CClinicalTrials.gg
Active, not recruitingNCT01536275PEPaNICUpdated Feb 12, 2024

Early Versus Late Parenteral Nutrition in the Pediatric Intensive Care Unit

An interventional study of Late parenteral nutrition in Critical Illness and Children, sponsored by KU Leuven. Active, not recruiting at 3 sites in 3 countries. Open to participants aged Up to 17 Years. Per ClinicalTrials.gov, last updated 2024-02-12.

Sponsored by KU Leuven · Not applicable, Interventional, and Treatment

Phase
Not applicable
Study type
Interventional
Enrollment
1,440
Allocation
Randomized
Ages
Up to 17 Years
Sex
All
01

Study summary

In the PEPaNIC trial it is investigated whether withholding parenteral nutrition during the first week in critically ill children is beneficial, compared to the current standard of the early start of parenteral nutrition.

02

Conditions studied

  • Critical Illness
  • Children

Browse trials for

Keywords

  • critical illness
  • children
  • nutrition
  • metabolism
03

In context

Critical Illness

1,881 studies on the registry are indexed under Critical Illness; 462 are open to participants now.

This study's enrollment of 1,440 is above the median of 90 across 979 interventional studies indexed under Critical Illness.

Browse Critical Illness studies →

Lead sponsor

KU Leuven is the lead sponsor of 358 studies on the registry; 62 are open to participants now.

Counted across the registry records on this site, refreshed daily.

04

Who can participate

Ages eligible
Up to 17 Years
Sexes eligible
All
Accepts healthy volunteers
No

Inclusion criteria

  • All patients admitted to the PICU with a STRONGkids score of 2 points or more upon ICU admission

Exclusion criteria

Exclusion Criteria:

  • Age of 17 years or older
  • Patients with a DNR code at the time of ICU admission.
  • Patients expected to die within 12 hours (=moribund patients).
  • Patient readmitted to ICU after randomization to the PEPaNIC trial, more than 48 hours after the initial discharge
  • Patients transferred from another paediatric intensive care after a stay of more than 7 days
  • Patients suffering from ketoacidotic or hyperosmolar coma on admission.
  • Patients suffering from Short Bowel Syndrome on home PN or other conditions that require home PN
  • Patients suspicious or established inborn metabolic diseases requiring specific diet
  • STRONGkids score lower than 2 on ICU admission.
  • Premature Newborns ( 37 weeks gestational age upon admission in the PICU)
  • Prior inclusion in another randomized controlled outcome study
05

Study design

Phase
Not applicable
Primary purpose
Treatment
Allocation
Randomized
Intervention model
Parallel assignment
Masking
Single (Outcomes assessor)
Enrollment
1,440 participants (actual)

Study arms

  • No intervention
    Early parenteral nutrition

    Parenteral nutrition supplements insufficient enteral nutrition from admission to ICU according to the current standard of care per center

  • Experimental
    Late parenteral nutrition

    Parenteral nutrition will be withheld during the first 7 days of ICU stay

    Other: Late parenteral nutrition

Interventions

  • OtherLate parenteral nutrition

    Withholding parenteral nutrition during the first 7 days of ICU stay

    Also known as: Late PN

06

What researchers measure

Primary outcomes

  1. Incidence of new infection during ICU stay

    Time frame: during ICU stay and up to 90 days post-randomization

  2. Duration of ICU dependency (crude stay days and time to alive discharge from ICU)

    Time frame: during ICU stay and up to 90 days post-randomization

Secondary outcomes

  1. Mortality

    Time frame: during ICU stay, hospital stay and up to 90 days post-randomization

  2. Time to alive discharge from hospital

    Time frame: during hospital stay and up to 90 days post-randomization

  3. Incidence of hypoglycaemia during ICU stay

    Time frame: during the intervention window up to day 8 post-randomization

  4. Time to final weaning from mechanical respiratory support

    Time frame: during ICU stay and up to 90 days post-randomization

  5. Incidence of liver dysfunction during ICU stay

    Time frame: during ICU stay and up 90 days post-randomization

  6. Need for haemodynamic support during ICU stay

    Time frame: during ICU stay and up 90 days post-randomization

  7. Incidence of new kidney injury during ICU stay

    Time frame: during ICU stay and up 90 days post-randomization

  8. Duration of antibiotics treatment during ICU stay

    Time frame: during ICU stay and up to 90 days post-randomization

  9. Number of readmissions to the ICU

    Time frame: up to 90 days post-randomization

  10. Amount of calories delivered during the ICU stay and in subset markers of feeding intolerance

    Time frame: during the intervention window of 8 days and up to 90 days post-randomization

  11. Markers of inflammation such as C-reactive protein concentrations during ICU stay

    Time frame: during ICU stay and up to 90 days post-randomization

  12. Structural and or functional differences in muscle tissue during ICU stay

    Time frame: during ICU stay and up to 90 days post-randomization

  13. biochemical, metabolic, endocrine, immunological, inflammatory and (epi)genetic markers on blood samples

    with healthy matched control group

    Time frame: up to 4 years post-randomization

  14. functional and neurocognitive development

    with healthy matched control group

    Time frame: up to 4 years post-randomization

  15. health economy analysis

    total health care costs during hospital stay

    Time frame: during index hospitalization

07

Study locations

3 sites
  • Dept Intensive Care Medicine
    Leuven, 3000, Belgium
  • Stollery Children's Hospital
    Edmonton, Alberta T6G 2B7, Canada
  • Erasmus MC Sophia Kinderziekenhuis
    Rotterdam, 3015, Netherlands
08

References and documents

Publications

  • Casaer MP, Mesotten D, Hermans G, Wouters PJ, Schetz M, Meyfroidt G, Van Cromphaut S, Ingels C, Meersseman P, Muller J, Vlasselaers D, Debaveye Y, Desmet L, Dubois J, Van Assche A, Vanderheyden S, Wilmer A, Van den Berghe G. Early versus late parenteral nutrition in critically ill adults. N Engl J Med. 2011 Aug 11;365(6):506-17. doi: 10.1056/NEJMoa1102662. Epub 2011 Jun 29. PubMed 21714640 ↗
  • Vlasselaers D, Milants I, Desmet L, Wouters PJ, Vanhorebeek I, van den Heuvel I, Mesotten D, Casaer MP, Meyfroidt G, Ingels C, Muller J, Van Cromphaut S, Schetz M, Van den Berghe G. Intensive insulin therapy for patients in paediatric intensive care: a prospective, randomised controlled study. Lancet. 2009 Feb 14;373(9663):547-56. doi: 10.1016/S0140-6736(09)60044-1. Epub 2009 Jan 26. PubMed 19176240 ↗
  • Coppens G, Vanhorebeek I, Verlinden I, Derese I, Wouters PJ, Joosten KF, Verbruggen SC, Guiza F, Van den Berghe G. Assessment of aberrant DNA methylation two years after paediatric critical illness: a pre-planned secondary analysis of the international PEPaNIC trial. Epigenetics. 2023 Dec;18(1):2146966. doi: 10.1080/15592294.2022.2146966. Epub 2022 Nov 16. PubMed 36384393 ↗
  • Vanhorebeek I, Jacobs A, Mebis L, Dulfer K, Eveleens R, Van Cleemput H, Wouters PJ, Verlinden I, Joosten K, Verbruggen S, Van den Berghe G. Impact of critical illness and withholding of early parenteral nutrition in the pediatric intensive care unit on long-term physical performance of children: a 4-year follow-up of the PEPaNIC randomized controlled trial. Crit Care. 2022 May 12;26(1):133. doi: 10.1186/s13054-022-04010-3. PubMed 35549984 ↗
  • Verlinden I, Guiza F, Dulfer K, Van Cleemput H, Wouters PJ, Guerra GG, Joosten KF, Verbruggen SC, Vanhorebeek I, Van den Berghe G. 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. Pediatr Crit Care Med. 2022 Aug 1;23(8):580-592. doi: 10.1097/PCC.0000000000002971. Epub 2022 May 9. PubMed 35522534 ↗
  • Jacobs A, Guiza F, Verlinden I, Dulfer K, Garcia Guerra G, Joosten K, Verbruggen SC, Vanhorebeek I, Van den Berghe G. Differential DNA methylation by early versus late parenteral nutrition in the PICU: a biological basis for its impact on emotional and behavioral problems documented 4 years later. Clin Epigenetics. 2021 Jul 27;13(1):146. doi: 10.1186/s13148-021-01124-3. PubMed 34315515 ↗
  • Verlinden I, Dulfer K, Vanhorebeek I, Guiza F, Hordijk JA, Wouters PJ, Guerra GG, Joosten KF, Verbruggen SC, Van den Berghe G. Role of age of critically ill children at time of exposure to early or late parenteral nutrition in determining the impact hereof on long-term neurocognitive development: A secondary analysis of the PEPaNIC-RCT. Clin Nutr. 2021 Mar;40(3):1005-1012. doi: 10.1016/j.clnu.2020.07.004. Epub 2020 Jul 14. PubMed 32758384 ↗
  • Jacobs A, Dulfer K, Eveleens RD, Hordijk J, Van Cleemput H, Verlinden I, Wouters PJ, Mebis L, Guerra GG, Joosten K, Verbruggen SC, Guiza F, Vanhorebeek I, Van den Berghe G. Long-term developmental effect of withholding parenteral nutrition in paediatric intensive care units: a 4-year follow-up of the PEPaNIC randomised controlled trial. Lancet Child Adolesc Health. 2020 Jul;4(7):503-514. doi: 10.1016/S2352-4642(20)30104-8. PubMed 32562632 ↗
  • Hordijk J, Verbruggen S, Vanhorebeek I, Guiza F, Wouters P, Van den Berghe G, Joosten K, Dulfer K. Health-related quality of life of children and their parents 2 years after critical illness: pre-planned follow-up of the PEPaNIC international, randomized, controlled trial. Crit Care. 2020 Jun 16;24(1):347. doi: 10.1186/s13054-020-03059-2. PubMed 32546247 ↗
  • van Puffelen E, Hulst JM, Vanhorebeek I, Dulfer K, Van den Berghe G, Joosten KFM, Verbruggen SCAT. Effect of late versus early initiation of parenteral nutrition on weight deterioration during PICU stay: Secondary analysis of the PEPaNIC randomised controlled trial. Clin Nutr. 2020 Jan;39(1):104-109. doi: 10.1016/j.clnu.2019.02.014. Epub 2019 Mar 4. PubMed 30879734 ↗
  • van Puffelen E, Hulst JM, Vanhorebeek I, Dulfer K, Van den Berghe G, Verbruggen SCAT, Joosten KFM. Outcomes of Delaying Parenteral Nutrition for 1 Week vs Initiation Within 24 Hours Among Undernourished Children in Pediatric Intensive Care: A Subanalysis of the PEPaNIC Randomized Clinical Trial. JAMA Netw Open. 2018 Sep 7;1(5):e182668. doi: 10.1001/jamanetworkopen.2018.2668. PubMed 30646158 ↗
  • Verstraete S, Verbruggen SC, Hordijk JA, Vanhorebeek I, Dulfer K, Guiza F, van Puffelen E, Jacobs A, Leys S, Durt A, Van Cleemput H, Eveleens RD, Garcia Guerra G, Wouters PJ, Joosten KF, Van den Berghe G. 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. Lancet Respir Med. 2019 Feb;7(2):141-153. doi: 10.1016/S2213-2600(18)30334-5. Epub 2018 Sep 14. PubMed 30224325 ↗
  • Verstraete S, Vanhorebeek I, van Puffelen E, Derese I, Ingels C, Verbruggen SC, Wouters PJ, Joosten KF, Hanot J, Guerra GG, Vlasselaers D, Lin J, Van den Berghe G. Leukocyte telomere length in paediatric critical illness: effect of early parenteral nutrition. Crit Care. 2018 Feb 21;22(1):38. doi: 10.1186/s13054-018-1972-6. PubMed 29463275 ↗
  • van Puffelen E, Polinder S, Vanhorebeek I, Wouters PJ, Bossche N, Peers G, Verstraete S, Joosten KFM, Van den Berghe G, Verbruggen SCAT, Mesotten D. Cost-effectiveness study of early versus late parenteral nutrition in critically ill children (PEPaNIC): preplanned secondary analysis of a multicentre randomised controlled trial. Crit Care. 2018 Jan 15;22(1):4. doi: 10.1186/s13054-017-1936-2. PubMed 29335014 ↗
  • Fivez T, Kerklaan D, Mesotten D, Verbruggen S, Wouters PJ, Vanhorebeek I, Debaveye Y, Vlasselaers D, Desmet L, Casaer MP, Garcia Guerra G, Hanot J, Joffe A, Tibboel D, Joosten K, Van den Berghe G. Early versus Late Parenteral Nutrition in Critically Ill Children. N Engl J Med. 2016 Mar 24;374(12):1111-22. doi: 10.1056/NEJMoa1514762. Epub 2016 Mar 15. PubMed 26975590 ↗
  • Fivez T, Kerklaan D, Verbruggen S, Vanhorebeek I, Verstraete S, Tibboel D, Guerra GG, Wouters PJ, Joffe A, Joosten K, Mesotten D, Van den Berghe G. Impact of withholding early parenteral nutrition completing enteral nutrition in pediatric critically ill patients (PEPaNIC trial): study protocol for a randomized controlled trial. Trials. 2015 May 1;16:202. doi: 10.1186/s13063-015-0728-8. PubMed 25927936 ↗
09

Updates

Tracking since Sep 25, 2026
No changes since tracking began. The registry record was last updated on Feb 12, 2024, before this site started recording changes on Sep 25, 2026. Its history is on ClinicalTrials.gov ↗
10

Registry details

Key details

Study ID
NCT01536275
Lead sponsor
KU Leuven
Collaborators
Sophia Kindergeneeskunde, Stollery Children's Hospital
Responsible party
Greet Van den Berghe (Head of Dept Intensive Care Medicine, KU Leuven) — Principal investigator
First posted
Feb 22, 2012
Start date
Jun 2012
Primary completion
Mar 2016
Completion
Dec 2026 (estimated)
Last update
Feb 12, 2024

Study contacts

Greet Van den Berghe, MD PhD
principal investigator · KU Leuven

Oversight

Data monitoring committee
Yes
View the source record on ClinicalTrials.gov ↗

Not currently enrolling

This study is active, not recruiting, as verified in Feb 2024. You cannot join it, but the record below documents what was studied.

Follow this study

Get an email when the registry record changes — status, dates, results — or when someone posts here.

Sign in to follow

Discussion

Questions and observations about this study, from anyone following it. Not medical advice, and not a channel to the study team — their contact details are on the registry record.

Sign in to join the discussion. Reading takes no account; posting does. You choose a display name, and a pseudonym is the default.

Nothing here yet. If you are running this trial, taking part in it, or weighing whether to, this is the place to say so.

Start the discussion