Protein Requirements of the Critically Ill Pediatric Patient

Abstract

This article includes a review of protein needs in children during health and illness, as well as a detailed discussion of protein metabolism, including nitrogen balance during critical illness, and assessment and prescription/delivery of protein to critically ill children. The determination of protein requirements in children has been difficult and challenging. The protein needs in healthy children should be based on the amount needed to ensure adequate growth during infancy and childhood. Compared with adults, children require a continuous supply of nutrients to maintain growth. The protein requirement is expressed in average requirements and dietary reference intake, which represents values that cover the needs of 97.5% of the population. Critically ill children have an increased protein turnover due to an increase in whole‐body protein synthesis and breakdown with protein degradation leading to loss of lean body mass (LBM) and development of growth failure, malnutrition, and worse clinical outcomes. The results of protein balance studies in critically ill children indicate higher protein needs, with infants and younger children requiring higher intakes per body weight compared with older children. Monitoring the side effects of increased protein intake should be performed. Recent studies found a survival benefit in critically ill children who received a higher percentage of prescribed energy and protein goal by the enteral route. Future randomized studies should evaluate the effect of protein dosing in different age groups on patient outcomes, including LBM, muscle structure and function, duration of mechanical ventilation, intensive care unit and hospital length of stay, and mortality.

Enteral Protein Supplementation in Critically Ill Children: A Randomized Controlled Pilot and Feasibility Study

“…Optimal nutrition support in critically ill children includes adequate protein dose to avoid negative nitrogen balance and to maintain the lean body mass . However, the optimal dose of protein needs to be determined in a controlled trial.…”

“…Optimal nutrition support in critically ill children includes adequate protein dose to avoid negative nitrogen balance and to maintain the lean body mass. 3 However, the optimal dose of protein needs to be determined in a controlled trial. Achieving delivery of optimal protein dose without increasing the caloric dose is often challenging because of the fixed protein/calorie ratios in current enteral formulations.…”

“…The catabolic phase of critical illness is associated with an increase in protein breakdown, and consequently results in a negative net protein balance with a substantial loss of muscle mass . The muscle mass in critically ill children is associated with disease severity and clinical outcomes …”

“…1,2 The muscle mass in critically ill children is associated with disease severity and clinical outcomes. 3 The role of nutrition therapy in the pediatric intensive care unit (PICU), particularly the impact of optimal protein intake on muscle mass, is of significant interest. Energy and protein deficits are associated with negative protein balance, morbidity, and mortality.…”

Feasibility of Enteral Protein Supplementation in Critically Ill Children

“…Protein catabolism is a characteristic response to stress from a variety of injuries in critically ill children. 1 In the setting of prolonged or excessive protein breakdown, loss of muscle mass and strength may occur, potentially leading to poor outcome that includes delayed weaning of mechanical ventilation and higher risk of mortality. 2 Optimizing protein intake during acute illness might enhance protein synthesis, facilitate wound healing and the inflammatory response, and minimize muscle mass depletion.…”