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Perioperative nutrition and metabolism in pediatric patients
1Department of Pediatric Surgery, Osaka Medical Center for Maternal and Child Health, Izumi, Japan.
Insights
Infants are susceptible to metabolic disturbances after surgery. Careful perioperative nutritional management, focusing on appropriate energy intake and amino acid formulas, is crucial for preventing complications in pediatric surgical patients.
Area of Science:
- Pediatric surgery
- Nutritional science
- Metabolic disorders
Background:
- Developing children have high metabolic rates and low nutrient stores, increasing susceptibility to surgical stress.
- Infants exhibit distinct physiological features, particularly in body fluid composition, requiring specialized perioperative nutritional considerations.
- Postoperative metabolic responses in children are similar to adults but occur more rapidly.
Purpose of the Study:
- To highlight the importance of tailored perioperative nutritional strategies for infants undergoing surgery.
- To discuss the metabolic changes and potential complications in pediatric surgical patients.
- To provide guidance on optimizing nutritional support to prevent adverse outcomes.
Main Methods:
- Assessing postoperative muscle protein degradation in infants using urinary 3-methylhistidine excretion.
- Evaluating the impact of increased amino acid intake on protein degradation.
- Analyzing energy intake from glucose or fat in relation to patient requirements.
Main Results:
- Postoperative muscle protein degradation in infants was found to be approximately double the preoperative level.
- Increased amino acid intake did not suppress this transient increase in protein degradation during the early postoperative period.
- Sufficient energy intake was provided, but excess carbohydrate intake was identified as a potential issue.
Conclusions:
- Preventing postoperative metabolic complications in infants requires precise energy intake, balancing glucose and fat, and avoiding carbohydrate excess.
- The quantity and quality of amino acid formulas are critical factors in perioperative nutritional care for pediatric surgical patients.
- Careful evaluation of nutritional strategies is essential for managing the unique metabolic needs of infants during the perioperative period.
Abstract:
A developing child, with a high metabolic rate and low body stores of nutrients, is susceptible to metabolic disturbances due to surgical stress. For perioperative nutritional care of infants, the distinct physiologic features of their body fluids must be carefully considered. The postoperative metabolic response is the same as that in adults, but in children this response is more rapid. Based on the urinary excretion of 3-methylhistidine in infants, the postoperative degradation of muscle protein is thought to be twice the preoperative level. This transient increase during the early postoperative period was not suppressed by increased amino acid intake, and energy intake was sufficient. To prevent postoperative metabolic complications, the energy intake of glucose or fat should correspond to the patient's requirements, and excess carbohydrate should be avoided. The quantity and quality of the amino acid formula used must be carefully evaluated.