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Critical IllnessPEPaNICNCT01536275

Early Versus Late Parenteral Nutrition in the Pediatric Intensive Care Unit

A study testing Late parenteral nutrition in people with Critical Illness and Children, run by KU Leuven at 3 sites in 3 countries.

Active, not recruiting

Under way, not looking for participants. Everyone needed has enrolled. The study is still running.

Official record
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Trial 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. Read more about this study

Who is it for?
Ages Up to 17 years
Conditions the study is for
Critical Illness, Children
What is being tested?
Late parenteral nutrition
Could I receive a placebo?
No, everyone receives an active treatment
How many people
1,440 participants
Where
3 sitesin 3 countries
Study dates
Jun 2012to Dec 2026
Phase
Interventional
Are there results?
Not yet: the study is under way

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages Up to 17 years
  • All sexes
  • No healthy volunteers
  • Child

Who may be able to join

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

Who cannot join

  • 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.
Show all 11Show fewer
  • 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

Trial locations and contacts

3 sites in 3 countries.

3 sites in 3 countries

Belgium1 site
  • Dept Intensive Care Medicine

    Leuven, 3000

Other trials in Belgium

Canada1 site
  • Stollery Children's Hospital

    Edmonton, Alberta, T6G 2B7

Other trials in Canada

Netherlands1 site
  • Erasmus MC Sophia Kinderziekenhuis

    Rotterdam, 3015

Other trials in Netherlands

About this study

Official title: Impact of Early Parenteral Nutrition Completing Enteral Nutrition in Paediatric Critically Ill Patients

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.

Being tested
Late parenteral nutrition
Keywords
critical illness, children, nutrition, metabolism
Medical subject headings
Critical Illness

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Late parenteral nutritionOther

    Also called Late PN

    Withholding parenteral nutrition during the first 7 days of ICU stay

Study groups in NCT01536275
Study groupRoleWhat they receive
Early parenteral nutritionNo interventionParenteral nutrition supplements insufficient enteral nutrition from admission to ICU according to the current standard of care per center
Late parenteral nutritionExperimentalParenteral nutrition will be withheld during the first 7 days of ICU stay
Receives: Other: Late parenteral nutrition

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Incidence of new infection during ICU stay

    Measured: 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)

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

Secondary outcomes (15)
  1. Mortality

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

  2. Time to alive discharge from hospital

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

  3. Incidence of hypoglycaemia during ICU stay

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

  4. Time to final weaning from mechanical respiratory support

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

  5. Incidence of liver dysfunction during ICU stay

    Measured: during ICU stay and up 90 days post-randomization

  6. Need for haemodynamic support during ICU stay

    Measured: during ICU stay and up 90 days post-randomization

  7. Incidence of new kidney injury during ICU stay

    Measured: during ICU stay and up 90 days post-randomization

  8. Duration of antibiotics treatment during ICU stay

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

  9. Number of readmissions to the ICU

    Measured: up to 90 days post-randomization

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

    Measured: 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

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

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

    Measured: 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

    Measured: up to 4 years post-randomization

  14. functional and neurocognitive development

    with healthy matched control group

    Measured: up to 4 years post-randomization

  15. health economy analysis

    total health care costs during hospital stay

    Measured: during index hospitalization

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted22 Feb 2012 (estimated)
  2. Study startJun 2012
  3. Primary completionMar 2016
  4. Study completionDec 2026 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
Single blind
Who is masked
Outcomes assessor
Enrolment
1,440 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT01536275
Sponsor's protocol ID
PEPaNIC
Other IDs
2012-000811-10, ML8052, NL38772.000.12, IWT-TBM 110685
Acronym
PEPaNIC
Status last verified
Feb 2024
First submitted
16 Feb 2012
Last updated
12 Feb 2024
Results posted
No
Data monitoring committee
Yes

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
  • Vanhorebeek I, Umman Serin N, Verbruggen SCAT, Joosten KFM, Van den Berghe G, Gunst J. Increased ureagenesis revealing metabolic intolerance to enhanced nutrition in the PICU: a secondary analysis of the PEPaNIC RCT. Crit Care. 2026 Sep 25;30(1):497. doi: 10.1186/s13054-026-06345-7.

    PubMed 42791581
  • Vanhorebeek I, Umman Serin N, Guiza F, Mebis L, Verbruggen SCAT, Joosten KFM, Van den Berghe G, Gunst J. Hypophosphatemia as a biomarker of metabolic intolerance to enhanced nutrition in the PICU: a secondary analysis of the PEPaNIC RCT. Crit Care. 2026 Feb 12;30(1):74. doi: 10.1186/s13054-026-05844-x.

    PubMed 41680910
  • Nakano FK, Dulfer K, Vanhorebeek I, Wouters PJ, Verbruggen SC, Joosten KF, Guiza Grandas F, Vens C, Van den Berghe G. Predicting adverse long-term neurocognitive outcomes after pediatric intensive care unit admission. Comput Methods Programs Biomed. 2024 Jun;250:108166. doi: 10.1016/j.cmpb.2024.108166. Epub 2024 Apr 10.

    PubMed 38614026
  • Veldscholte K, Hulst JM, Eveleens RD, de Jonge RCJ, de Koning BAE, van den Berg SAA, van der Wal R, Ruijter GJG, Rizopoulos D, Vanhorebeek I, Gunst J, Casaer M, Van den Berghe G, Joosten KFM, Verbruggen SCAT. Gastrointestinal Biomarkers and Their Association with Feeding in the First Five Days of Pediatric Critical Illness. J Pediatr Gastroenterol Nutr. 2023 Dec 1;77(6):811-818. doi: 10.1097/MPG.0000000000003950. Epub 2023 Sep 20.

    PubMed 37728917
  • Verlinden I, Coppens G, Vanhorebeek I, Guiza F, Derese I, Wouters PJ, Joosten KF, Verbruggen SC, Van den Berghe G. Long-term impact of paediatric critical illness on the difference between epigenetic and chronological age in relation to physical growth. Clin Epigenetics. 2023 Jan 14;15(1):8. doi: 10.1186/s13148-023-01424-w.

    PubMed 36639798
  • 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

Questions about this trial

What is this clinical trial studying?

A study testing Late parenteral nutrition in people with Critical Illness and Children, run by KU Leuven at 3 sites in 3 countries.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 1 inclusion and 11 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: under way, not looking for participants, as of the sponsor's last update on 12 Feb 2024. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 3 sites in Belgium, Canada, Netherlands. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

This study is still under way. Results are not available in the source record yet.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Incidence of new infection during ICU stay (time frame: during ICU stay and up to 90 days post-randomization). The study lists 2 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT01536275, which also lists 21 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 12 Feb 2024.

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