Whole Body Protein Turnover and Net Protein Balance After Pediatric Thoracic Surgery: A Noninvasive Single‐Dose <sup>15</sup>N Glycine Stable Isotope Protocol With End‐Product Enrichment

Fullerton, Brenna S.; Sparks, Eric A.; Khan, Faroque A.; Fisher, Jeremy G.; Anzaldi, Rocco; Scoville, Michael R.; Yu, Yong‐Ming; Wagner, David; Jaksic, Tom; Mehta, Nilesh M.

doi:10.1177/0148607116678831

Cited by 9 publications

(4 citation statements)

References 37 publications

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“…Although this method is robust, its complexity renders it costly and impractical as a clinical biomarker in large RCTs. Similar limitations appear in the pediatric population [ 39 ].…”

Section: Biomarkers In Critical Care Nutrition: Current State Of the mentioning

confidence: 66%

Biomarkers in critical care nutrition

Stoppe

Wendt²,

Mehta

et al. 2020

Crit Care

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The goal of nutrition support is to provide the substrates required to match the bioenergetic needs of the patient and promote the net synthesis of macromolecules required for the preservation of lean mass, organ function, and immunity. Contemporary observational studies have exposed the pervasive undernutrition of critically ill patients and its association with adverse clinical outcomes. The intuitive hypothesis is that optimization of nutrition delivery should improve ICU clinical outcomes. It is therefore surprising that multiple large randomized controlled trials have failed to demonstrate the clinical benefit of restoring or maximizing nutrient intake. This may be in part due to the absence of biological markers that identify patients who are most likely to benefit from nutrition interventions and that monitor the effects of nutrition support. Here, we discuss the need for practical risk stratification tools in critical care nutrition, a proposed rationale for targeted biomarker development, and potential approaches that can be adopted for biomarker identification and validation in the field.

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“…Although this method is robust, its complexity renders it costly and impractical as a clinical biomarker in large RCTs. Similar limitations appear in the pediatric population [ 39 ].…”

Section: Biomarkers In Critical Care Nutrition: Current State Of the mentioning

confidence: 66%

Biomarkers in critical care nutrition

Stoppe

Wendt²,

Mehta

et al. 2020

Crit Care

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“…The 24‐h protein and arginine metabolism showed high intraindividual variability in the continuously fed children. The last study published in 2018 in 19 critically ill children after thoracic surgery (median age, 14 years) showed that a single‐dose oral administration of N‐glycine stable isotope with measurement of urinary end‐product enrichment was a feasible and noninvasive method to investigate whole‐body protein turnover 61 . The protein balance obtained using the isotope and urinary urea nitrogen methods was significantly correlated.…”

Section: Resultsmentioning

confidence: 99%

“…These included the blood urea nitrogen method, balance of phosphate and the rate of creatinine excretion, use of stable isotopes, and administration of N‐glycine stable isotopes with measurement of urinary end‐product enrichment. The latter was promising in 19 older critically ill children to assess whole‐body protein turnover 61 and needs further investigation in larger samples of younger children.…”

Section: Discussionmentioning

confidence: 99%

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Determining energy and protein needs in critically ill pediatric patients: A scoping review

Jotterand Chaparro,

Pabion,

Tume

et al. 2023

Nut in Clin Prac

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IntroductionIn critically ill pediatric patients, optimal energy and protein intakes are associated with a decreased risk of morbidity and mortality. However, the determination of energy and protein needs is complex. The objective of this scoping review was to understand the extent and type of evidence related to the methods used to determine energy and protein needs in critically ill pediatric patients.MethodsAn international expert group composed of dietitians, pediatric intensivists, a nurse, and a methodologist conducted the review, based on the Johanna Briggs Institute methodology. Two researchers searched for studies published between 2008 and 2023 in two electronic databases, screened abstracts and relevant full texts for eligibility, and extracted data.ResultsA total of 39 studies were included, mostly conducted in critically ill children undergoing ventilation, to assess the accuracy of predictive equations for estimating resting energy expenditure (REE) (n = 16, 41%) and the impact of clinical factors (n = 22, 56%). They confirmed the risk of underestimation or overestimation of REE when using predictive equations, of which the Schofield equation was the least inaccurate. Apart from weight and age, which were positively correlated with REE, the impact of other factors was not always consistent. No new indirect calorimeter method used to determine protein needs has been validated.ConclusionThis scoping review highlights the need for scientific data on the methods used to measure energy expenditure and determine protein needs in critically ill children. Studies using a reference method are needed to validate an indirect calorimeter.

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

Hauschild

Oliveira

Farias

et al. 2018

J Parenter Enteral Nutr

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Background Loss of muscle mass in critically ill children can negatively impact outcomes. The aims of this study were to conduct a pilot randomized control trial (RCT) to examine the difference in protein delivery and nitrogen balance in critically ill children with enteral protein supplementation vs controls. We also aimed to assess the feasibility, safety, and tolerance of the pilot trial. Methods This is a 3‐arm RCT in critically ill children eligible for enteral nutrition (EN) therapy. Patients were randomized to 1 of the 3 groups: (1) control (routine EN), (2) polymeric protein module added to EN to reach protein goal by day 4, or (3) oligomeric protein supplementation. Demographics, clinical characteristics, nutrition status, and daily nutrition intake variables were recorded. Protein delivery, nitrogen balance, feasibility variables, and rate of adverse events were the outcomes. Results After screening 286 consecutive patients admitted to the pediatric intensive care unit over 11 months, we enrolled and randomized 25 patients. Twenty‐two patients (88% of the enrolled) completed the study procedures. Significantly higher protein prescription and actual protein intake within the first 5 days was achieved in the intervention groups, compared with the control group. Nitrogen balance was obtained in 15 patients. There was no significant difference between the groups for the rate of adverse effects and clinical outcomes. Conclusion In our pilot trial, protein supplementation was safe and well tolerated. Our preliminary results suggest that a larger RCT is potentially feasible, with some modifications of the entry criteria. Trial enrollment was low, likely due to restrictive entry criteria.

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Whole Body Protein Turnover and Net Protein Balance After Pediatric Thoracic Surgery: A Noninvasive Single‐Dose ¹⁵N Glycine Stable Isotope Protocol With End‐Product Enrichment

Cited by 9 publications

References 37 publications

Biomarkers in critical care nutrition

Biomarkers in critical care nutrition

Determining energy and protein needs in critically ill pediatric patients: A scoping review

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

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Whole Body Protein Turnover and Net Protein Balance After Pediatric Thoracic Surgery: A Noninvasive Single‐Dose 15N Glycine Stable Isotope Protocol With End‐Product Enrichment

Cited by 9 publications

References 37 publications

Biomarkers in critical care nutrition

Biomarkers in critical care nutrition

Determining energy and protein needs in critically ill pediatric patients: A scoping review

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

Contact Info

Product

Resources

About

Whole Body Protein Turnover and Net Protein Balance After Pediatric Thoracic Surgery: A Noninvasive Single‐Dose ¹⁵N Glycine Stable Isotope Protocol With End‐Product Enrichment