Beneficial Effects of Aggressive Protein Feeding in Severely Burned Children

Abstract

To determine any potential benefit of feeding increased amounts of protein to hypermetbolic burned patients, 18 children with burns averaging 60% total surface area were randomized into two matched groups and studied serially for at least six weeks: the first group was given a normal diet with a balanced nutritional supplement, and the second group was supplemented with milk whey protein. The normal protein group received 87.1% of their desired caloric intake with 16.5% of calories from protein compared to 77.7% of desired caloric intake with 23.0% of calories from protein for the high protein group. Despite a higher caloric intake, the normal protein group had a worse opsonic index compared to the high protein group (0.42 +/- 0.04 vs. 0.62 +/- 0.05, p < 0.0007), lower levels of C3 (1371 +/- 55 vs. 1585 +/- 64 micrograms/ml, p < 0.01), lower levels of IgG (805 +/- 52 vs. 975 +/- 56 micrograms/ml, p < 0.03), lower levels of transferrin (200 +/- 10 vs. 283 +/- 18 mg/dl, p < 0.0001), lower levels of total serum protein (5.5 +/- 0.1 vs. 6.3 +/- 0.2 g/dl, p < 0.005), more bacteremic days (11% vs. 8%, p < 0.005) and worse survival (5/9--56% vs. 9/9--100%, p < 0.03). Patients receiving the high protein diet had significantly higher plasma levels of valine, lysine, threonine, leucine, aginine, isoleucine, proline, serine, asparagine, tryptophane, and tyrosine. Asparagine levels were significantly (p < 0.01) associated with better neutrophil function and opsonic index. Except for phenylalanine, significant associations were found for serum levels of each of the amino acids with concentrations of one or more serum proteins. These studies provide evidence that many immunologic functions are dependent upon optimal availability of specific amino acids, and that routine diets do not provide sufficient protein to satisfy the needs of seriously burned children.

A study of problems associated with the delivery of enteral feed in critically ill patients in five ICUs in the UK

“…Early enteral feeding appears to attenuate part of the stress response in particular groups of patients. This has been demonstrated in animal studies and a few small patient studies [4][5][6]. The ability to manipulate the patient's immune response using specific enteral nutrients (immunonutrition) has also provoked considerable interest [7][8][9][10][11].…”

Nutrition in Trauma and Critically Ill Patients

“…Many reports in the early 1980s defined the importance of early nutritional support. Two major prospective, randomized, controlled trials (PRCTs) done by Moore and Jones [11] in trauma patients and Alexander et al [12] in patients with major burns found significant benefit for patients with early nutrition. Moore and Jones showed that the early nutritional support group had significantly fewer major septic complications and significant changes in nutrition parameters, as compared with the control group [11].…”

Bacterial Translocation and Gut-Derived Sepsis

“…These include trauma, 44 burn, 45 and critically ill patients. 46,47 Similarly, early enteral nutrition started within 6 hours of injury and shock has been shown in one prospective RCT study to reduce the incidence of organ failure and largely abrogated injury-induced increases in gut permeability when compared with patients whose feedings were started 24 hours or longer after injury.…”