ABSTRACT
Parenteral nutrition is used to treat children that cannot be fully fed by the enteral route. While the revised ESPGHAN/ESPEN/ESPR/CSPEN pediatric parenteral nutrition guidelines provide clear guidance on the use of parenteral nutrition in neonates, infants, and children based on current available evidence, they have helped to crystallize areas where research is lacking or more studies are needed in order to refine recommendations. This paper collates and discusses the research gaps identified by the authors of each section of the guidelines and considers each nutrient or group of nutrients in turn, together with aspects around delivery and organization. The 99 research priorities identified were then ranked in order of importance by clinicians and researchers working in the field using a survey methodology. The highest ranked priority was the need to understand the relationship between total energy intake, rapid catch-up growth, later metabolic function, and neurocognitive outcomes. Research into the optimal intakes of macronutrients needed in order to achieve optimal outcomes also featured prominently. Identifying research priorities in PN should enable research to be focussed on addressing key issues. Multicentre trials, better definition of exposure and outcome variables, and long-term metabolic and developmental follow-up will be key to achieving this. IMPACT: The recent ESPGHAN/ESPEN/ESPR/CSPEN guidelines for pediatric parenteral nutrition provided updated guidance for providing parenteral nutrition to infants and children, including recommendations for practice. However, in several areas there was a lack of evidence to guide practice, or research questions that remained unanswered. This paper summarizes the key priorities for research in pediatric parenteral nutrition, and ranks them in order of importance according to expert opinion.
Subject(s)
Child Nutritional Physiological Phenomena , Parenteral Nutrition , Child , Consensus , Humans , Infant , Infant, Newborn , Parenteral Nutrition, Total , ResearchSubject(s)
COVID-19/mortality , Health Policy/trends , Health Services Needs and Demand/trends , Adult , COVID-19/prevention & control , Child , England , Forecasting , HumansSubject(s)
Intestinal Diseases/complications , Intestinal Diseases/therapy , Parenteral Nutrition/adverse effects , Parenteral Nutrition/history , Acidosis/complications , Caseins/administration & dosage , Caseins/therapeutic use , Digestion/physiology , Gastroenterology , History, 17th Century , History, 20th Century , Humans , Hypoglycemia/complications , Infant , Infant, Premature/growth & development , Infant, Premature/metabolism , Intestinal Diseases/physiopathology , Nutritional Status/physiology , Parenteral Nutrition/economics , Pharmaceutical PreparationsSubject(s)
COVID-19 , Child Health/standards , Financial Stress , Health Services Accessibility , Undocumented Immigrants/psychology , COVID-19/epidemiology , COVID-19/prevention & control , Child , Health Services Accessibility/economics , Health Services Accessibility/ethics , Health Services Accessibility/legislation & jurisprudence , Health Services Needs and Demand , Humans , SARS-CoV-2 , Social Conditions , State Medicine , United Kingdom/epidemiologySubject(s)
Celiac Disease , Child Health Services/economics , Cost of Illness , Diet, Gluten-Free , Food Assistance/organization & administration , Celiac Disease/diet therapy , Celiac Disease/economics , Child , Child Health/economics , Diet, Gluten-Free/economics , Diet, Gluten-Free/methods , Humans , Needs Assessment , Patient Compliance , State Medicine , United KingdomSubject(s)
Anthropometry , Child Nutritional Physiological Phenomena , Feeding Behavior , Nutrition Assessment , Nutritional Sciences/methods , Anthropometry/methods , Body Mass Index , Child Development , Child, Preschool , Energy Intake , Humans , Infant , Malnutrition/complications , Malnutrition/diet therapy , Nutritional Status , Pediatrics/methods , Reference Values , Wasting Syndrome/diet therapy , Wasting Syndrome/etiologySubject(s)
Bone Marrow Transplantation/adverse effects , Malnutrition/therapy , Neoplasms/complications , Nutritional Status , Nutritional Support , Child , Humans , Leukemia, Myeloid, Acute/complications , Leukemia, Myeloid, Acute/therapy , Malnutrition/etiology , Medical Oncology , Neoplasms/therapy , Nutrition AssessmentABSTRACT
Recent guidelines focus on a non-interventionist approach to management of gastro-oesophageal reflux in infancy and emphasise the importance of explanation, reassurance and simple measures such as attention to feeding. Relying on clinical history alone leads to over diagnosis of disease, and widely used medications are often ineffective for symptom relief and carry significant risk of harm. The association between vomiting in infancy and other problems such as crying and poor feeding should not be interpreted as implying causality. When there are strong pointers to underlying gastro-oesophageal reflux disease, invasive investigations are required in order to formulate appropriate intervention.