Parenteral nutrition is used to treat children that cannot be fully fed by the enteral route. While the revised ESPGHAN/ESPEN/ESPR/CSPEN pediatric parenteral nutrition guidelines provide clear guidance on the use of parenteral nutrition in neonates, infants, and children based on current available evidence, they have helped to crystallize areas where research is lacking or more studies are needed in order to refine recommendations. This paper collates and discusses the research gaps identified by the authors of each section of the guidelines and considers each nutrient or group of nutrients in turn, together with aspects around delivery and organization. The 99 research priorities identified were then ranked in order of importance by clinicians and researchers working in the field using a survey methodology. The highest ranked priority was the need to understand the relationship between total energy intake, rapid catch-up growth, later metabolic function, and neurocognitive outcomes. Research into the optimal intakes of macronutrients needed in order to achieve optimal outcomes also featured prominently. Identifying research priorities in PN should enable research to be focussed on addressing key issues. Multicentre trials, better definition of exposure and outcome variables, and long-term metabolic and developmental follow-up will be key to achieving this. IMPACT: The recent ESPGHAN/ESPEN/ESPR/CSPEN guidelines for pediatric parenteral nutrition provided updated guidance for providing parenteral nutrition to infants and children, including recommendations for practice. However, in several areas there was a lack of evidence to guide practice, or research questions that remained unanswered. This paper summarizes the key priorities for research in pediatric parenteral nutrition, and ranks them in order of importance according to expert opinion.

Amsterdam UMC University of Amsterdam Vrije Universiteit Emma Children's Hospital Amsterdam The Netherlands

Bnai Zion Medical Center Rappaport Faculty of Medicine Technion Haifa Israel

Children's Hospital University of Zagreb School of Medicine Zagreb Croatia

Department of Clinical Sciences Pediatrics Umeå University Umeå Sweden

Department of Neonatal Intensive Care CHU La Réunion Saint Pierre France

Department of Neonatal Intensive Care Oslo University Hospital Oslo Norway

Department of Neonatal Medicine University Hospital Southampton NHS Trust Southampton UK

Department of Neonatology La Paz University Hospital Red De Salud Materno Infantil Y Desarrollo E Samid Universidad Autonoma De Madrid Madrid Spain

Department of Paediatrics University Hospital Motol Prague Czech Republic

Department of Pediatrics Ulm University Ulm and Neu Ulm University of Applies Sciences Neu Ulm Germany

Erasmus MC Sophia Children's Hospital Rotterdam The Netherlands

Evangelisches Waldkrankenhaus Spandau Berlin Germany

France and CNRC Department of Pediatrics Baylor College of Medicine Houston TX USA

Institute of Gastroenterology Nutrition and Liver Diseases Schneider Children's Medical Center Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel

National Institute for Health Research Biomedical Research Centre Southampton University Hospital Southampton NHS Trust and University of Southampton Southampton UK

Neonatal Intensive Care Unit Necker Enfants Malades Hospital Paris University Paris France

Neonatal Unit Newcastle University Newcastle upon Tyne UK

Newcastle University Newcastle Upon Tyne UK

The General Infirmary at Leeds Leeds UK

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