Audit of successful weight maintenance in adult and paediatric survivors of thermal injury at a UK regional burn centre

Abstract

Most subjects maintained weight within an acceptable limit during the inpatient episode. Children appeared particularly successful at weight maintenance. Reasons are multifactorial and warrant further investigation.

Glutamine Supplementation in Critical Illness: Evidence, Recommendations, and Implications for Clinical Practice in Burn Care

“…Weight appears to be better maintained in burned children compared with adults in the inpatient phase, but growth in younger pediatric patients is delayed for up to 3 years after burn, particularly in subjects who are malnourished. [32][33][34] The mechanism for this long-term inability to obtain catch-up growth is not understood fully. Resting energy expenditure in severe burns remains increased in patients for at least 12 months after injury, 35 but glutamine kinetics in this period are unknown.…”

Dietetic service provision for burn care in the United Kingdom: are nutrition support standards being met?

“…An average 7% weight loss (with as much as 22% weight loss in individual patients) has previously been reported by one UK burn unit, despite the use of artificial nutrition support (Windle, 2004). In the inpatient phase, adults may lose more weight than children with similar sized injuries, although catch‐up growth in children can be delayed for up to 3 years (Rutan & Herndon, 1990; Windle, 2004). Increasing severity of malnutrition in burn injury is associated with a higher risk of infection, delayed donor site healing and an increased length of stay, and a trend in increased mortality may exist, particularly in elderly burned patients (Demling, 2005).…”

“…In acute illness, weight loss of approximately 10% may adversely affect surgical outcome and thermoregulation (Fellows et al, 1985;Windsor & Hill, 1988). An average 7% weight loss (with as much as 22% weight loss in individual patients) has previously been reported by one UK burn unit, despite the use of artificial nutrition support (Windle, 2004). In the inpatient phase, adults may lose more weight than children with similar sized injuries, although catch-up growth in children can be delayed for up to 3 years (Rutan & Herndon, 1990;Windle, 2004).…”

“…Randomised controlled trials in burns have demonstrated that aggressive enteral tube feeding approaches may achieve quicker resolution of negative nitrogen balance, better delivery of energy prescriptions, lower wound infection rates and a shorter length of stay (Chiarelli et al, 1990;Jenkins et al, 1994). Minimisation of weight loss to within an acceptable standard is possible in most paediatric and adult burn admissions with the use of nutrition support (Windle, 2004). Parenteral and enteral glutamine have been shown to confer an immunological and nutritional advantage in critically ill burned patients (Wischmeyer et al, 2001;Windle, 2006).…”

Immune modulating nutrition support for a patient with severe toxic epidermal necrolysis

“…Admission weight was 72.6 kg, body mass index 24.5 kg m −2 with no evidence of preadmission weight loss. Energy requirements were calculated at approximately 1800 kcal day −1 (7531 kJ) based on prediction equations for basal metabolic rate (Schofield, 1985) and adjustment for metabolic stress based on percentage TBSA affected following previously described protocol for burns (Windle, 2004). Protein need was estimated at approximately 90 g day −1 (14.4 g day −1 nitrogen) based on 20% total energy provision (Saffle et al.…”