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Protein-Enriched Enteral Nutrition in Childhood Critical Illness

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Diet and Nutrition in Critical Care

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Abstract

In the healthy child nutrition has a critical role to enable development and growth. By contrast, critically ill children primarily use nutrients to defend from disease, and even if a high-caloric intake is given, he/she may not be able to use it to grow. Therefore, nutritional treatment should aim to provide the appropriate quality and proportion of substrates that are necessary to enable the maintenance of normal organ function and recovery from the disease. The rationale for the need of an increased protein intake is based on two main reasons: the incidence of protein malnutrition in critically ill children is high, and protein catabolism is increased in these patients, leading to a negative net protein balance and loss of body mass.

It is not known what protein intake a critically ill child should receive. A protein intake between 2 and 3 g/Kg/day is recommended, based on the observation that a minimum protein intake of 1.5 g/Kg/day and 57 kcal/Kg/day is necessary to achieve a positive nitrogen balance. Enteral nutrition is better tolerated than parenteral, and therefore it should be the initial approach in most critically ill children. Enteral diets for infants and children contain an insufficient protein concentration when a restricted caloric intake is given as it usually occurs in the critically ill patient (50–60 % of calories in relation to their age). For this reason it is necessary to use high-protein nutritional products or to add protein supplements to the existing ones.

Some studies have found that protein-enriched diets increase protein synthesis and related biochemical parameters, availability of essential and branched amino acids in plasma, and improve nitrogen balance. However, broader studies are needed to assess the impact of diets supplemented with proteins in anthropometric, biochemical, and clinical parameters in critically ill children.

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Abbreviations

AA:

Amino acids

ASPEN:

American Society for Parenteral and Enteral Nutrition

EE:

Energy expenditure

IC:

Indirect calorimetry

NB:

Nitrogen balance

PICU:

Pediatric intensive care unit

RBP:

Retinol-binding protein

TEN:

Total enteral nutrition

TPN:

Total parenteral nutrition

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Authors and Affiliations

  1. Department of Pediatric Critical Care, Gregorio Marañón University Hospital, C/ Doctor Castelo 46, 28009, Madrid, Spain

    Javier Urbano, Sarah N. Fernández & Jesús López-Herce

Authors
  1. Javier Urbano
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  2. Sarah N. Fernández
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  3. Jesús López-Herce
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Correspondence to Jesús López-Herce .

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Editors and Affiliations

  1. Department of Nutrition, King's College London, London, United Kingdom

    Rajkumar Rajendram

  2. School of Medicine, King's College London, London, United Kingdom

    Victor R. Preedy

  3. Department of Biomedical Sciences, University of Westminster, London, United Kingdom

    Vinood B. Patel

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Urbano, J., Fernández, S.N., López-Herce, J. (2014). Protein-Enriched Enteral Nutrition in Childhood Critical Illness. In: Rajendram, R., Preedy, V., Patel, V. (eds) Diet and Nutrition in Critical Care. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-8503-2_81-1

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  • DOI: https://doi.org/10.1007/978-1-4614-8503-2_81-1

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