The Price to Pay : Consequences of paediatric critical illness and the role of parenteral nutrition

Optimal nutrition is essential for growth and development in children. Providing optimal nutrition is challenging when a child is critically ill. This thesis focuses on the short-term consequences of the timing of initiating parenteral nutrition in critically ill children, with special attention to term neonates and undernourished children, as well as to health-economic effects.

Nowadays, most critically ill children survive, which stresses the importance of examining long-term outcomes of these children. Therefore, the children’s physical and neurocognitive functioning two years after critical illness was investigated additionally and compared with healthy children’s functioning, and the effect of the timing of initiating parenteral nutrition hereon.

In critically ill children, irrespective of nutritional status or age, nutritional modification by withholding PN during the first week, while administering micronutrients, was shown to be clinically beneficial on the short-term, long-term as well as from a health economic point of view. By withholding PN in the acute phase of critical illness, the literal, as well as the figurative price to pay for paediatric critical illness can be reduced for the children, their families, and society.