Energy Expenditure Of Critically Ill Children

Part I. The measurement of resting energy expenditure of children without stress before surgical proceduresObjectives:To understand the impact of energy consumption and associated iactors the resting energy expenditure of children without stress before surgical procedures was tested.Methods:Resting energy expenditure of children without infectious, traumatic or tumors’stress in Urology ward of Children’s Hospital of Fudan University were determined before surgical procedures by U.S. Med Graphic Company CCM/D Energy metabolism test system from November 2012 to December 2013. Patient-related information were recorded. Results were compared with PEE calculated by the Schofield-HW and Harris-benedict formula. Correlation between the patients’general information and resting energy expenditure was analyzed,Results:A total of 42 (30 males,12 females) children from November 2012 to December 2013 were enrolled in the study. Resting energy expenditure of these children was statistically significant difference (P<0.05) between the measured value and the predicted value by Schofield-HW and Harris-benedict equation. Univariate regression analysis showed that age, weight, height and REE values were correlated (P<0.01), and there was no relation between sex and REE.Conclusions:Schofield-HW and Harris-benedict equation overestimated resting energy expenditure of children without stress before surgical procedures. Age, height and weight correlated to energy metabolism of children in this study.Part Ⅱ. The measurement of resting ene rgy expenditure of critically ill children under stressObjectives:To evaluate nutritional support status of critically ill children the energy metabolism was tested. To provide the basis for clinical nutrition monitoring and intervention the energy consumption of critically ill patients and correlation factors was investigated.Methods:Resting energy expenditure of children including multiple trauma, sepsis, severe sepsis in PICU ward of Children’s Hospital of Fudan University were determined by U.S. Med Graphic Company CCM/D Energy metabolism test system from December 2012 to March 2O14.Patient-related information and bio-indicators were recorded. Results were compared with PEE calculated by the Schofield and Harris-benedict formula and with the caloric intake to evaluate the nutritional support status. Correlation between the patients’general information and resting energy expenditure was analyzed. To understand the energy metabolism state of critically children above 3 years the MREE was compared to the children’s without stress.Results:A total of 40(23 males,17 females) critically ill children from December 2012 to March 2014 were enrolled in the study. The results showed that 30% of children in malnutrition state when admitted to hospital and 90% of children were underfeeding after admission. Resting energy expenditure of critically ill children was not statistically significant difference (P> 0.05) between the measured value and the predicted value by Schofield-HW and HB equation. The analysis of PEE showed neither the Schofield-HW nor Harris-benedict predictive equations predicted energy requirement was within acceptable clinical accuracy. Univariate regression analysis showed that age, weight, height and REE values were correlated (P<0.01), and there was relation between sex, PCIS and REE. The results showed no differences of the Resting energy expenditure between critically ill male children and those without stress.Conclusions:There was a higher incidence (30%) of malnutrition in critically ill children. Age, height and weight correlated to energy metabolism of critically ill children, and gender, PCIS, or the duration of disease showed no correlation. Critically ill children were not in a high metabolic state. Neither the Schofield-HW nor Harris-benedict predictive equations predicted energy requirement was within acceptable clinical accuracy. Indirect calorimetry allowed detection of unstable energy imbalance in critically ill children and played a role in optimizing energy intake in the PICU.