Sascha Verbruggen (Netherlands)
Erasmus Medical Centre-Sophia Children's Hospital Paediatric Intensive Care UnitAuthor Of 4 Presentations
FEEDING THE OBESE CHILD IN THE PICU
HYPOPHOSPHATAEMIA IS ASSOCIATED WITH WORSE CLINICAL OUTCOME IN CRITICALLY ILL CHILDREN – A SECONDARY ANALYSIS OF THE PEPANIC RCT
Abstract
Background and Aims
Withholding parenteral nutrition (PN) during the first week in PICU (late-PN vs. early-PN) accelerated recovery and reduced new infections. Hypophosphataemia may occur when enteral or parenteral nutrition is reintroduced. We investigated whether hypophosphataemia was associated with clinical outcomes affected by PN.
Methods
For this secondary analysis of the PEPaNIC-RCT (N=1440) patients with renal replacement therapy were excluded. Hypophosphataemia was defined as serum phosphate <0.65 mmol/L on any of the studied days (day 1-14 of PICU admission). Multivariable Cox proportional hazard and logistic regression analyses assessed the association of hypophosphataemia with likelihood of early live weaning from mechanical ventilation and PICU discharge, and risk of new infection, adjusted for baseline risk factors and randomisation.
Results
1247 patients were eligible (618 early-PN, 629 late-PN). Median age was 1.6 years (IQR 0.3-6.7); 705 (56.5%) were male and median PELOD was 21 (IQR 12-31). Hypophosphataemia occurred in 109 patients (76 early-PN, 33 late-PN; p<0.001). Hypophosphataemia was associated with lower likelihood of early live weaning from mechanical ventilation (HR, 0.62; p<0.001), lower likelihood of early live discharge from PICU (HR, 0.54; p<0.001) and more new infections (OR, 4.06; p<0.001) (Table 1).
Conclusions
The occurrence of hypophosphataemia was independently associated with a lower likelihood of early live weaning from mechanical ventilation, a lower likelihood of early live discharge from PICU and with more new infections.