Table 2 Barriers for de-implementation (> 1 answer per PICU possible) in the 33 PICUs that have partially or not de-implemented early administration of PN

 Not convinced of the safety and/or efficacy in undernourished children

 Convinced that critically ill children need amino acids in the acute phase of illness

 Not convinced of the safety and/or efficacy in neonates

 Convinced that critically ill children need lipids in the acute phase of illness

 Not convinced of the safety in general

 Convinced that critically ill children need more glucose in the acute phase of illness

 Waiting for updated international guidelines^a

 Waiting for replicating studies

 Waiting for long term results

 Don’t consider these results to be cost-effective

 Non-consensus within staff

 Other^b

 Lack of nutritional protocol

 Because of logistic reasons (i.e. arrangements with pharmacy)

Total number of reasons