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Extra protein improves metabolism in very ill kids

Reuters Health • The Doctor's Channel Daily Newscast

NEW YORK (Reuters Health) – Adding extra protein to enteral nutrition for critically ill children is safe and may help improve their protein metabolism, Spanish researchers report.

Critically ill children are often malnourished, and while their protein catabolization typically outpaces their protein synthesis, their caloric requirements may be lower than healthy children given that their energy expenditures are usually less, Dr. Jesus Lopez-Herce and colleagues from the hospital General Universitario Gregorio Maranon in Madrid and colleagues note in a March 21 online publication in The Journal of Pediatrics.

To investigate whether protein enrichment could benefit these patients, the researchers randomly assigned 51 children to receive a standard diet or a diet enriched with 1.1 gram protein/100 milliliters of feeding formula. Forty-one children completed the study. All of the children were being treated in the pediatric intensive care unit, and were receiving mechanical ventilation. Three-quarters of the children were under a year old, and the median age was 7 months. Most were being treated after undergoing cardiac or airway surgery.

At the study’s outset, 17.1 percent of the patients had total proteins of below 4.5 grams/deciliter (g/dL), 29.3 percent had albumin below 3 g/dL, 38.2 percent had prealbumin below 10 mg/dL, and 93.3 percent had retinol-binding protein below 3 mg/dL. Eighty-seven percent had transferrin levels below 200 mg/dL.

At five days, there was a trend toward higher levels of prealbumin, transferrin, retinol-binding protein, and total protein for the children on the protein-enriched diet, although the difference was only statistically significant for retinol-binding protein.

A trend toward positive nitrogen balance was seen among the children given protein-enriched formula, but this was again not statistically significant.

There were no adverse effects among the children given the enriched protein diet, nor were there any instances of hyperproteinemia.

Right now, Dr. Lopez-Herce told Reuters Health, the standard practice is to give critically ill children the same type of enteral nutrition formulas given to healthy children. “The ideal is to give a hyperproteic nonhypercaloric special diet, but this special formula for children does not exist,” he added in an email interview. “For this reason critically ill children must receive children’s formula with protein supplement.”

He and his colleagues conclude: “The standard diet provides insufficient protein delivery to critically ill children. Enteral protein supplementation is safe and can improve some biochemical parameters of protein metabolism.”

The Journal of Pediatrics