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1. Rapid normalization of vitamin D deficiency in PICU (VITdALIZE-KIDS): study protocol for a phase III, multicenter randomized controlled trial

Author

O’Hearn, Katie, Menon, Kusum, Albrecht, Lisa, Amrein, Karin, Britz-McKibbin, Philip, Cayouette, Florence, Choong, Karen, Foster, Jennifer Ruth, Fergusson, Dean A., Floh, Alejandro, Fontela, Patricia, Geier, Pavel, Gilfoyle, Elaine, Guerra, Gonzalo Garcia, Gunz, Anna, Helmeczi, Erick, Khamessan, Ali, Joffe, Ari R., Lee, Laurie, McIntyre, Lauralyn, Murthy, Srinivas, Parsons, Simon J., Ramsay, Tim, Ryerson, Lindsay, Tucci, Marisa, and McNally, Dayre

Published
2024
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6. Rapid normalization of vitamin D deficiency in PICU (VITdALIZE-KIDS): study protocol for a phase III, multicenter randomized controlled trial.

Author

O'Hearn, Katie, Menon, Kusum, Albrecht, Lisa, Amrein, Karin, Britz-McKibbin, Philip, Cayouette, Florence, Choong, Karen, Foster, Jennifer Ruth, Fergusson, Dean A., Floh, Alejandro, Fontela, Patricia, Geier, Pavel, Gilfoyle, Elaine, Guerra, Gonzalo Garcia, Gunz, Anna, Helmeczi, Erick, Khamessan, Ali, Joffe, Ari R., Lee, Laurie, and McIntyre, Lauralyn

Subjects
CRITICALLY ill children, VITAMIN D deficiency, QUALITY of life, VITAMIN D, LENGTH of stay in hospitals, GESTATIONAL age
Abstract

Background: The rate of vitamin D deficiency (VDD) in critically ill children worldwide has been estimated at 50%. These children are at risk of multiple organ dysfunction, chronic morbidity, and decreased health related quality of life (HRQL). Pediatric and adult ICU clinical trials suggest that VDD is associated with worse clinical outcomes, although data from supplementation trials are limited and inconclusive. Our group's phase II multicenter dose evaluation pilot study established the efficacy and safety of an enteral weight-based cholecalciferol loading dose to rapidly restore vitamin D levels in critically ill children. Methods: Our aim is to evaluate the impact of this dosing regimen on clinical outcomes. VITdALIZE-KIDS is a pragmatic, phase III, multicenter, double-blind RCT aiming to randomize 766 critically ill children from Canadian PICUs. Participants are randomized using a 1:1 scheme to receive a single dose at enrollment of enteral cholecalciferol (10,000 IU/kg, max 400,000 IU) or placebo. Eligibility criteria include critically ill children aged newborn (> 37 weeks corrected gestational age) to < 18 years who have blood total 25-hydroxyvitamin D < 50 nmol/L. The primary objective is to determine if rapid normalization of vitamin D status improves HRQL at 28 days following enrollment. The secondary objective is to evaluate the impact of rapid normalization of vitamin D status on multiple organ dysfunction. The study includes additional tertiary outcomes including functional status, HRQL and mortality at hospital discharge and 90 days, PICU and hospital length of stay, and adverse events related to vitamin D toxicity. Additionally, we are performing comprehensive vitamin D speciation and non-targeted metabolite profiling as part of a sub-study for the first 100 participants from whom an enrollment and at least one post-intervention blood and urine sample were obtained. Discussion: The VITdALIZE-KIDS trial is the first phase III, multicenter trial to evaluate whether rapid normalization of vitamin D status could represent a simple, inexpensive, and safe means of improving outcomes following pediatric critical illness. Recruitment was initiated in June 2019 and is expected to continue to March 2026. Trial registration: Clinicaltrials.gov, NCT03742505. Study first submitted on November 12, 2018 https://clinicaltrials.gov/study/NCT03742505 [ABSTRACT FROM AUTHOR]

Published
2024
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7. Leukocyte telomere length in paediatric critical illness: effect of early parenteral nutrition.

Author

Verstraete, Sören, Vanhorebeek, Ilse, van Puffelen, Esther, Derese, Inge, Ingels, Catherine, Verbruggen, Sascha, Wouters, Pieter, Joosten, Koen, Hanot, Jan, Guerra, Gonzalo, Vlasselaers, Dirk, Lin, Jue, and Van den Berghe, Greet

Subjects
Children, Critical care, Critical illness, Intensive care, Nutrition, PICU, Paediatric, Telomere length, Telomeres, Adolescent, Child, Child, Preschool, Critical Illness, Female, Humans, Infant, Intensive Care Units, Pediatric, Leukocytes, Male, Parenteral Nutrition, Pediatrics, Propensity Score, Survival Analysis, Telomere, Time Factors
Abstract

BACKGROUND: Children who have suffered from critical illnesses that required treatment in a paediatric intensive care unit (PICU) have long-term physical and neurodevelopmental impairments. The mechanisms underlying this legacy remain largely unknown. In patients suffering from chronic diseases hallmarked by inflammation and oxidative stress, poor long-term outcome has been associated with shorter telomeres. Shortened telomeres have also been reported to result from excessive food consumption and/or unhealthy nutrition. We investigated whether critically ill children admitted to the PICU have shorter-than-normal telomeres, and whether early parenteral nutrition (PN) independently affects telomere length when adjusting for known determinants of telomere length. METHODS: Telomere length was quantified in leukocyte DNA from 342 healthy children and from 1148 patients who had been enrolled in the multicenter, randomised controlled trial (RCT), PEPaNIC. These patients were randomly allocated to initiation of PN within 24 h (early PN) or to withholding PN for one week in PICU (late PN). The impact of early PN versus late PN on the change in telomere length from the first to last PICU-day was investigated with multivariable linear regression analyses. RESULTS: Leukocyte telomeres were 6% shorter than normal upon PICU admission (median 1.625 (IQR 1.446-1.825) telomere/single-copy-gene ratio (T/S) units vs. 1.727 (1.547-1.915) T/S-units in healthy children (P

Published
2018

10. Supplementation of vitamins, trace elements and electrolytes in the PEPaNIC Randomised Controlled Trial: Composition and preparation of the prescription

Author

Eveleens, Renate D., Witjes, Bregje C.M., Casaer, Michael P., Vanhorebeek, Ilse, Guerra, Gonzalo Garcia, Veldscholte, Karlien, Hanff, Lidwien M., Cosaert, Katrien, Desmet, Lars, Vlasselaers, Dirk, Maebe, Sofie, Bernard, Britney, Van den Berghe, Greet, Verbruggen, Sascha C.A.T., and Joosten, Koen F.M.

Published
2021
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12. Effect of early parenteral nutrition during paediatric critical illness on DNA methylation as a potential mediator of impaired neurocognitive development: a pre-planned secondary analysis of the PEPaNIC international randomised controlled trial

Author

Güiza, Fabian, Vanhorebeek, Ilse, Verstraete, Sören, Verlinden, Ines, Derese, Inge, Ingels, Catherine, Dulfer, Karolijn, Verbruggen, Sascha C, Garcia Guerra, Gonzalo, Joosten, Koen F, Wouters, Pieter J, and Van den Berghe, Greet

Published
2020
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18. Muscle Fitness Cut Points for Early Assessment of Cardiovascular Risk in Children and Adolescents

Author

Marcos, Ascension, Gomez-Martinez, Sonia, Nova, Esther, Diaz, Ligia-Esperanza, Zapatera, Belen, Veses, Ana M., Hernandez, Aurora, Gheorghe, Alina, Castro-Piñero, José, Mora-Vicente, Jesus, Gonzalez Montesinos, Jose L., Conde-Caveda, Julio, Ruiz, Jonatan R., Ortega, Francisco B., Moledo, Carmen Padilla, Baeza, Ana Carbonell, Chillon, Palma, del Rosario Fernandez, Jorge, Galo, Ana Gonzalez, Guerra, Gonzalo Bellvis, Alfonso, Alvaro Delgado, Parrilla, Fernando, Gomez, Roque, Gavala, Juan, Veiga, Oscar L., Villagra, H. Ariel, del, Juan, Campo, Cordente, Carlos, Diaz, Mario, Tejero, Carlos M., Acha, Aitor, Moya, Jose M., Sanz, Alberto, Martinez-Gomez, David, Cabanas-Sanchez, Veronica, Rodriguez Romo, Gabriel, Izquierdo, Rocio, Garcia-Cervantes, Laura, Esteban-Cornejo, Irene, Bandres, Fernando, Lucia, Alejandro, Santiago, Catalina, Gomez-Gallego, Felix, Perez-Bey, Alejandro, Cuenca-Garcia, Magdalena, Cabanas-Sanchez, Verónica, Gómez-Martínez, Sonia, and Marcos, Ascensión

Published
2019
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19. 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

Author

Verstraete, Sören, Verbruggen, Sascha C, Hordijk, José A, Vanhorebeek, Ilse, Dulfer, Karolijn, Güiza, Fabian, van Puffelen, Esther, Jacobs, An, Leys, Sandra, Durt, Astrid, Van Cleemput, Hanna, Eveleens, Renate D, Garcia Guerra, Gonzalo, Wouters, Pieter J, Joosten, Koen F, and Van den Berghe, Greet

Published
2019
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24. Effect of red blood cell storage time in pediatric cardiac surgery patients: A subgroup analysis of a randomized controlled trial.

Author

Martin, Sophie, Tucci, Marisa, Spinella, Philip Charles, Ducruet, Thierry, Fergusson, Dean A, Freed, Darren H, Lacroix, Jacques, Poirier, Nancy, Sivarajan, Venkatesan VB, Steiner, Katharina Marie, Willems, Ariane, Garcia Guerra, Gonzalo, Age of Blood in Children in Pediatric Intensive Care Unit Trial Investigators, Canadian Critical Care Trials Group, Pediatric Acute Lung Injury and Sepsis Investigators Network, BloodNet Pediatric Critical Care Blood Research Network, Groupe Francophone de Réanimation et Urgences Pédiatriques, Martin, Sophie, Tucci, Marisa, Spinella, Philip Charles, Ducruet, Thierry, Fergusson, Dean A, Freed, Darren H, Lacroix, Jacques, Poirier, Nancy, Sivarajan, Venkatesan VB, Steiner, Katharina Marie, Willems, Ariane, Garcia Guerra, Gonzalo, Age of Blood in Children in Pediatric Intensive Care Unit Trial Investigators, Canadian Critical Care Trials Group, Pediatric Acute Lung Injury and Sepsis Investigators Network, BloodNet Pediatric Critical Care Blood Research Network, and Groupe Francophone de Réanimation et Urgences Pédiatriques

Abstract

This study aimed to determine whether or not transfusion of fresh red blood cells (RBCs) reduced the incidence of new or progressive multiple organ dysfunction syndrome compared with standard-issue RBCs in pediatric patients undergoing cardiac surgery., info:eu-repo/semantics/published

Published
2023

25. Sistema robótico de auto-acoplamiento para la interfaz multifuncional SIROM

Author

Ingeniería de sistemas y automática, Sistemen ingeniaritza eta automatika, Bilbao, Daniel, Ferrer, Unai, Vinals, Javier, Guerra, Gonzalo, Irigoyen Gordo, Eloy, Cabanes Axpe, Itziar, Ingeniería de sistemas y automática, Sistemen ingeniaritza eta automatika, Bilbao, Daniel, Ferrer, Unai, Vinals, Javier, Guerra, Gonzalo, Irigoyen Gordo, Eloy, and Cabanes Axpe, Itziar

Abstract

Con objeto de realizar tareas de servicio en órbita de manera autónoma y sin necesidad de personal humano, este trabajo presenta el desarrollo de un sistema robótico de auto-acoplamiento basado en cámaras y marcadores visuales que permiten facilitar el ensamblaje de la interfaz multifuncional SIROM (Standard Interface for Robotic Manipulation), diseñada por SENER Aeroespacial. Para ello se ha implementado un control servo visual, logrando realizar el acoplamiento de manera autónoma entre un dispositivo SIROM activo utilizado como herramienta de un manipulador robótico y su homólogo SIROM pasivo acoplado a un módulo espacial. Este desarrollo permitirá que en el futuro dicha interfaz robótica sea una solución de referencia vanguardista para la realización de estas tareas. La solución presentada ha sido validada mediante la realización de ensayos independientes para cada uno de los subsistemas que componen el prototipo desarrollado y, posteriormente, se ha verificado el funcionamiento del sistema al completo en diferentes escenarios de ensamblaje y ante situaciones de gran desalineamiento. El análisis de los resultados obtenidos en este trabajo permiten corroborar que el prototipo diseñado logra cumplir con el objetivo principal de manera satisfactoria.

Published
2023

29. PTEN inhibitor and kit ligand increase in vitro activation and survival of primordial follicles in alpaca.

Author

Rojas‐Guerra, Gonzalo, Dipaz‐Berrocal, Deysi, and Mellisho, Edwin

Subjects
*OVARIAN follicle, *STEM cell factor, *TISSUE culture, *ALPACA, *PHOSPHATIDYLINOSITOL 3-kinases
Abstract

In mammals, activation of primordial follicles to primary follicle is a progressive and highly regulated process. There is evidence in mice that phosphatase and tensin homologue deleted on Chromosome 10 (PTEN) silencing is an important negative regulator of phosphatidylinositol 3‐kinase (PI3K), which initiates activation of dormant follicles. The objective of the study was to evaluate the effect of the addition of PTEN inhibitor (bpV(HOpic)) (10 μM) and/or Kit Ligand (KL) (100 ng/mL) on the in vitro activation and survival of alpaca primordial follicles. Ovarian cortical fragments from 11 adult alpacas were cultured for 24 h in tissue culture medium (α‐MEM+) supplemented with KL and bpV or the association of both. Subsequently, each sample was processed by classical histology and follicular counting and classification were performed. The results obtained show a reduction (p < 0.05) of primordial follicles in more than 50% in follicular tissue cultured in vitro in α‐MEM+ or supplemented with bpV and/or KL versus the control (not cultured). Further, >25% increase in primary follicles in follicular tissue cultured in vitro in α‐MEM+ or supplemented with KL and/or bpV versus control. However, the follicular survival rate showed a decrease of 20% in the cultured tissues, except for the α‐MEM+ supplemented with KL and bpV. In conclusion, supplementation of bpV (HOpic) (10 μM) and KL (100 ng/mL) increased the activation in vitro of primordial follicles and survival after in vitro culture of alpaca ovarian tissue. [ABSTRACT FROM AUTHOR]

Published
2023
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30. Sistema robótico de auto-acoplamiento para la interfaz multifuncional SIROM

Author

Bilbao, Daniel, Ferrer, Unai, Vinals, Javier, Guerra, Gonzalo, Irigoyen Gordo, Eloy, and Cabanes Axpe, Itziar

Abstract

Con objeto de realizar tareas de servicio en órbita de manera autónoma y sin necesidad de personal humano, este trabajo presenta el desarrollo de un sistema robótico de auto-acoplamiento basado en cámaras y marcadores visuales que permiten facilitar el ensamblaje de la interfaz multifuncional SIROM (Standard Interface for Robotic Manipulation), diseñada por SENER Aeroespacial. Para ello se ha implementado un control servo visual, logrando realizar el acoplamiento de manera autónoma entre un dispositivo SIROM activo utilizado como herramienta de un manipulador robótico y su homólogo SIROM pasivo acoplado a un módulo espacial. Este desarrollo permitirá que en el futuro dicha interfaz robótica sea una solución de referencia vanguardista para la realización de estas tareas. La solución presentada ha sido validada mediante la realización de ensayos independientes para cada uno de los subsistemas que componen el prototipo desarrollado y, posteriormente, se ha verificado el funcionamiento del sistema al completo en diferentes escenarios de ensamblaje y ante situaciones de gran desalineamiento. El análisis de los resultados obtenidos en este trabajo permiten corroborar que el prototipo diseñado logra cumplir con el objetivo principal de manera satisfactoria.

Published
2023

34. Post-PICU Outcomes: A Scoping Review and Development of a Living Database

Author

McQuaid, Cara, Hay, Rebecca, Zorko, David, DuPont-Thibodeau, Genevieve, Ducharme-Crevier, Laurence, Guerra, Gonzalo, Lee, Laurie, O'Hearn, Katie, Sampson, Margaret, Choong, Karen, and McNally, James

Subjects
Post PICU syndrome, Pediatric critical care, Medicine and Health Sciences, PICU Follow up, Post traumatic stress
Abstract

This project aims to identify and characterize all research studies published from the year 2000 to present describing any post-discharge outcomes of PICU patients or their family members.

Published
2023
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35. sj-pdf-3-cjk-10.1177_20543581231168088 – Supplemental material for Perspectives of Pediatric Nephrologists, Intensivists and Nurses Regarding AKI Management and Expected Outcomes

Author

Che, Adrian, D’Arienzo, David, Dart, Allison, Mammen, Cherry, Samuel, Susan, Alexander, Todd, Morgan, Catherine, Blydt-Hansen, Tom, Fontela, Patricia, Guerra, Gonzalo Garcia, Chanchlani, Rahul, Wang, Stella, Cockovski, Vedran, Jawa, Natasha, Lee, Jasmine, Nunes, Sophia, Reynaud, Stephanie, and Zappitelli, Michael

Subjects
Medicine
Abstract

Supplemental material, sj-pdf-3-cjk-10.1177_20543581231168088 for Perspectives of Pediatric Nephrologists, Intensivists and Nurses Regarding AKI Management and Expected Outcomes by Adrian Che, David D’Arienzo, Allison Dart, Cherry Mammen, Susan Samuel, Todd Alexander, Catherine Morgan, Tom Blydt-Hansen, Patricia Fontela, Gonzalo Garcia Guerra, Rahul Chanchlani, Stella Wang, Vedran Cockovski, Natasha Jawa, Jasmine Lee, Sophia Nunes, Stephanie Reynaud and Michael Zappitelli in Canadian Journal of Kidney Health and Disease

Published
2023
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36. sj-pdf-2-cjk-10.1177_20543581231168088 – Supplemental material for Perspectives of Pediatric Nephrologists, Intensivists and Nurses Regarding AKI Management and Expected Outcomes

Author

Che, Adrian, D’Arienzo, David, Dart, Allison, Mammen, Cherry, Samuel, Susan, Alexander, Todd, Morgan, Catherine, Blydt-Hansen, Tom, Fontela, Patricia, Guerra, Gonzalo Garcia, Chanchlani, Rahul, Wang, Stella, Cockovski, Vedran, Jawa, Natasha, Lee, Jasmine, Nunes, Sophia, Reynaud, Stephanie, and Zappitelli, Michael

Subjects
Medicine
Abstract

Supplemental material, sj-pdf-2-cjk-10.1177_20543581231168088 for Perspectives of Pediatric Nephrologists, Intensivists and Nurses Regarding AKI Management and Expected Outcomes by Adrian Che, David D’Arienzo, Allison Dart, Cherry Mammen, Susan Samuel, Todd Alexander, Catherine Morgan, Tom Blydt-Hansen, Patricia Fontela, Gonzalo Garcia Guerra, Rahul Chanchlani, Stella Wang, Vedran Cockovski, Natasha Jawa, Jasmine Lee, Sophia Nunes, Stephanie Reynaud and Michael Zappitelli in Canadian Journal of Kidney Health and Disease

Published
2023
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37. sj-pdf-4-cjk-10.1177_20543581231168088 – Supplemental material for Perspectives of Pediatric Nephrologists, Intensivists and Nurses Regarding AKI Management and Expected Outcomes

Author

Che, Adrian, D’Arienzo, David, Dart, Allison, Mammen, Cherry, Samuel, Susan, Alexander, Todd, Morgan, Catherine, Blydt-Hansen, Tom, Fontela, Patricia, Guerra, Gonzalo Garcia, Chanchlani, Rahul, Wang, Stella, Cockovski, Vedran, Jawa, Natasha, Lee, Jasmine, Nunes, Sophia, Reynaud, Stephanie, and Zappitelli, Michael

Subjects
Medicine
Abstract

Supplemental material, sj-pdf-4-cjk-10.1177_20543581231168088 for Perspectives of Pediatric Nephrologists, Intensivists and Nurses Regarding AKI Management and Expected Outcomes by Adrian Che, David D’Arienzo, Allison Dart, Cherry Mammen, Susan Samuel, Todd Alexander, Catherine Morgan, Tom Blydt-Hansen, Patricia Fontela, Gonzalo Garcia Guerra, Rahul Chanchlani, Stella Wang, Vedran Cockovski, Natasha Jawa, Jasmine Lee, Sophia Nunes, Stephanie Reynaud and Michael Zappitelli in Canadian Journal of Kidney Health and Disease

Published
2023
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38. sj-docx-1-cjk-10.1177_20543581231168088 – Supplemental material for Perspectives of Pediatric Nephrologists, Intensivists and Nurses Regarding AKI Management and Expected Outcomes

Author

Che, Adrian, D’Arienzo, David, Dart, Allison, Mammen, Cherry, Samuel, Susan, Alexander, Todd, Morgan, Catherine, Blydt-Hansen, Tom, Fontela, Patricia, Guerra, Gonzalo Garcia, Chanchlani, Rahul, Wang, Stella, Cockovski, Vedran, Jawa, Natasha, Lee, Jasmine, Nunes, Sophia, Reynaud, Stephanie, and Zappitelli, Michael

Subjects
Medicine
Abstract

Supplemental material, sj-docx-1-cjk-10.1177_20543581231168088 for Perspectives of Pediatric Nephrologists, Intensivists and Nurses Regarding AKI Management and Expected Outcomes by Adrian Che, David D’Arienzo, Allison Dart, Cherry Mammen, Susan Samuel, Todd Alexander, Catherine Morgan, Tom Blydt-Hansen, Patricia Fontela, Gonzalo Garcia Guerra, Rahul Chanchlani, Stella Wang, Vedran Cockovski, Natasha Jawa, Jasmine Lee, Sophia Nunes, Stephanie Reynaud and Michael Zappitelli in Canadian Journal of Kidney Health and Disease

Published
2023
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41. Early hypophosphatemia in critically ill children and the effect of parenteral nutrition: A secondary analysis of the PEPaNIC RCT

Author

Veldscholte, K., primary, Veen, M.A.N., additional, Eveleens, R.D., additional, de Jonge, R.C.J., additional, Vanhorebeek, I., additional, Gunst, J., additional, Casaer, M.P., additional, Wouters, P.J., additional, Guerra, Gonzalo Garcia, additional, Van den Berghe, G., additional, Joosten, K.F.M., additional, and Verbruggen, S.C.A.T., additional

Published
2022
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47. Standard VersusRestrictive Transfusion Strategy for Pediatric Cardiac ECLS Patients: Single Center Retrospective Cohort Study

Author

Garcia Guerra, Andres, Ryerson, Lindsay, Garros, Daniel, Nahirniak, Susan, Granoski, Don, Calisin, Olivia, Sheppard, Cathy, Lequier, Laurance, and Garcia Guerra, Gonzalo

Abstract

This retrospective cohort study aimed to compare blood component transfusion before and after the implementation of a restrictive transfusion strategy (RTS) in pediatric cardiac Extracorporeal Life Support (ECLS) patients. The study included children admitted to the pediatric cardiac intensive care unit (PCICU) at the Stollery Children’s Hospital who received ECLS between 2012 and 2020. Children on ECLS between 2012 and 2016 were treated with standard transfusion strategy (STS), while those on ECLS between 2016 and 2020 were treated with RTS. During the study, 203 children received ECLS. Daily median (interquartile range [IQR]) packed red blood cell (PRBC) transfusion volume was significantly lower in the RTS group; 26.0 (14.4–41.5) vs.41.5 (26.6–64.4) ml/kg/day, pvalue <0.001. The implementation of a RTS led to a median reduction of PRBC transfusion of 14.5 (95% CI: 6.70–21.0) ml/kg/day. Similarly, the RTS group received less platelets: median (IQR) 8.4 (4.50–15.0) vs.17.5 (9.40–29.0) ml/kg/day, pvalue <0.001. The implementation of a RTS resulted in a median reduction of platelet transfusion of 9.2 (95% CI: 5.45–13.1) ml/kg/day. The RTS resulted in less median (IQR) fluid accumulation in the first 48 hours: 56.7 (2.30–121.0) vs.140.4 (33.8–346.2) ml/kg, pvalue = 0.001. There were no significant differences in mechanical ventilation days, PCICU/hospital days, or survival. The use of RTS resulted in lower blood transfusion volumes, with similar clinical outcomes.

Published
2023
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48. Early hypophosphatemia in critically ill children and the effect of parenteral nutrition:A secondary analysis of the PEPaNIC RCT

Author

Veldscholte, K., Veen, M.A.N., Eveleens, R. D., de Jonge, R. C.J., Vanhorebeek, I., Gunst, J., Casaer, M. P., Wouters, P. J., Guerra, Gonzalo Garcia, Van den Berghe, G., Joosten, K. F.M., Verbruggen, S. C.A.T., Veldscholte, K., Veen, M.A.N., Eveleens, R. D., de Jonge, R. C.J., Vanhorebeek, I., Gunst, J., Casaer, M. P., Wouters, P. J., Guerra, Gonzalo Garcia, Van den Berghe, G., Joosten, K. F.M., and Verbruggen, S. C.A.T.

Abstract

Background & aims: Hypophosphatemia during critical illness has been associated with adverse outcome. The reintroduction of enteral or parenteral nutrition, leading to refeeding hypophosphatemia (RFH), has been presented as potential risk factor. We investigated the occurrence of early RFH, its association with clinical outcome, and the impact of early parenteral nutrition (PN) on the development of early RFH in pediatric critical illness. Methods: This is a secondary analysis of the PEPaNIC randomized controlled trial (N = 1440), which showed that withholding supplemental parenteral nutrition (PN) for 1 week (late-PN) in the pediatric intensive care unit (PICU) accelerated recovery and reduced new infections compared to early-PN (<24 h). Patients with renal replacement therapy or unavailable phosphate concentrations were excluded from this analysis. Early RFH was defined as serum/plasma phosphate <0.65 mmol/L and a drop of >0.16 mmol/L within 3 days of admission to the PICU. The association between baseline characteristics and early RFH, and the association of early RFH with clinical outcome were investigated using logistic and linear regression models, both uncorrected and corrected for possible confounders. To examine the impact of nutritional intake on phosphate concentrations, structural nested mean models with propensity score and censoring models were used. Results: A total of 1247 patients were eligible (618 early-PN, 629 late-PN). Early RFH occurred in 40 patients (3%) in total, significantly more in the early-PN group (n = 31, within-group occurrence 5%) than in the late-PN-group (n = 9, within-group occurrence 1%, p < 0.001). Patients who were older (OR 1.14 (95% CI 1.08; 1.21) per year added, p < 0.001) and who had a higher Pediatric Risk of Mortality (PIM3) score had a higher risk of developing early RFH (OR 1.36 (95% CI 1.15; 1.59) per unit added, p < 0.001), whereas patients in the late-PN group had a lower risk of early RFH (

Published
2022

49. 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∗

Author

Verlinden, Ines, Güiza, Fabian, Dulfer, Karolijn, Van Cleemput, Hanna, Wouters, Pieter J., Guerra, Gonzalo Garcia, Joosten, Koen F., Verbruggen, Sascha C., Vanhorebeek, Ilse, Van Den Berghe, Greet, Verlinden, Ines, Güiza, Fabian, Dulfer, Karolijn, Van Cleemput, Hanna, Wouters, Pieter J., Guerra, Gonzalo Garcia, Joosten, Koen F., Verbruggen, Sascha C., Vanhorebeek, Ilse, and Van Den Berghe, Greet

Abstract

OBJECTIVES: PICU patients face long-term developmental impairments, partially attributable to early parenteral nutrition (PN) versus late-PN. We investigated how this legacy and harm by early-PN evolve over time. DESIGN: Preplanned secondary analysis of the multicenter PEPaNIC-RCT (ClinicalTrials.gov, NCT01536275) that enrolled 1,440 critically ill children from 2012 to 2015 and its 2- (2014-2018) and 4-year (2016-2019) cross-sectional follow-up studies. SETTING: PICUs of Leuven (Belgium), Rotterdam (The Netherlands), and Edmonton (Canada). PATIENTS: Patients and demographically matched healthy control children that underwent longitudinal assessment for physical/emotional/behavioral/neurocognitive functions at both follow-up time points. INTERVENTIONS: In the PEPaNIC-RCT, patients were randomly allocated to early-PN versus late-PN. MEASUREMENTS AND MAIN RESULTS: This within-individual longitudinal study investigated changes in physical/emotional/behavioral/neurocognitive functions from 2 to 4 years after PICU admission for 614 patients (297 early-PN and 317 late-PN, tested at mean ± sd age 5.4 ± 4.2 and 7.3 ± 4.3 yr) and for 357 demographically matched healthy children tested at age 5.6 ± 4.3 and 7.5 ± 4.3 years. We determined within-group time-courses, interaction between time and group, and independent impact of critical illness and early-PN on these time-courses. Most deficits in patients versus healthy children remained prominent over the 2 years (p ≤ 0.01). Deficits further aggravated for height, body mass index, the executive function metacognition, intelligence, motor coordination (alternating/synchronous tapping), and memory learning-index, whereas verbal memory deficits became smaller (working/immediate/delayed memory) (p ≤ 0.05). Adjustment for risk factors confirmed most findings and revealed that patients "grew-into-deficit" for additional executive functions (flexibility/emotional control/total executive functioning) and "grew-out-of-deficit" for add

Published
2022

50. 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*

Author

Verlinden, Ines, primary, Güiza, Fabian, additional, Dulfer, Karolijn, additional, Van Cleemput, Hanna, additional, Wouters, Pieter J., additional, Guerra, Gonzalo Garcia, additional, Joosten, Koen F., additional, Verbruggen, Sascha C., additional, Vanhorebeek, Ilse, additional, and Van den Berghe, Greet, additional

Published
2022
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