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

Background & aimsEarly use of parenteral nutrition (early-PN), as compared with withholding it for one week (late-PN), in the PICU, has shown to slow down recovery from critical illness and impair long-term development 6 neurocognitive/behavioural/emotional functions assessed 2 years later. Given that key steps brain maturation occur at different times during childhood, we hypothesised age time exposure determines developmental impact early-PN.MethodsThe 786 children who were neurocognitively tested after participation PEPaNIC-RCT included this study. First, each studied outcome, interaction between randomisation early-PN versus late-PN was multivariable linear regression analysis. Subsequently, outcomes an p ≤ 0.15, analysed, adjustment risk factors, 4 subgroups defined based on developmentally-relevant [≤28 days (n = 121), 29 11 months 239), <5 223) ≥5 203)].ResultsInteraction present weight, parent-reported inhibitory control, cognitive flexibility, working memory, planning/organisation, metacognition, total executive functioning, internalising behavioural/emotional problems. Subgroup analyses revealed none age-groups benefit, whereas aged <11 most vulnerable harm by control (p 0.008), memory 0.009), planning/organisation 0.004), metacognition functioning 0.005) problems 0.01). Children 0.003). In contrast, neonates ≤28 appeared less vulnerable.ConclusionsCritically ill identified evoked early-PN.Clinical trials.govNCT01536275. Early early-PN. The 203)]. Interaction vulnerable. Critically