Septic shock is the most severe clinical manifestation of meningococcal disease and is predominantly seen in children under 5 yr of age. Very limited research has been performed to elucidate the alterations of the GH/IGF-I axis in critically ill children. We evaluated the GH/IGF-I axis and the levels of IGF-binding proteins (IGFBPs), IGFBP-3 protease, glucose, insulin, and cytokines in 27 children with severe septic shock due to meningococcal sepsis during the first 3 d after admission. The median age was 22 months (range, 4 -185 months). Eight patients died. Nonsurvivors had extremely high GH levels that were significant different compared with mean GH levels in survivors during a 6-h GH profile (131 vs. 7 mU/liter; P < 0.01). Significant differences were found between nonsurvivors and survivors for the levels of total IGF-I (2.6 vs.

Although the current recommended methionine intake of 28 mg ⋅ kg(-1) ⋅ d(-1) is within the CIs of our study, the estimated mean requirement is substantially higher. However, most of the infant formulas provide a methionine intake of 49-80 mg ⋅ kg(-1) ⋅ d(-1), which is above the upper CI of our study. This trial was registered at www.trialregister.nl as NTR1610.

Background: Infant nutrition has a major impact on child growth and functional development. Low and high intakes of protein or amino acids could have a detrimental effect. Objective: The objective of the study was to determine the lysine requirement of enterally fed term neonates by using the indicator amino acid oxidation (IAAO) method. L-[1-13 C]phenylalanine was used as an indicator amino acid. Design: Twenty-one neonates were randomly assigned to lysine intakes that ranged from 15 to 240 mg Á kg 21 Á d 21 . Breath, urine, and blood samples were collected at baseline and during the plateau. The mean lysine requirement was determined by using biphasic linear regression crossover analysis on the fraction of 13 CO 2 recovery from L-[1-13 C]phenylalanine oxidation (F 13 CO 2 ) and phenylalanine oxidation rates calculated from the L-[1-13 C]phenylalanine enrichment of urine and plasma. Results: The mean (6SD) phenylalanine flux calculated from urine and plasma L-[1-13 C]phenylalanine enrichment data were 88.3 6 6.9 and 84.5 6 7.4 lmol Á kg 21 Á h 21 , respectively. Graded intakes of lysine had no effect on phenylalanine fluxes. mean requirement was identical to the requirement determined by using phenylalanine oxidation rates in urine and plasma. Conclusions: The mean lysine requirement of enterally fed term neonates was determined by using F 13 CO 2 and phenylalanine oxidation rates calculated from the L-[1-13 C]phenylalanine enrichment of urine and plasma. These methods yielded a similar result of 130 mg lysine Á kg 21 Á d 21 . This study demonstrates that sampling of 13 CO 2 in expired air is sufficient to estimate the lysine requirement by using the IAAO method in infants. This trial was registered at www.trialregister.nl as NTR1610.

Current human milk-based recommendations for isoleucine and valine in term infants aged 0-1 mo are correct. However, the current recommendation for leucine (166 mg · kg(-1) · d(-1)) is higher than the mean requirement of 140 mg · kg(-1) · d(-1) that we determined in this study. This trial was registered at www.trialregister.nl as NTR1610.

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