Determinants of energy expenditure in ventilated preterm infants

DeMarie, Mark P.; Hoffenberg, Analice; Biggerstaff, Stacy L. B.; Jeffers, Barrett W.; Hay, William W.; Thureen, Patti J.

doi:10.1515/jpm.1999.062

Cited by 26 publications

(12 citation statements)

References 23 publications

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“…Mechanical ventilation decreases the work of breathing as well as heat loss through the respiratory tract, thereby decreasing EE. 21,22 Sedation and muscle relaxation decrease Vo 2 and EE by reducing activity. 23 Moreover, neonates in the previous investigations had a wide range of gestational and postnatal ages.…”

Section: Discussionmentioning

confidence: 99%

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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Section: Discussionmentioning

confidence: 99%

Effect of Sepsis Syndrome on Neonatal Oxygen Consumption and Energy Expenditure

2002

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“…Inevitable losses of nitrogen are assumed to be 160 mg/kg/day (27 mg/kg/day via the skin [27 ]and 133 mg/kg/day via the urine [28]), equivalent to 1.0 g/kg/day of protein. Resting energy expenditure is assumed to be 45 kcal/kg/day in infants <900 g and 50 kcal/kg/day in larger infants, and expenditures for occasional cold exposure and physical activity are assumed be 15 kcal/kg/day in infants <1,200 g and 20 kcal/kg/day in larger infants [29,30]. Enteral requirements are obtained from parenteral requirements by applying corrections for incomplete absorption of protein (88%) and energy (85%).…”

Section: Nutrient Requirementsmentioning

confidence: 99%

Meeting the Nutritional Needs of the Low-Birth-Weight Infant

2011

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Delivering adequate amounts of nutrients to premature infants at all times is challenging because the infant’s immature gastrointestinal tract is initially unable to accept feedings, necessitating the use of parenteral nutrition. In the past, inadequate amounts of nutrients have commonly been given to premature infants because the administration of nutrients was thought to be hazardous. Inadequate nutrient intakes have resulted in widespread postnatal growth restriction. Now that it is known that postnatal growth restriction is associated with poor neurocognitive development, efforts are made to increase nutrient intakes. In this review, nutrient requirements of premature infants that have been determined by the factorial and empirical methods are reviewed. Current good practices regarding parenteral nutrition are discussed, as are guidelines for the introduction and advancement of enteral feedings. Because of its trophic effects on the gastrointestinal tract and its anti-infectious effects, human milk is strongly preferred as the early feeding of choice for premature infants. Human milk also protects infants against necrotizing enterocolitis. Once full feeding is achieved, the challenge is to provide nutrients in amounts that support the infant’s growth like that of the fetus. In the case of the infant fed his/her mother’s milk or banked donor milk, nutrient fortification is necessary and is generally practiced. However, adequate intakes of protein are seldom achieved with routine fortification and methods of providing additional fortification are discussed.

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“…Diseases of organs with high baseline metabolic rates disproportionately increase the total body oxygen consumption and thus total energy demand. Thus, heart failure (31) and recurrent or ongoing seizures increase energy requirements by approximately 30%, whereas the effect of respiratory distress syndrome (surfactant deficiency) is equivocal (32, 33) especially with assistant ventilator support. Chronic lung disease increases resting energy expenditure by 15% (34, 35), but this may be more a function of right heart strain than of the lung disease itself.…”

Section: The Effects Of Illness On Individual Nutrients In the Neonatementioning

confidence: 99%

The Impact of Neonatal Illness on Nutritional Requirements: One Size Does Not Fit All

2014

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Sick neonates are at high risk for growth failure and poorer neurodevelopment than their healthy counterparts. The etiology of postnatal growth failure in sick infants is likely multi-factorial and includes undernutrition due to the difficulty of feeding them during their illness and instability. Illness also itself induces fundamental changes in cellular metabolism that appear to significantly alter nutritional demand and nutrient handling. Inflammation and physiologic stress play a large role in inducing the catabolic state characteristic of the critically ill newborn infant. Inflammatory and stress responses are critical shortterm adaptations to promote survival, but are not conducive to promoting long-term growth and development. Conditions such as sepsis, surgery, necrotizing enterocolitis, chronic lung disease and intrauterine growth restriction, and their treatments are characterized by altered energy, protein, and micronutrient metabolism that result in nutritional requirements that are different from those of the healthy, growing term, or preterm infant.

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Determinants of energy expenditure in ventilated preterm infants

Cited by 26 publications

References 23 publications

Effect of Sepsis Syndrome on Neonatal Oxygen Consumption and Energy Expenditure

Effect of Sepsis Syndrome on Neonatal Oxygen Consumption and Energy Expenditure

Meeting the Nutritional Needs of the Low-Birth-Weight Infant

The Impact of Neonatal Illness on Nutritional Requirements: One Size Does Not Fit All

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