Nutritional support and measured energy expenditure of the child and adolescent with head injury

Abstract

Energy expenditure, nitrogen excretion, and serum protein levels were studied from the time of hospital admission until 2 weeks after severe head injury in eight adolescents and four children with peak 24-hour Glasgow Coma Scale scores ranging from 3 to 8. The mean measured energy expenditure (MEE) was 1.3 times Harris and Benedict's predicted value for energy expenditure. Seventy percent of the patients achieved caloric balance (MEE X 1.2) by 4 to 14 days after injury, but balance was not consistently maintained. Five of the 12 patients had intermittent diarrhea, and two had increased gastric residuals. In five patients fluid restrictions were imposed due to either the syndrome of inappropriate secretion of antidiuretic hormone, pulmonary complications, or intracranial pressure complications. For the adolescents (aged 11 to 17 years) the mean calorie intake during the 1st week was 752 kcal/day and for the children (aged 2 to 5 years) it was 340 kcal/day. During the 2nd week the mean calorie intake for the adolescents was 1671 kcal/day and for the children was 691 kcal/day. Mean urinary nitrogen excretion was 307 mg/kg/day for the adolescents and 160 mg/kg/day for the children. The calculated mean nitrogen balance for the eight adolescents and the four younger children was -13.6 and -4.1, respectively. Mean albumin levels decreased from 2.9 gm/dl during the 1st week to 2.4 gm/dl during the 2nd week (normal 3.5 to 5.0 gm/dl). Mean total protein level during the 1st week was 5.4 gm/dl and increased to a mean of 6.0 gm/dl during the 2nd week (normal 6.0 to 7.8 gm/dl). Weight loss ranged from 2 to 26 lb during the 2-week period. From these studies it can be concluded that head injury in the child and adolescent induces a metabolic response that includes increased energy expenditure and decreased serum albumin levels similar to those observed for head-injured adults. Mean nitrogen excretion values are less than those in adults with a severe head injury.

Resting energy expenditure, oxygen consumption and carbon dioxide production during sleep in children with atopic dermatitis

“…In Europe, the prevalence of AD has increased over the last 30 years [3]. Disease-associated changes in energy expenditure of children have been observed in many chronic conditions [4][5][6][7]. The association of short stature with atopic dermatitis is well documented and particularly worrisome [8][9][10][11].…”

Adequate feeding and the usefulness of the respiratory quotient in critically ill children

“…individual response to the same type of injury [4,5]. Because standard feeding protocols do not provide for interindividual differences in energy requirements and because the available prediction equations are inadequate for calculating energy needs in critically ill children, these children are more vulnerable to complications that arise from underfeeding or overfeeding.…”

The Effect of Severe Head Injury on Whole Body Energy Expenditure and Its Possible Hormonal Mediators in Children

“…However, in adults with a severe head injury, most studies show an increase in energy expenditure that varies up to 160% of predicted (25), suggesting that adults mount a marked hypermetabolic response to head injury. Although there arc few studies of energy cxpenditure after trauma in children, the results imply a similar hypermetabolic responsc to head injury (26). However, these studies includc unparalyzed and unscdated patients (25, 26).…”