ESPGHAN/ESPEN/ESPR/CSPEN guidelines on pediatric parenteral nutrition: Carbohydrates

Tabled 1Table: Recommendations for carbohydratesR 5.1The amount of glucose to be provided by PN should be guided by [1] the balance between meeting energy needs and the risks of overfeeding/excess glucose load [2], phase of illness (acute, stable, recovery/growing) [3], macronutrient supply by enteral and parenteral nutrition, and [4] glucose administered outside enteral and parenteral nutrition, e.g. with medication (GPP, conditional recommendation)R 5.2Excessive glucose intake should be avoided because it may be responsible for hyperglycemia (LoE 1−, RG A, strong recommendation), causes increased lipogenesis and fat tissue deposition together with subsequent liver steatosis and enhanced production of VLDL triglycerides by the liver (LOE 2+, RG B, strong recommendation), and may cause increased CO2 production and minute ventilation (LoE 2+, RG B, strong recommendation)R 5.3Glucose intake does not lower protein catabolism in the acute phase of critical illness (LoE 1−, RG A, strong recommendation)R 5.4Recommended parenteral glucose supply in (pre)term newborns in mg/kg per min (g/kg per day) (LoE 2+, RG B, conditional Tabled 1Day 1Day 2 onwardsStart withIncrease gradually over 2–3 days toPreterm newborn4–8 (5.8–11.5)Target 8–10 (11.5–14.4)Min 4 (5.8); max 12 (17.3)Term newborn2.5–5 (3.6–7.2)Target 5–10 (7.2–14.4)Min 2.5 (3.6); max 12 (17.3) Open table in a new tab R 5.5Newborns < 28 days of age, who have an episode of acute illness such as infection or sepsis, should temporarily receive the carbohydrate supply of day 1 (R5.4), guided by the blood glucose levels (GPP, conditional recommendation)R 5.6Recommended parenteral glucose supply in infants and children according to body weight and phase of illness. The units are mg/kg/min (g/kg per day) (LoE 1+, RG A, strong recommendation)Tabled 1Acute phaseStable phaseRecovery phase28 d–10 kg2–4 (2.9–5.8)4–6 (5.8–8.6)6–10 (8.6–14)11–30 kg1.5–2.5 (2.2–3.6)2–4 (2.8–5.8)3–6 (4.3–8.6)31–45 kg1–1.5 (1.4–2.2)1.5–3 (2.2–4.3)3–4 (4.3–5.8)>45 kg0.5–1 (0.7–1.4)1–2(1.4–2.9)2–3 (2.9–4.3) Open table in a new tab Acute phase = resuscitation phase when the patient requires vital organ support (sedation, mechanical ventilation, vasopressors, fluid resuscitation).Stable phase = patient is stable on, or can be weaned, from this vital support.Recovery phase = patient who is mobilizing.R 5.7Blood glucose measurements should preferably be performed on equipment validated for use such as blood gas analysers (LoE 2+, RG B, strong recommendation)R 5.8Hyperglycaemia >8 mmol/L (145 mg/dL) should be avoided in paediatric ICU patients because of increased morbidity and mortality (LoE 1+, RG A, strong recommendation)R 5.9In children in the PICU, repetitive blood glucose levels >10 mmol/L (180 mg/dL) should be treated with continuous insulin infusion (LoE 1+, RG A, strong recommendation)R 5.10Hyperglycaemia >8 mmol/L (145 mg/dL) should be avoided in neonatal ICU patients because it is associated with increased morbidity and mortality (LoE 2−, RG B, strong recommendation)R 5.11In neonates in the NICU, repetitive blood glucose levels >10 mmol/L (180 mg/dL) should be treated with insulin therapy, when reasonable adaptation of glucose infusion rate has been insufficient (LoE 2++, RG 0, conditional recommendation)R 5.12Repetitive and/or prolonged hypoglycaemia ≤2.5 mmol/L (45 mg/dL) should be avoided in all ICU patients (extrapolated LoE 2+, RG 0, strong recommendation) Open table in a new tab Literature Search Medline search, Pub-Med search, Embase, expert search Search conducted on 30.11.2014 and on 17.09.2016 Timeframe: publications from <1946 to 17.09.2016>. Type of publications: original papers, meta-analyses and overviews Key words: children, parenteral nutrition, glucose, carbohydrate, energy-resource, insulin, critical illness Language: English