Abstract
Rationale: This longitudinal study aimed to assess resting energy expenditure and urinary nitrogen in ventilated critically ill children.
Methods: Resting energy expenditure (REEm) was measured daily by indirect calorimetry in children with expected mechanical ventilation ≥ 72 hours and FiO2 ≤ 60%. Urinary nitrogen was measured by chemoluminescence. Nitrogen balance was calculated as the difference between nitrogen intake and total nitrogen loss. Comparisons were made with Recommended Dietary Allowances (RDA).
Results: We included 74 children, 42 boys and 32 girls with a mean age (±SD) of 24.2±22.9 months. 407 indirect calorimetry and urinary nitrogen measurements were performed. REEm was 55.3±12.2 kcal/kg/d and corresponded to 54.8±11.1% of RDA. REEm was lower in children 4-8 years old than in other groups (p< 0.05). When measurements were performed in children with body temperature >37.5°C, REEm was higher (58.7±12.1 kcal/kg/d) than when body temperature was < 37.5°C (54.3±12.1 kcal/kg/d; p=0.003). REEm was lower on days with neuromuscular blocking drugs (55.5±11.4 kcal/kg/d) than without (58.6±12.4 kcal/kg/d; p=0.031). Mean urinary nitrogen was 0.2±0.06 g/kg/d. Children aged 4-8 years old had higher urinary nitrogen than younger children (p< 0.001) and required more protein (2.22 g/kg/d) to achieve zero nitrogen balance. No difference of REEm and urinary nitrogen was observed among medical/surgical diagnosis, sepsis/no sepsis, cardiopulmonary bypass/no cardiopulmonary bypass, normal nutritional status/malnutrition.
Conclusion: Resting energy expenditure only reached 55% of RDA and was mainly affected by fever, beside age. Surprisingly, urinary nitrogen was higher in older children who required more protein than RDA to achieve zero nitrogen balance.
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Jotterand, C., Depeyre, J., Perez, MH. et al. 360 Factors Affecting Resting Energy Expenditure and Urinary Nitrogen in Ventilated Critically Ill Children. Pediatr Res 68 (Suppl 1), 186 (2010). https://doi.org/10.1203/00006450-201011001-00360
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DOI: https://doi.org/10.1203/00006450-201011001-00360