More and sooner, but not necessarily better

Critically ill children have generalized nutrition compromise. The timing of parenteral nutrition (PN) initiation has been under debate in both adults and children. A recent report of a multi-national randomized control trial in children demonstrated clinical superiority of delaying initiation of parental nutrition, and was associated with improved clinical outcomes and a lower rate of infection. In this editorial, we discuss our communication with the authors and our experience in a large cardiac intensive care unit (CICU) in the United States where improved nutrition delivery, and early PN, has improved weight-for-age z-score (WAZ) but has not shown any difference in length of hospital stay or reduced ventilator times.