Protein Requirements of the Critically Ill Pediatric Patient

被引:29
作者
Coss-Bu, Jorge A. [1 ,2 ]
Hamilton-Reeves, Jill [3 ]
Patel, Jayshil J. [4 ]
Morris, Claudia R. [5 ]
Hurt, Ryan T. [6 ]
机构
[1] Baylor Coll Med, Dept Pediat, Sect Crit Care, Houston, TX 77030 USA
[2] Texas Childrens Hosp, Houston, TX 77030 USA
[3] Univ Kansas, Med Ctr, Dept Dietet & Nutr, Kansas City, KS 66103 USA
[4] Med Coll Wisconsin, Div Pulm & Crit Care Med, Milwaukee, WI 53226 USA
[5] Emory Univ, Sch Med, Dept Pediat, Emory Childrens Ctr Cyst Fibrosis & Airways Dis R, Atlanta, GA USA
[6] Mayo Clin, Div Gen Internal Med, Rochester, MN USA
关键词
protein; child; nitrogen balance; critical illness; protein balance; intensive care; catabolism; pediatrics; AMINO-ACID-REQUIREMENTS; FAT-FREE MASS; URINARY UREA NITROGEN; INTENSIVE-CARE UNITS; BODY-COMPOSITION; SKELETAL-MUSCLE; ENERGY-EXPENDITURE; NUTRITION SUPPORT; ENTERAL NUTRITION; CRITICAL ILLNESS;
D O I
10.1177/0884533617693592
中图分类号
R15 [营养卫生、食品卫生]; TS201 [基础科学];
学科分类号
100403 ;
摘要
This article includes a review of protein needs in children during health and illness, as well as a detailed discussion of protein metabolism, including nitrogen balance during critical illness, and assessment and prescription/delivery of protein to critically ill children. The determination of protein requirements in children has been difficult and challenging. The protein needs in healthy children should be based on the amount needed to ensure adequate growth during infancy and childhood. Compared with adults, children require a continuous supply of nutrients to maintain growth. The protein requirement is expressed in average requirements and dietary reference intake, which represents values that cover the needs of 97.5% of the population. Critically ill children have an increased protein turnover due to an increase in whole-body protein synthesis and breakdown with protein degradation leading to loss of lean body mass (LBM) and development of growth failure, malnutrition, and worse clinical outcomes. The results of protein balance studies in critically ill children indicate higher protein needs, with infants and younger children requiring higher intakes per body weight compared with older children. Monitoring the side effects of increased protein intake should be performed. Recent studies found a survival benefit in critically ill children who received a higher percentage of prescribed energy and protein goal by the enteral route. Future randomized studies should evaluate the effect of protein dosing in different age groups on patient outcomes, including LBM, muscle structure and function, duration of mechanical ventilation, intensive care unit and hospital length of stay, and mortality.
引用
收藏
页码:128S / 141S
页数:14
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