Early or Late Parenteral Nutrition in Critically Ill Children: Practical Implications of the PEPaNIC Trial.

come) may have been biased. A 3 days shorter duration of mechanical ventilation ( p = 0.01) and a 4.1 day shorter hospital stay ( p = 0.005) were also observed with EarlyPN. Mortality was similar in both groups, but hypoglycemia was more frequent with LatePN (9.1%) vs. EarlyPN (4.8%, p = 0.001). The authors conclude that withholding PN for 1 week is advantageous in critically ill children. Based on the previous experience with the EPaNIC trial in adult ICU patients [6] , we consider it likely that these findings will invigorate the controversy about potential harm of early sPN. However, several important points and questions related to the PEPaNIC trial arise, including the selection and heterogeneity of included patients and the choices taken regarding nutrition and glucose control management.