Extra protein improves metabolism in very ill kids

Adding extra protein to enteral nutrition for critically ill children led to modestly improved markers of protein metabolism, in a randomised trial by Spanish researchers.

The standard diet doesn't nourish these children well enough, according to Dr Jesus Lopez-Herce and colleagues. They say in their paper that critically ill children are often either poorly nourished to start with, or they become malnourished over time. And while their protein catabolism typically outpaces their protein synthesis, their caloric needs may be lower than healthy children given that their energy expenditures are usually less.

To investigate the value of protein enrichment, the research team from the Hospital General Universitario Gregorio Maranon in Madrid randomly assigned 51 children to receive a standard diet or one enriched with 1.1 g protein/100 mL of feeding formula.

Mechanical ventilation

All of the children were receiving mechanical ventilation in an intensive care unit. Three-quarters were under a year old; the median age was 7 months. Most were being treated after cardiac or airway surgery. Children receiving parenteral nutrition were not eligible.

Forty-one children completed the study. Of the 10 who dropped out, four were extubated early, four needed special treatments that either precluded calorimetry or changed their energy requirements, and two could no longer receive enteral nutrition.

Twenty patients received the intervention; these children were generally similar to the controls. In the total study population at baseline, 17% had total proteins <4.5 g/dL, 29.3% had albumin <3 g/dL, 38.2% had prealbumin <10 mg/dL, and 93.3% had retinol-binding protein <3 mg/dL. 87% had transferrin levels below 200 mg/dL, according to a March 21 online report in The Journal of Paediatrics.

The findings

At 5 days, there was a trend toward higher levels of prealbumin, transferrin, and total protein for the children on the protein-enriched diet. Extra protein also produced a trend toward a positive nitrogen balance. The only statistically significant improvement, however, was in retinol-binding protein.

There were no adverse effects among the children given the enriched protein diet, nor were there any instances of hyperproteinemia.

Currently, Dr Lopez-Herce told Reuters Health, the standard practice is to give critically ill children the same type of enteral nutrition formulas given to healthy children. "The ideal is to give a hyperproteic nonhypercaloric special diet, but this special formula for children does not exist," the researcher said in an email. "For this reason critically ill children must receive children's formula with protein supplement."

"The standard diet provides insufficient protein delivery to critically ill children," he and his colleagues conclude. "Enteral protein supplementation is safe and can improve some biochemical parameters of protein metabolism." (Reuters Health/ April 2011)

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Diet and Nutrition

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