaborator

KU Leuven

OTHER

Sponsor Role lead

Responsible Party

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Greet Van den Berghe

Head of Dept Intensive Care Medicine

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Greet Van den Berghe, MD PhD

Role: PRINCIPAL_INVESTIGATOR

KU Leuven

Locations

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Dept Intensive Care Medicine

Leuven, , Belgium

Site Status

Stollery Children's Hospital

Edmonton, Alberta, Canada

Site Status

Erasmus MC Sophia Kinderziekenhuis

Rotterdam, , Netherlands

Site Status

Countries

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Belgium Canada Netherlands

References

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Casaer MP, Mesotten D, Hermans G, Wouters PJ, Schetz M, Meyfroidt G, Van Cromphaut S, Ingels C, Meersseman P, Muller J, Vlasselaers D, Debaveye Y, Desmet L, Dubois J, Van Assche A, Vanderheyden S, Wilmer A, Van den Berghe G. Early versus late parenteral nutrition in critically ill adults. N Engl J Med. 2011 Aug 11;365(6):506-17. doi: 10.1056/NEJMoa1102662. Epub 2011 Jun 29.

Reference Type BACKGROUND
PMID: 21714640 (View on PubMed)

Vlasselaers D, Milants I, Desmet L, Wouters PJ, Vanhorebeek I, van den Heuvel I, Mesotten D, Casaer MP, Meyfroidt G, Ingels C, Muller J, Van Cromphaut S, Schetz M, Van den Berghe G. Intensive insulin therapy for patients in paediatric intensive care: a prospective, randomised controlled study. Lancet. 2009 Feb 14;373(9663):547-56. doi: 10.1016/S0140-6736(09)60044-1. Epub 2009 Jan 26.

Reference Type BACKGROUND
PMID: 19176240 (View on PubMed)

Nakano FK, Dulfer K, Vanhorebeek I, Wouters PJ, Verbruggen SC, Joosten KF, Guiza Grandas F, Vens C, Van den Berghe G. Predicting adverse long-term neurocognitive outcomes after pediatric intensive care unit admission. Comput Methods Programs Biomed. 2024 Jun;250:108166. doi: 10.1016/j.cmpb.2024.108166. Epub 2024 Apr 10.

Reference Type DERIVED
PMID: 38614026 (View on PubMed)

Veldscholte K, Hulst JM, Eveleens RD, de Jonge RCJ, de Koning BAE, van den Berg SAA, van der Wal R, Ruijter GJG, Rizopoulos D, Vanhorebeek I, Gunst J, Casaer M, Van den Berghe G, Joosten KFM, Verbruggen SCAT. Gastrointestinal Biomarkers and Their Association with Feeding in the First Five Days of Pediatric Critical Illness. J Pediatr Gastroenterol Nutr. 2023 Dec 1;77(6):811-818. doi: 10.1097/MPG.0000000000003950. Epub 2023 Sep 20.

Reference Type DERIVED
PMID: 37728917 (View on PubMed)

Verlinden I, Coppens G, Vanhorebeek I, Guiza F, Derese I, Wouters PJ, Joosten KF, Verbruggen SC, Van den Berghe G. Long-term impact of paediatric critical illness on the difference between epigenetic and chronological age in relation to physical growth. Clin Epigenetics. 2023 Jan 14;15(1):8. doi: 10.1186/s13148-023-01424-w.

Reference Type DERIVED
PMID: 36639798 (View on PubMed)

Coppens G, Vanhorebeek I, Verlinden I, Derese I, Wouters PJ, Joosten KF, Verbruggen SC, Guiza F, Van den Berghe G. Assessment of aberrant DNA methylation two years after paediatric critical illness: a pre-planned secondary analysis of the international PEPaNIC trial. Epigenetics. 2023 Dec;18(1):2146966. doi: 10.1080/15592294.2022.2146966. Epub 2022 Nov 16.

Reference Type DERIVED
PMID: 36384393 (View on PubMed)

Vanhorebeek I, Jacobs A, Mebis L, Dulfer K, Eveleens R, Van Cleemput H, Wouters PJ, Verlinden I, Joosten K, Verbruggen S, Van den Berghe G. 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. Crit Care. 2022 May 12;26(1):133. doi: 10.1186/s13054-022-04010-3.

Reference Type DERIVED
PMID: 35549984 (View on PubMed)

Verlinden I, Guiza F, Dulfer K, Van Cleemput H, Wouters PJ, Guerra GG, Joosten KF, Verbruggen SC, Vanhorebeek I, Van den Berghe G. Physical, Emotional/Behavioral, and Neurocognitive Developmental Outcomes From 2 to 4 Years After PICU Admission: A Secondary Analysis of the Early Versus Late Parenteral Nutrition Randomized Controlled Trial Cohort. Pediatr Crit Care Med. 2022 Aug 1;23(8):580-592. doi: 10.1097/PCC.0000000000002971. Epub 2022 May 9.

Reference Type DERIVED
PMID: 35522534 (View on PubMed)

Jacobs A, Guiza F, Verlinden I, Dulfer K, Garcia Guerra G, Joosten K, Verbruggen SC, Vanhorebeek I, Van den Berghe G. Differential DNA methylation by early versus late parenteral nutrition in the PICU: a biological basis for its impact on emotional and behavioral problems documented 4 years later. Clin Epigenetics. 2021 Jul 27;13(1):146. doi: 10.1186/s13148-021-01124-3.

Reference Type DERIVED
PMID: 34315515 (View on PubMed)

Verlinden I, Dulfer K, Vanhorebeek I, Guiza F, Hordijk JA, Wouters PJ, Guerra GG, Joosten KF, Verbruggen SC, Van den Berghe G. Role of age of critically ill children at time of exposure to early or late parenteral nutrition in determining the impact hereof on long-term neurocognitive development: A secondary analysis of the PEPaNIC-RCT. Clin Nutr. 2021 Mar;40(3):1005-1012. doi: 10.1016/j.clnu.2020.07.004. Epub 2020 Jul 14.

Reference Type DERIVED
PMID: 32758384 (View on PubMed)

Jacobs A, Dulfer K, Eveleens RD, Hordijk J, Van Cleemput H, Verlinden I, Wouters PJ, Mebis L, Guerra GG, Joosten K, Verbruggen SC, Guiza F, Vanhorebeek I, Van den Berghe G. Long-term developmental effect of withholding parenteral nutrition in paediatric intensive care units: a 4-year follow-up of the PEPaNIC randomised controlled trial. Lancet Child Adolesc Health. 2020 Jul;4(7):503-514. doi: 10.1016/S2352-4642(20)30104-8.

Reference Type DERIVED
PMID: 32562632 (View on PubMed)

Hordijk J, Verbruggen S, Vanhorebeek I, Guiza F, Wouters P, Van den Berghe G, Joosten K, Dulfer K. Health-related quality of life of children and their parents 2 years after critical illness: pre-planned follow-up of the PEPaNIC international, randomized, controlled trial. Crit Care. 2020 Jun 16;24(1):347. doi: 10.1186/s13054-020-03059-2.

Reference Type DERIVED
PMID: 32546247 (View on PubMed)

van Puffelen E, Hulst JM, Vanhorebeek I, Dulfer K, Van den Berghe G, Joosten KFM, Verbruggen SCAT. Effect of late versus early initiation of parenteral nutrition on weight deterioration during PICU stay: Secondary analysis of the PEPaNIC randomised controlled trial. Clin Nutr. 2020 Jan;39(1):104-109. doi: 10.1016/j.clnu.2019.02.014. Epub 2019 Mar 4.

Reference Type DERIVED
PMID: 30879734 (View on PubMed)

van Puffelen E, Hulst JM, Vanhorebeek I, Dulfer K, Van den Berghe G, Verbruggen SCAT, Joosten KFM. Outcomes of Delaying Parenteral Nutrition for 1 Week vs Initiation Within 24 Hours Among Undernourished Children in Pediatric Intensive Care: A Subanalysis of the PEPaNIC Randomized Clinical Trial. JAMA Netw Open. 2018 Sep 7;1(5):e182668. doi: 10.1001/jamanetworkopen.2018.2668.

Reference Type DERIVED
PMID: 30646158 (View on PubMed)

Verstraete S, Verbruggen SC, Hordijk JA, Vanhorebeek I, Dulfer K, Guiza F, van Puffelen E, Jacobs A, Leys S, Durt A, Van Cleemput H, Eveleens RD, Garcia Guerra G, Wouters PJ, Joosten KF, Van den Berghe G. Long-term developmental effects of withholding parenteral nutrition for 1 week in the paediatric intensive care unit: a 2-year follow-up of the PEPaNIC international, randomised, controlled trial. Lancet Respir Med. 2019 Feb;7(2):141-153. doi: 10.1016/S2213-2600(18)30334-5. Epub 2018 Sep 14.

Reference Type DERIVED
PMID: 30224325 (View on PubMed)

Verstraete S, Vanhorebeek I, van Puffelen E, Derese I, Ingels C, Verbruggen SC, Wouters PJ, Joosten KF, Hanot J, Guerra GG, Vlasselaers D, Lin J, Van den Berghe G. Leukocyte telomere length in paediatric critical illness: effect of early parenteral nutrition. Crit Care. 2018 Feb 21;22(1):38. doi: 10.1186/s13054-018-1972-6.

Reference Type DERIVED
PMID: 29463275 (View on PubMed)

van Puffelen E, Polinder S, Vanhorebeek I, Wouters PJ, Bossche N, Peers G, Verstraete S, Joosten KFM, Van den Berghe G, Verbruggen SCAT, Mesotten D. Cost-effectiveness study of early versus late parenteral nutrition in critically ill children (PEPaNIC): preplanned secondary analysis of a multicentre randomised controlled trial. Crit Care. 2018 Jan 15;22(1):4. doi: 10.1186/s13054-017-1936-2.

Reference Type DERIVED
PMID: 29335014 (View on PubMed)

Fivez T, Kerklaan D, Mesotten D, Verbruggen S, Wouters PJ, Vanhorebeek I, Debaveye Y, Vlasselaers D, Desmet L, Casaer MP, Garcia Guerra G, Hanot J, Joffe A, Tibboel D, Joosten K, Van den Berghe G. Early versus Late Parenteral Nutrition in Critically Ill Children. N Engl J Med. 2016 Mar 24;374(12):1111-22. doi: 10.1056/NEJMoa1514762. Epub 2016 Mar 15.

Reference Type DERIVED
PMID: 26975590 (View on PubMed)

Fivez T, Kerklaan D, Verbruggen S, Vanhorebeek I, Verstraete S, Tibboel D, Guerra GG, Wouters PJ, Joffe A, Joosten K, Mesotten D, Van den Berghe G. Impact of withholding early parenteral nutrition completing enteral nutrition in pediatric critically ill patients (PEPaNIC trial): study protocol for a randomized controlled trial. Trials. 2015 May 1;16:202. doi: 10.1186/s13063-015-0728-8.

Reference Type DERIVED
PMID: 25927936 (View on PubMed)

Other Identifiers

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2012-000811-10

Identifier Type: EUDRACT_NUMBER

Identifier Source: secondary_id

ML8052

Identifier Type: OTHER

Identifier Source: secondary_id

NL38772.000.12

Identifier Type: OTHER

Identifier Source: secondary_id

IWT-TBM 110685

Identifier Type: OTHER_GRANT

Identifier Source: secondary_id

PEPaNIC

Identifier Type: -

Identifier Source: org_study_id

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