Energy balance in infants born from HIV seropositive mothers

Abstract

Objectives: A nutritional evaluation of infants born from HIV seropositive mothers was carried out during their follow up and diagnostic investigation. The energy balance (EB) of infected and noninfected children were compared.Methods: The energy balance (intake energy, fecal energy, and resting energy expenditure) was prospectively determined by indirect calorimetry, considering 13 infants (6 girls and 7 boys) between 1 and 6 months of age, born from HIV positive mothers. This was made in two opportunities: before and after the diagnosis of the disease. A full nutritional assessment, including clinical examination and anthropometric measures (weight, height and skinfold thickness), was also determined in these two opportunities. After the definite diagnosis, the infants were finally assembled in 2 different groups: infected (5 in 13) and noninfected (8 in 13). The children were monthly submitted to clinical evaluations and orientation, during all the study.Results: By analyzing the anthropometric measures of the two groups, it was observed that the infected group had malnutritional manifestations since the first evaluation. The resting energy expenditure (kcal/kg/dia) of the infected group was higher than that of the noninfected group: 64.5+16.8 vs 48.0+5.7 (p<0.05) at the first evaluation and 68.0+11.7 vs 51.8+3.1 (p<0.05) at the second, respectively.Conclusion: The higher resting energy expenditure of the children in the infected group might be the cause of the protein energy malnutrition during the asymptomatic phase when the diagnosis was uncertain. ResumoObjetivo: A avaliação nutricional de lactentes filhos de mães soropositivas para o HIV foi efetuada durante seguimento clínico e investigação diagnóstica. Os balanços de energia (BE) das crianças infectadas e não-infectadas pelo HIV foram comparados.Métodos: As determinações dos BE (energia ingerida, energia fecal e gasto energético de repouso, determinados por calorimetria indireta) foram realizadas prospectivamente em 13 lactentes filhos de mães soropositivas para o HIV (6 meninas e 7 meninos), com idades entre 1e 6 meses. Isso ocorreu em duas oportunidades: antes e depois da definição diagnóstica da criança. Uma avaliação nutricional completa, incluindo exame físico e medidas antropométricas (peso, estatura e pregas cutâneas), também foi realizada nessas duas etapas. Com a definição diagnóstica as crianças foram divididas em dois grupos: infectados (5/13) e não infectados (8/13). As crianças foram seguidas em ambulatório durante todo o estudo, e atendidas mensalmente para avaliação clínica e orientação.Resultados: Do ponto de vista antropométrico, as crianças infectadas apresentaram maior comprometimento nutricional nas duas avaliações efetuadas. Os valores médios do gasto energético de repouso em kcal/kg/dia das crianças infectadas foram maiores que aqueles das não infectadas nas duas avaliações, de maneira significante: 64.5+16.8 vs 48.0+5.7 (p<0.05) na primeira e 68.0+11.7 vs 51.8+3.1 (p<0.05) na segunda avaliação, respectivamente.Conclusões...

Rest energy expenditure is decreased during the acute as compared to the recovery phase of sepsis in newborns

“…The same can be said about the VO 2 and VCO 2 . The average VO 2 of our study was 7.4 ± 1.9 ml/kg/min, similar to the value of 7.41 ± 0.88 ml/kg/min verified by Hamamoto [ 19 ]. The VCO 2 during acute phase of sepsis averaged 5.1 ± 1.7 ml/kg/min, which was below the average of 6.36 ± 1.04 reported by the authors.…”

“…The most used is the indirect calorimetry, due to its accuracy, portability, comfort and safety for the patient, even in seriously ill subjects [ 29 ]. The equipment and technique utilized in the present study were developed by Hamamoto [ 19 ] and are especially appropriate for newborns and young children. The method validation was performed by measuring REE in newborns and comparing the results with data from studies that used the same technique.…”

“…During our study there were no changes in the oxygen saturation and axillary temperature of the newborns. The technique is utilized in our center as part of the patient assessment and it is used frequently for children with metabolic disorders and/or to determine adequacy of nutritional support [ 19 ].…”

“…Validation studies have shown the technique to give results equivalent to direct measurements [ 16 , 18 ]. The calorimeter used was developed by Hamamoto [ 19 ] and built from the incubator model C-86 of Fanem. Routine calibration was performed prior to each study using a 0.5 L syringe and primary standard calibration gases.…”