Monitoring of protein catabolism in neonates and young infants post‐cardiac surgery

Teixeira-Cintra, Monica Akissue Camargo; Monteiro, Jacqueline Pontes; Tremeschin, Marina Hjertquist; Trevilato, Tânia Maria Beltramini; Halperin, Mitchell L.; Carlotti, Ana P. C. P.

doi:10.1111/j.1651-2227.2011.02187.x

Cited by 14 publications

(13 citation statements)

References 14 publications

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“…Various authors have reported in postsurgical infants the use of biochemical markers (creatinine, phosphate, 3‐methylhistidine, urea, insulin‐like growth factor I, C‐reactive protein, prealbumin, etc.) to assess whether the inflammatory response to surgery has subsided and a transition from a state of catabolism to one of anabolism has occurred . Nitrogen balance remains the gold standard and should be sufficient to assess the presence of an anabolic or catabolic condition.…”

Section: Discussionmentioning

confidence: 99%

Perioperative Nutritional Support and Malnutrition in Infants and Children with Congenital Heart Disease

et al. 2013

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Section: Discussionmentioning

confidence: 99%

Perioperative Nutritional Support and Malnutrition in Infants and Children with Congenital Heart Disease

et al. 2013

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“…In a small study from Brazil, patients became anabolic post-cardiac surgery with a calorie intake of 54 kcal/kg/day and a protein intake of 1.1 g/kg/day. 42 The decline in C-reactive protein levels to values <2 is considered an indirect marker of the onset of the anabolic phase in critically ill patients; however, its relevance in post-cardiac surgical patients has not been proven. 59 For neonates and infants, particularly in low-and middle-income countries, human breast milk is the preferred form of enteral feeding, although the practicalities of maintaining breast milk production in this context may be challenging.…”

Section: Postoperative Nutritionmentioning

confidence: 99%

“…Because of their lower protein and energy reserves, infants and newborns may be particularly vulnerable to the hypercatabolic state that is expected following heart surgery, 41 , 42 although hypercatabolism may not follow all paediatric cardiac operations 43 . This situation is further worsened by comorbidities such as lack of protein:calorie provision or major infections (Fig 1).…”

Section: Impact Of Preoperative State On Postoperative Outcomementioning

confidence: 99%

Management of undernutrition and failure to thrive in children with congenital heart disease in low- and middle-income countries

et al. 2017

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Poor growth with underweight for age, decreased length/height for age, and underweight-for-height are all relatively common in children with CHD. The underlying causes of this failure to thrive may be multifactorial, including innate growth potential, severity of cardiac disease, increased energy requirements, decreased nutritional intake, malabsorption, and poor utilisation of absorbed nutrition. These factors are particularly common and severe in low-and middle-income countries.Although nutrition should be carefully assessed in all patients, failure of growth is not a contraindication to surgical repair, and patients should receive surgical repair where indicated as soon as possible.Close attention should be paid to nutritional support -primarily enteral feeding, with particular use of breast milk in infancy -in the perioperative period and in the paediatric ICU. This nutritional support requires specific attention and allocation of resources, including appropriately skilled personnel.Thereafter, it is essential to monitor growth and development and to identify causes for failure to catch-up or grow appropriately.

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“…A significant negative nitrogen balance has been reported in critically ill children with hypercatabolic conditions like injury, trauma, postsurgical condition, or severe sepsis 25 , 89 – 100 . To accurately estimate the protein status, nitrogen balance is calculated as nitrogen intake minus nitrogen losses from urine, stool, skin, and other fluids, including dialysate and thoracic or abdominal drainage 100 – 105 .…”

Section: Assessment Of Body Composition and Protein Turnover During Cmentioning

confidence: 99%

“…Multiple studies in infants, children, and adolescents have reported protein prescription practices and protein balance results in different clinical conditions, including neonates on extracorporeal life support, 54 , 115 surgical infants, 135 – 138 postsurgical repair of congenital heart disease, 92 , 97 , 116 , 139 – 141 children with acute kidney injury on continuous renal replacement therapy or hemodialysis, 100 , 104 , 105 , 120 and critically ill children admitted to the PICU (Table 2). 26 , 28 , 97 , 110 , 124 , 131 , 142 …”

Section: Clinical Studiesmentioning

confidence: 99%

Protein Requirements of the Critically Ill Pediatric Patient

et al. 2017

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This article includes a review of protein needs in children during health and illness, as well as a detailed discussion of protein metabolism, including nitrogen balance during critical illness, and assessment and prescription/delivery of protein to critically ill children. The determination of protein requirements in children has been difficult and challenging. The protein needs in healthy children should be based on the amount needed to ensure adequate growth during infancy and childhood. Compared with adults, children require a continuous supply of nutrients to maintain growth. The protein requirement is expressed in average requirements and dietary reference intake, which represents values that cover the needs of 97.5% of the population. Critically ill children have an increased protein turnover due to an increase in whole‐body protein synthesis and breakdown with protein degradation leading to loss of lean body mass (LBM) and development of growth failure, malnutrition, and worse clinical outcomes. The results of protein balance studies in critically ill children indicate higher protein needs, with infants and younger children requiring higher intakes per body weight compared with older children. Monitoring the side effects of increased protein intake should be performed. Recent studies found a survival benefit in critically ill children who received a higher percentage of prescribed energy and protein goal by the enteral route. Future randomized studies should evaluate the effect of protein dosing in different age groups on patient outcomes, including LBM, muscle structure and function, duration of mechanical ventilation, intensive care unit and hospital length of stay, and mortality.

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Monitoring of protein catabolism in neonates and young infants post‐cardiac surgery

Abstract: Children with congenital heart disease undergoing cardiac surgery achieved anabolism with >55 kcal/kg/day and >1 g/kg/day of protein. Balance of phosphate was useful to monitor cell breakdown. Anthropometric measurements were not valuable to evaluate nutritional therapy in this population.

Cited by 14 publications

References 14 publications

Perioperative Nutritional Support and Malnutrition in Infants and Children with Congenital Heart Disease

Perioperative Nutritional Support and Malnutrition in Infants and Children with Congenital Heart Disease

Management of undernutrition and failure to thrive in children with congenital heart disease in low- and middle-income countries

Protein Requirements of the Critically Ill Pediatric Patient

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