Proefschrift Kerklaan

Chapter 5

Table 1. Overview of 5 RCTs and 1 post-hoc analysis identified as support of use of parenteral nutrition (PN) in critical ill children Study Patients Comparator Intervention Outcome parameters Limitations Jordan I. et al. Clin Nutr. 2015 Glutamine effects on heat shock protein 70 and interleukines 6 and 10: Randomized trial of glutamine supplementation versus standard parenteral nutrition in critically ill children 13 101 patients (1 month -14 years) with severe sepsis or post major surgery Standard PN (SPN) Standard PN plus Glutamine 0.33g/kg/d (SPN + Gln) High Heat Shock Protein-70 longer maintained in SPN + Gln. No difference in interleukin 6, interleukin 10 1) Surrogate endpoints Larsen B. et al. JPEN J Parenteral Enteral Nutr. 2015;39:171-179 Pretreatment with an intravenous lipid emulsion increases plasma eicosapentanoic acid and downregulates leukotriene b4, procalcitonin, and lymphocyte concentrations after open heart surgery in infants 11 32 patients (neonates 40 weeks ± 2.2 weeks) post cardiac surgery Standard group Intralipid® Intervention group Lipoplus® (50% MCT, 40% LCT, 10% Fish oil) Intervention group: Procalcitonin lower in at day 1, Leukotriene B4 higher at day 1 and 7, but lower at day 10. Lymphocyte concentration lower 1) Post-hoc analysis 2) Underpowered to draw clinical conclusions 3) Intervention already started before surgery Lekmanov A. et al.Anesteziol Reanimatol 2013; Jan-Feb;(1):49-51 Study of glutamine solution use efficiency in pediatric patients with heavy thermic burns and concomitant injuries in the intensive care unit 14 40 patients (2-15 years old) with thermic burns Standard PN Standard PN plus glutamine (2 ml/kg) Intervention group: shorter duration of mechanical ventilation. No differences in levels of protein, albumin or glutamine 1) No statistical analysis description 2) Methods inaccurately described 3) Glutamine levels not different between groups Larsen B. et al. Clin Nutr. 2012 Jun;31(3):322-9 Pre-treatment with an intravenous lipid emulsion containing fish oil (eicosapentaenoic and docosahexaenoic acid) decreases inflammatory markers after open-heart surgery in infants: a randomized, controlled trial 17 32 patients (neonates 40 weeks ± 2.2 weeks) post cardiac surgery Standard group Intralipid® Intervention group Lipoplus® (50% MCT, 40% LCT, 10% Fish oil) Intervention group: TNF alpha plasma levels lower prior to and after surgery. Pro- inflammatory markers lower 1) Surrogate endpoints 2) No clinical outcome difference 3) Intervention already started before surgery

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