605 a Nutrition Survey of Pediatric Inpatients

Abstract

. and Surg., Salt Lake City, Utah. ~osit'ional therapy for gastroesophageal re-flux was evaluated by extended pH monitoring of the esophagus during the postprandial period in 28 normal and 45 reflux patients. Frequency of reflux (F), percent time the esophagus was pH<4 (%) and mean duration of reflux (MD) were determined while awake, asleep, su ine, sitting, and prone on a board with the head elevated g 30 . In normals, position or state of alertness did not affect reflux. Compared to normals, the increased % in reflux patients while awake (p<.001) was mainly related to increased F (p<.001) and normal MD; while asleep the increased % (p<.05) was related to normal F and prolonged MD (p<.05). Reflux patients have less % while on the board than while sitting or supine, both awake and asleep (p<.05). MD while asleep on the board was less than supine (p=.05), but F was unchanged; while awake, F was less on the board (p=.02) than supine, but MD was unchanged. These data demonstrate that alertness and position affect gastroesophageal reflux only in abnormal patients. The major determinant of increased acid exposure to the esophagus in reflux patients varies with the state of alertness, being mainly frequency of reflux while awake and prolonged duration while asleep. The prone Urinary urea nitrogen (UUN) excretion as an index of protein catabolism was assayed in 32 children (2m to 15y, median 6y)(50% mechanically ventilated) during an ICU course of 1 to 10 days (median 3d). Mean daily UUN excretion was 171 i 89 mglkg (4.38 rt 2.22 gm/m2), with greater excretion within 24 hours of ICU admission than subsequently. Average daily nitrogen balance per child was -146 f 82 mg/kg (-3.73 k 2.04 gm/m2), and was independent of caloric intake.Average daily UUN excretion per child was well described by regression equations for weight (mg = 219.76(kg) -1.74(kg)2, r2 = 0.908), height (mg = 4.07(cm) + 0.25(cm)2, r2 = 0,917), and meter squared body surface area (mg = 4421,5(BSA), r2=0.903). Excretion data in mechanically ventilated versus spontaneously breathing children, and in 4 diagnostic subgroups (sepsis 6, Reye syndrome 7, elective surgery 7, and,miscellaneous 12) was evenly distributed about regression lines for length, weight, and body surface area. Increased UUN excretion accompanied isoproterenol infusion and prednisone administration, Decreased excretion accompanied insulin infusion and high blood levels of barbiturates.This study documents the magnitude and time course of protein catabolism in critically ill children and suggests rarely considered drug effects, It confirms progressive protein depletion at per kg rates of UUN excretion comparable to critically ill adults with wide individual variability but little variation between diagnostic subgroups. To assess the state of nutrition of patients3talized at CMC, objective data were obtained by physical and biochemical measurements. Anthropometrics, body weight, and clinical observations were made by the CMC Nutrition Support Team on 74 of the total inpatient census of 77 ...