Resting energy expenditure and nitrogen balance in critically ill pediatric patients on mechanical ventilation.

Nutritional support is important in critically ill patients, with variable energy and nitrogen requirements (e.g., sepsis, trauma, postsurgical state) in this population. This study investigates how age, severity of illness, and mechanical ventilation are related to resting energy expenditure (REE) and nitrogen balance. Nineteen critically ill children (mean age, 8 +/- 6 [SD] y and range 0.4-17.0 y) receiving total parenteral nutrition (TPN) were enrolled. We used indirect calorimetry to measure REE. Expected energy requirements (EER) were obtained from Talbot tables. Pediatric Risk of Mortality (PRISM) and Therapeutic Intervention Scoring System (TISS) score were calculated. Total urinary nitrogen was measured using the Kjeldahl method. PRISM and TISS scores were 9 +/- 5 and 31 +/- 6 points, respectively. REE was 62 +/- 25 kcal.kg-1.d-1, EER was 42 +/- 11 kcal.kg-1. d-1, and caloric intake was 49 +/- 22 kcal.kg-1.d-1. Nitrogen intake was 279 +/- 125 mg.kg-1.d-1, total urinary nitrogen was 324 +/- 133 mg.kg-1.d-1, and nitrogen balance was -120 +/- 153 mg.kg-1.d-1. The protein requirement in this population was approximately 2.8 g.kg-1.d-1. These critically ill children were hypermetabolic, with REE 48% higher (20 kcal.kg-1.d-1) than expected. Nitrogen balance significantly correlated with caloric and protein intake, urinary nitrogen, and age, but not with severity of illness scores or ventilatory parameters.

Resting energy expenditure in children in a pediatric intensive care unit: comparison of Harris-Benedict and Talbot predictions with indirect calorimetry values.

The use of prediction equations has been recommended for calculating energy expenditure. We evaluated two equations that predict energy expenditure, each of which were corrected for two different stress factors, and compared the values obtained with those calculated by indirect calorimetry. The subjects were 55 critically ill children on mechanical ventilation. Basal metabolic rates were calculated with the Harris-Benedict and Talbot methods. Measured resting energy expenditure was 4.72 +/- 2.53 MJ/d. The average difference between measured resting energy expenditure and the Harris-Benedict prediction with a stress factor of 1.5 was -0.98 MJ/d, with an SD delta of 1.56 MJ/d and limits of agreement from -4.12 to 2.15; for a stress factor of 1.3 the average difference was -0.22 MJ/d, with an SD delta of 1.57 MJ/d and limits of agreement from -3.37 to 2.93. The average difference between measured resting energy expenditure and the Talbot prediction with a stress factor of 1.5 was -0.23 MJ/d, with an SD delta of 1.36 MJ/d and limits of agreement from -2.95 to 2.48; for a stress factor of 1.3, it was 0.42 MJ/d, with an SD delta of 1.24 MJ/d and limits of agreement from -2.04 to 2.92. These limits of agreement indicate large differences in energy expenditure between the measured value and the prediction estimated for some patients. Therefore, neither the Harris-Benedict nor the Talbot method will predict resting energy expenditure with acceptable precision for clinical use. Indirect calorimetry appears to be the only useful way of determining resting energy expenditure in these patients.

Infant feeding practices among Bedouins in transition from seminomadic to settlement conditions in the Negev area of Israel.

Infant feeding practices among 353 Bedouin families in transition from seminomadic to settlement conditions in the Negev area of Israel were compared with those of 302 Jewish families from the same area. Over 99% of the Bedouin infants were initially breast-fed, in contrast to 79% of the Jewish infants; none of the Jewish infants continued to be breast-fed by the end of the first year of life, while 63% of the Bedouins were. Rice was the first solid food to be introduced to Bedouin infants, while fruits and vegetables were the first solids introduced to the Jewish infants. Rice was not an important constituent of the Jewish infants' diet. By the age of 6 months, 93% of the Jewish infants were eating fruits and vegetables, 78% meat, 49% bread and 55% eggs, in contrast to 20, 13, 8 and 18% among the Bedouins, respectively. Introduction of meat lagged significantly among the Bedouin infants, taking place after the 8th month of life for greater than 50%. Bedouin infant-feeding practices resembled those prevalent among rural populations in developing countries. It is likely that with increasing modernization this pattern will gradually disappear and will be replaced by that prevalent among Western populations.

PIP: Infant feeding practices among 353 Bedouin families in transition from seminomadic to settlement conditions in the Negev area of Israel were compared with those of 302 Jewish families from the same area. Over 99% of the Bedouin infants were initially breastfed, in contrast to 79% of the Jewish infants; none of the Jewish infants continued to be breastfed by the end of the 1st year of life, while 63% of the Bedouins were. Rice was the 1st solid food to be introduced to Bedouin infants, while fruits and vegetables were the 1st solids introduced to the Jewish infants. Rice was not an important constituent of the diet of Jewish infants. By age 6 months, 93% of the Jewish infants were eating fruits and vegetables, 78% meat, 49% bread, and 55% eggs, in contrast to 20, 13, 8, and 18% among the Bedouins. Introduction of meat lagged significantly among Bedouin infants, taking place after the 8th month of life for 50%. Bedouin infant feeding practices resembled those prevalent among rural populations in developing countries. It is likely that with increasing modernization, this pattern will gradually disappear and will be replaced by that prevalent among Western populations.