The 1995 Clinical Research Award. Younger pediatric patients with burns are at risk for continuing postdischarge weight loss.

Pediatric patients with severe burns exhibit growth delays. This study investigates weight history after discharge. Twenty-seven children with burns covering more than 40% of their total body surface area were studied from admission until 2 to 4 years after injury. Younger children decreased their weights for height; older patients mainly increased theirs. Alterations during the first year of follow-up correlated with alterations until 2 and 3 years (r = 0.91 and r = 0.76, respectively). Once initiated, net weight gain continued, whereas net weight losses diminished with time. Preburn equivalent weights, however, could not be reached within 3 years. Special attention must be paid to children who are close to or less than their ideal body weights at the time of injury, especially if they are young, because further weight loss may be critical. Outpatient nutritional therapy should be focused to control these developments.

Caloric requirements of patients with burns under one year of age.

Formulas for estimating the caloric requirements of pediatric patients with burns have been suggested. However, the needs of infant patients with burns have not been specifically addressed. This study was undertaken to determine the caloric intake required to maintain weight in patients under 1 year of age who had burns covering more than 25% total body surface area. Thirty patients were studied, and a comparison was made between the actual intake required for weight maintenance and the suggested calorie levels provided by published pediatric caloric formulas. The results indicated that a new formula was needed. Multivariate regression analysis indicated that body surface area and burn surface area were significant predictors of caloric requirements, but body surface area was the more important predictor in this infant population. The equation resulting from the regression provides 2100 kcal/m2 body surface area/day plus 1000 kcal/m2 body surface area burned/day.

Current treatment reduces calories required to maintain weight in pediatric patients with burns.

A previous study indicated that formulas for determining caloric requirements of severely burned children overestimated their needs. This study was undertaken to determine the caloric intake required to maintain weight in patients under 12 years of age with burns over more than 30% total body surface area. The 102 patients studied were divided into two groups according to weight changes. A comparison of the actual caloric intakes of these groups was conducted. Multivariate regression analysis indicated that body surface area in square meters and burn surface were significant predictors of caloric requirements to maintain weight in these patients. It was determined that 1800 kcal was a plausible value for the calories per body surface area. Therefore the regression was formed with 1800 kcal as the multiplier of body surface area, and the multiplier of burn surface area was estimated. The resulting formula provides 1300 kcal/m2 burned, which is 900 kcal/m2 burned less than our previously suggested formula.

Caloric needs of adolescent patients with burns.

Formulas for estimating the caloric requirements of pediatric and adult patients with burns have been suggested. However, the needs of adolescent patients with burns have not been specifically addressed. This study was undertaken to determine the calorie intake required to maintain weight of adolescent patients with burns over more than 35% of the total body surface area. The 29 patients studied were divided into two groups according to sex. Caloric requirements were determined with the use of the Galveston surface area formula and the Curreri formula. The comparison of these estimations with the actual intake required to maintain weight indicated that there is a significant difference between the calories indicated by the formulas and the actual intake. A surface area formula that also correlates with the results of indirect-calorimetry studies is suggested for this adolescent population with burns.

Basic nutritional guidelines for pediatric burn patients.

This article has described current recommendations for nutritional support of the burned pediatric patient. A checklist for monitoring the progress of pediatric burn patients from admission to discharge is included.

Reassessing caloric requirements in pediatric burn patients.

New formulas for estimating the caloric requirements of burned children have been suggested. These formulas appeared to exceed the caloric estimates made by the Galveston Shriners Burns Institute formula. This study was undertaken to compare the Curreri Junior formulas and the Galveston Shriners Burns Institute formula with the actual intake required by pediatric patients with burns greater than 30% total body surface area to maintain weight. The 121 patients studied were divided into three age groups to coincide with those in the Curreri Junior formulas and calorie requirements as estimated by both formulas were determined. The comparison of these estimations with the actual intake required to maintain weight indicated that there is a significant difference in the caloric requirement per m2 burn between the age three and under group and the older age group. The results also suggest that overfeeding may occur with the historic formulas.

Evaluation of a caloric requirement formula in burned children treated with early excision.

This study was undertaken to evaluate the effectiveness of a standard caloric requirement formula, as determined by retrospective analysis of weight gain of patients treated by serial debridement, for patients treated by early excision. The caloric intakes of 61 patients with more than 40% third-degree burn, 27 treated with serial debridement of the burn wound and 34 treated with early massive excision, were reviewed and compared to their calculated requirements. Nutritional support in both groups was similar. Of the 48 survivors there was no difference in their age, % TBSA burn, and per cent meeting caloric requirement. The early excision survivors had a greater percentage third-degree burn and weight change but a decreased length of stay. It was concluded that even though the formula, previously developed at our institution, may lead to a slight overestimation in determination of the caloric needs of early excision patients, it is an acceptable means of determining their requirements.