How much protein and energy are needed to equilibrate nitrogen and energy balances in ventilated critically ill children?. Issue 2 (April 2016)

• Record Type: Journal Article
• Authors: Jotterand Chaparro, Corinne; Laure Depeyre, Jocelyne; Longchamp, David; Perez, Marie-Hélène; Taffé, Patrick; Cotting, Jacques
• Is Part Of: Clinical nutrition. Volume 35:Issue 2(2016:Apr.)
• Page Start: 460
• Page End: 467
• Publication Date: 2016-04
• Subjects: Critical care -- Child -- Infant -- Nitrogen -- Energy expenditure -- Indirect calorimetry; A.S.P.E.N. American Society for Parenteral and Enteral Nutrition -- CRP C-reactive protein -- DRI Dietary Reference Intakes -- REE resting energy expenditure -- PICU paediatric intensive care unit -- PRISM Pediatric Risk of Mortality -- TUN total urinary nitrogen -- WHO World Health Organization; Critically ill -- Nutrition -- Periodicals; Diet therapy -- Periodicals; Parenteral feeding -- Periodicals; Enteral feeding -- Periodicals; Enteral Nutrition -- Periodicals; Parenteral Nutrition -- Periodicals; Metabolism -- Periodicals; Diétothérapie -- Périodiques; Alimentation parentérale -- Périodiques; Alimentation entérale -- Périodiques; Nutrition -- Périodiques; Diet therapy; Enteral feeding; Nutrition; Parenteral feeding; Electronic journals; Periodicals; Electronic journals; 615.854
• DOI: 10.1016/j.clnu.2015.03.015
• Languages: English
• ISSNs: 0261-5614

Abstract

Summary: Background & aims: Protein and energy requirements in critically ill children are currently based on insufficient data. Moreover, longitudinal measurements of both total urinary nitrogen (TUN) and resting energy expenditure (REE) are lacking. The aim of this study was to investigate how much protein and energy are needed to equilibrate nitrogen and energy balances in ventilated critically ill children on the basis of daily measurements of TUN, REE and protein and energy intakes. Comparisons were made with the guidelines of the American Society for Parenteral and Enteral Nutrition and the Dietary Reference Intakes. Methods: Children with an expected duration of mechanical ventilation ≥72 h were prospectively recruited. TUN was measured by chemiluminescence, and REE was measured by indirect calorimetry. Generalised linear models for longitudinal data were used to study the relation between protein intake and nitrogen balance and to calculate the minimum intake of protein needed to achieve nitrogen equilibrium. A similar approach was used for energy. Results were compared to the recommended values. Results: Based on 402 measurements performed in 74 children (median age: 21 months), the mean TUN was high at 0.20 (95% CI: 0.20, 0.22) g/kg/d and the REE was 55 (95% CI: 54, 57) kcal/kg/d. Nitrogen and energy balances were achieved with 1.5 (95% CI: 1.4, 1.6) g/kg/d of protein and 58 (95% CI: 53, 63) kcal/kg/d for the entire group, but there were differences among children of different ages. Children required more protein and less energy than the Dietary Reference Intakes. Conclusions: In critically ill children, TUN was elevated and REE was reduced during the entire period of mechanical ventilation. Minimum intakes of 1.5 g/kg/d of protein and 58 kcal/kg/d can equilibrate nitrogen and energy balances in children up to 4 years old. Older children require more protein.