Effect of Late-Onset Sepsis on Energy Expenditure in Extremely Premature Infants

Abstract

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...

Nutritional support for extremely low-birth weight infants: abandoning catabolism in the neonatal intensive care unit

“…However, we should recognize that most studies concern 'healthy' or stable preterm infants and that little is known about the metabolic impact of particular diseases, and how all this affects the needs of the infant [98][99][100][101]. Although some research has been done regarding the metabolic differences and capabilities between small-for-gestational-age and appropriate-for-gestational-age infants, this has not led to a comprehensive nutritional strategy that suits their specific demands.…”

Energy Expenditure in Extremely Low Birth Weight Infants Near Time of Hospital Discharge

“…This method has been applied by our group and others to assess energy metabolism in normal and premature infants, as well as in infants with congenital heart disease and cystic fibrosis (7,8,14–17). Total energy expenditure values obtained in the normal term infants in the present study (~60kcal/kg/day) are similar to previously reported determinations (5,14).…”

“…Energy intake reported is the mean intake for the seven day study period. Energy intake for the term control group was calculated by the deuterium isotope dilution method as previously described (7,8). …”

“…Total body water was calculated from the dilution spaces of both deuterium and 18 O as we have previously described (7). …”

“…Lean body mass was calculated from total body water (7). Fat mass was determined as the difference between body weight and lean body mass.…”