Low birthweight infants and total parenteral nutrition immediately after birth. I. Energy expenditure and respiratory quotient of ventilated and non-ventilated infants.

Forsyth, J. S.; Crighton, A.

doi:10.1136/fn.73.1.f4

Cited by 36 publications

(18 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…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. Values of Vo 2 and EE decrease with rising gestational age and increase with rising postnatal age.…”

Section: Discussionmentioning

confidence: 99%

Effect of Sepsis Syndrome on Neonatal Oxygen Consumption and Energy Expenditure

2002

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionmentioning

confidence: 99%

Effect of Sepsis Syndrome on Neonatal Oxygen Consumption and Energy Expenditure

2002

View full text Add to dashboard Cite

show abstract

“…If energy and protein are not adequately provided by this alternative source, catabolism becomes inevitable. Data from the study conducted by Forsyth and Crighton [104] have revealed that to avoid catabolism total parenteral energy intake from day 1 of life needs to be 650 kcal/kg/day, including 1.0-1.5 g/kg amino acids. A higher energy intake decreases proteolysis to some extent and higher intakes of both protein and energy result in net protein anabolism [105].…”

Section: How Much Protein Is Needed By Infants Born At !30 Weeks Of Gmentioning

confidence: 99%

“…An infant's clinical status with associated hormonal and cytokine responses also need to be taken into account as they exert profound effects on protein metabolism in different body compartments, including increased production of certain (acute-phase) proteins and change in turnover of structural proteins, hence altered requirements for protein and amino acids as well as all other nutrients [106][107][108][109][110][111]. In spite of these illuminating nutrition study data from the study of Forsyth and Crighton [104] published in 1995, many clinicians still feel that protein administration in the first days of life in low gestation or sick newborns would not be tolerated, and many low gestation infants are not provided even such modest intravenous amino acids and energy during the first several days of life, virtually assuring the development and continuation of a catabolic state [77]. Even beyond the first few days of life, for a variety of reasons infants do not receive adequate protein or amino acids for several weeks.…”

Section: How Much Protein Is Needed By Infants Born At !30 Weeks Of Gmentioning

confidence: 99%

Nutritionally Regulated Hormonal Factors in Prolonged Postnatal Growth Retardation and Its Associated Adverse Neurodevelopmental Outcome in Extreme Prematurity

Yeung¹,

Smyth²

2003

Neonatology

View full text Add to dashboard Cite

Recent published data show that at hospital discharge, most infants born at <30 weeks of gestation would not achieve the median birth weight of the reference fetus at the same postconceptional age, and many would be less than the 10th centile. Estimating from the current recommendations of calorie and protein intakes, these infants accrue large deficits in intakes of protein and calorie during the first weeks of life. Postnatal growth retardation over a prolonged period of time is related to neurodevelopmental delays. While a total energy intake of 120 kcal/kg/day has generally been considered adequate, protein requirement in low gestation infants remains a matter for debate. Increasing the dietary protein:calorie ratio has previously been proposed as a strategy to enhance growth and to achieve a body composition similar to that of the reference fetus. Previous study data reveal that serum insulin-like growth factor I (IGF-I) concentration is positively correlated with protein intake, and nitrogen retention, in turn, is positively correlated with serum IGF-I concentration. Remarkably, elevated serum growth hormone but low serum IGF-I concentrations have been reported in low gestation infants and in infants with intrauterine growth retardation, suggesting IGF-I being a nutritionally regulated hormonal factor in the postnatal growth retardation. As neurodevelopment in extreme prematurity is likely affected by multiple factors, we hypothesize that a combined strategy of the previously proposed hormonal supplement with hydrocortisone and tri-iodothyronine together with increased dietary protein intake (progressively increasing from 1.5 g/kg/day intravenously administered amino acids immediately after birth, then 3.6 g/100 kcal at ≈125 kcal/kg/day when enterally fed till the infant reaches a body weight of ≧1.8 kg and at ≧50th centile weight of the reference fetus at the same postconceptional age) would likely be synergistic and more effective in improving neurodevelopmental outcome.

show abstract

“…In reviewing these options, it is important to consider that fats provide the highest concentrated energy source relative to carbohydrates and have a lower respiratory quotient and thus lower production of carbon dioxide. 30 …”

Section: Poindexter and Martinmentioning

confidence: 97%