ABSTRACT:The purpose of this study was to compare total energy expenditure (TEE) in extremely premature infants during and after an episode of sepsis. We hypothesized that TEE in the sepsis group (SEP) would be higher during the septic period and higher than an age-matched control group (CTL). We further hypothesized that the TEE of the SEP group during the recovery period would be similar to that of the CTL group. The doubly labeled water method was used to determine TEE in both groups. Infant characteristics were as follows: SEP group, n ϭ 10, gestation ϭ 26 Ϯ 1 wk, birth weight ϭ 854 Ϯ 218 g; CTL group, n ϭ 10, gestation ϭ 26 Ϯ 1 wk, birth weight ϭ 880 Ϯ 158 g. TEE of the SEP group during the septic period was significantly greater than during the recovery period (96 Ϯ 25 kcal/kg/d versus 55 Ϯ 17 kcal/kg/d) and significantly greater than the CTL group during the first study period (96 Ϯ 25 kcal/kg/d versus 67 Ϯ 12 kcal/kg/d). TEE in the SEP group during the recovery period was similar to the CTL group. These increases in TEE may contribute to impaired growth and need to be considered when providing nutritional support for extremely premature infants. I nfections remain a common and important problem in premature infants. Late-onset sepsis (Ͼ72 h of life) occurs in approximately 20% of very low birth weight infants and 35% of extremely low birth weight infants (1). Morbidities in survivors of late-onset sepsis are significant and include neurodevelopmental disabilities and poor growth outcomes (2). Understanding how particular clinical conditions in extremely premature infants (Ͻ29 wk of gestation) affect nutritional requirements is necessary to support optimal growth. Specifically, the effect of late-onset sepsis on energy expenditure and requirements has not been evaluated in extremely preterm infants. Studies in adult subjects with sepsis have documented 50%-90% higher energy expenditures (3-5); a 20% increase in energy expenditure has been measured in full-term neonates with early-onset sepsis (6).The purpose of this study was to measure TEE in extremely premature infants during an episode of late-onset sepsis and again after recovery using the doubly labeled water technique. To control for the potential effect of time, TEE was also measured in a control group of age-and gestation-matched extremely preterm infants without sepsis. We hypothesized that TEE would be higher in the septic group during the septic episode compared with recovery. We further hypothesized that TEE would be higher in the septic group during sepsis compared with the control group. METHODS Subjects.The study population consisted of two groups. The first included 10 infants with sepsis (SEP group) documented by a positive blood culture. The second was the CTL group of 10 infants without sepsis. Infants were eligible for inclusion in the study at Ͼ72 h of life with birth weights Ͻ1500 g and gestational ages Ͻ29 wk. Exclusion criteria included any chromosomal and/or congenital anomalies, seizures, or necrotizing enterocolitis. Variance ex...
Objective To test the hypothesis that total energy expenditure would be significantly higher in ELBW infants near discharge compared with healthy term infants. Study design This study was designed to determine total energy expenditure and body composition in a group of ELBW infants nearing discharge on full volume enteral feedings of fortified breast milk or post-discharge formula (Neosure™) (n=10, birth weight 0.8±0.1kg, gestation 26±0.8 wk, age at study 68±9 d, postconceptional age 36±1wk) and compare them with healthy term newborns all receiving breast milk (n=14, birth weight 3.5±0.5 kg, gestation 39.0±1.4 wk, age at study 2.3±1 d). Body composition and total energy expenditure were measured using the doubly labeled water method over a 7 day period. Results The total energy expenditure for ELBW infants was significantly higher than in term infants (89±22 kcal/kcal/kg/day vs. 58±19 kcal/kg/d (p≤0.001)). Total energy expenditure normalized to fat free mass was also significantly greater in ELBW infants (98±3 kcal/kg/d compared with 73±20 kcal/kg/d (p ≤0.01)). Conclusions Rates of total energy expenditure in ELBW infants nearing discharge are greater than normal healthy term infants. Higher energy intakes in the ELBW infants compensated for the higher rates of total energy expenditure in the ELBW infants.
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