A new equation to predict the resting energy expenditure of surgical infants

Pierro, Agostino; Jones, Matthew O.; Hammond, Peter J.; Donnell, S.C.; Lloyd, David

doi:10.1016/0022-3468(94)90288-7

Cited by 45 publications

(19 citation statements)

References 25 publications

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“…20 However, we found no variation in energy metabolism between the 2 consecutive days of the study. In addition, our control group had an REE similar to that reported by other authors studying healthy control infants 21 or children 22 of similar age.…”

Section: Figurementioning

confidence: 42%

Energy Metabolism of Infants and Children with Systemic Inflammatory Response Syndrome and Sepsis

Turi¹,

Petros²,

Eaton³

et al. 2001

Annals of Surgery

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ObjectiveTo evaluate whether critically ill children with systemic inflammatory response syndrome (SIRS) or sepsis have altered resting energy expenditure (REE) and substrate utilization. Summary Background DataStudies in adults with sepsis have shown increased energy expenditure and mobilization of endogenous fat. In infants and children, energy metabolism and substrate utilization during sepsis have not been characterized. MethodsMetabolic studies were performed in 21 critically ill children with SIRS or sepsis. Twenty-one stable control children, matched for weight, were also studied. Seven patients required inotropic support and 17 received mechanical ventilation. Fifteen patients with SIRS had evidence of bacterial, fungal, or viral infection and were considered septic. Respiratory gas exchange was measured by computerized indirect calorimetry for 1 to 2 hours continuously. ResultsThe REE of patients with SIRS or sepsis was not different from that of controls. Similarly, there were no differences in carbon dioxide production and oxygen consumption. Resting energy metabolism was not different between patients with SIRS and patients with sepsis. In addition, the presence of low platelet count or inotropic support did not affect resting energy metabolism. The median respiratory quotient of patients with SIRS or sepsis was 0.88 (range 0.75-1.12), indicating mixed utilization of fat and carbohydrate; this was not significantly different from that of controls. The Pediatric Risk of Mortality Score was not significantly correlated with REE or respiratory quotient. ConclusionsThe energy requirements of children with SIRS or sepsis are not increased. Their resting metabolism is based on both carbohydrate and fat utilization. The authors speculate that these children divert the energy for growth into recovery processes.Studies in adults have shown that the metabolic response to trauma and sepsis is characterized by hypermetabolism and increased tissue catabolism.1 Plank et al 2 have found that resting energy expenditure (REE) in adults with severe sepsis resulting from peritonitis increases up to 49% above normal and remains high for at least 3 weeks from the onset of disease. Hypermetabolism in these patients is associated with lipolysis and catabolism despite increased caloric intake.1,2 The energy requirement of adult patients with critical illness or those undergoing severe stress is thought to be increased by 30% above normal.3 Van Lanschot et al 4 have shown that energy expenditure measured by indirect calorimetry in these patients is greater than energy expenditure predicted on the basis of body size and age.There is little information on the metabolic response to critical illness in infancy and childhood. Preliminary studies 5,6 have not demonstrated a hypermetabolic response similar to that described in adults.2,4 Chwals et al 5 measured REE by indirect calorimetry in critically ill ventilated infants and young children and showed that the measured

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Section: Figurementioning

confidence: 42%

Energy Metabolism of Infants and Children with Systemic Inflammatory Response Syndrome and Sepsis

Turi¹,

Petros²,

Eaton³

et al. 2001

Annals of Surgery

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“…Values of Vo 2 and EE decrease with rising gestational age and increase with rising postnatal age. 11,12 All infants in our study were full term, and their postnatal age was Ͻ5 days at the beginning of the study period.…”

Section: Discussionmentioning

confidence: 99%

“…Necrotizing enterocolitis in neonates with gestational age ranging from 28 to 40 weeks and postnatal age of 6 to 47 days was not associated with increased Vo 2 and EE. 10 Because Vo 2 and EE are strongly affected by the gestational age and postnatal age, 11,12 the wide range of gestational and postnatal ages in previous studies may have hidden effects of neonatal sepsis on Vo 2 and EE. The present investigation was designed to study Vo 2 , Vco 2 , and EE in term infants with earlyonset sepsis (ie, beginning within the first 5 days of postnatal life) daily during the first 7 days of the septic illness.…”

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confidence: 93%

Effect of Sepsis Syndrome on Neonatal Oxygen Consumption and Energy Expenditure

2002

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ABSTRACT. Objective. To evaluate oxygen consumption (VO 2 ), carbon dioxide production, and energy expenditure (EE) in full-term neonates with early-onset neonatal septicemia daily for 7 days beginning at the day of clinical diagnosis of sepsis.Methods. A total of 17 spontaneously breathing fullterm neonates, 10 with clinical signs of sepsis and 7 healthy neonates (control group), were enrolled in the study. Age at first study day was 3 ؎ 0.9 days in both groups. Sepsis syndrome was defined as a systemic response to a bacterial infection with clinical signs of infection, elevated values of interleukins 6 and 8 and C-reactive protein, and abnormal white blood cell count and positive blood cultures (9 group B streptococci, 1 Escherichia coli). Measurements of VO 2 and carbon dioxide production were performed daily for 7 days by means of indirect calorimetry.Results. In the septic infants, VO 2 and EE were increased by about 20% at days 1 to 3 and by 15% at day 4 when compared with the controls. From days 1 to 3, EE averaged 57 ؎ 3 kcal/kg/d in the septic neonates and 47 ؎ 2 kcal/kg/d in the controls. At day 4, EE was 55 ؎ 2 and 47 ؎ 2 kcal/kg/d, respectively. Energy intake was about the same in both groups, whereas weight gain during the 7 study days was significantly lower in the sick patients than in the control group (19 ؎ 2 g/d vs 33 ؎ 9 g/d and 5.4 ؎ 0.5 g/kg/d vs 9.4 ؎ 2.6 g/kg/d, respectively). Increased EE was associated with increased heart rate (126 ؎ 4 vs 112 ؎ 4 min ؊1 at day 1) and respiratory rate (56 ؎ 6 vs 40 ؎ 4 min ؊1 at day 1). There were no differences in rectal temperature (37.3 ؎ 0.4°C vs 37.4 ؎ 0.2°C), skin temperature (36.5 ؎ 0.4°C vs 36.6 ؎ 0.3°C), and oxygen saturation (96 ؎ 3% vs 96 ؎ 3%) between the 2 groups.Conclusions. Neonates with sepsis syndrome have elevated VO 2 and EE values that could explain impaired growth during the illness period and may make the infants vulnerable to insufficient calorie supply during the acute phase of septic disease. Pediatrics 2002;110(6). URL: http://www.pediatrics.org/cgi/content/full/110/6/e69; oxygen consumption, energy expenditure, sepsis, newborn.ABBREVIATIONS. Vo 2 , oxygen consumption; Vco 2 , carbon dioxide production; EE, energy expenditure; SNAP, score for neonatal acute physiology; IL, interleukin; CRP, C-reactive protein.

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“…In a subsequent study we made 122 measurements of REE in 46 stable, non-ventilated surgical infants [18]. The observed values ranged between 25 and 49 cal/kg per min (36-71 kcal/kg per day) indicating that REE may vary by as much as 2-fold amongst individuals in similar clinical conditions.…”

Section: Energy Requirementmentioning

confidence: 93%

“…The error in predicting REE from the equation was -0.95 f3.65% [18]. The multiple regression equation described can be used to predict basal energy requirements in stable surgical infants.…”

Section: Energy Requirementmentioning

confidence: 99%