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Gastrointestinal protein loss in children recovering from burns
I Matoth1, E Granot, A Gorenstein
1Department of Pediatrics, Hadassah Hebrew University Medical Center, Jerusalem, Israel.
Insights
Children with extensive burns experience significant gastrointestinal protein loss, indicated by elevated fecal alpha-1-antitrypsin (FA-1-AT) levels. This loss directly correlates with the percentage of body surface area (BSA) affected by burns.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Burn Medicine
Background:
- Gastrointestinal (GI) protein loss is a concern in pediatric burn patients.
- Assessing this loss is crucial for nutritional management and patient outcomes.
Purpose of the Study:
- To evaluate qualitative gastrointestinal protein loss in pediatric burn patients using fecal alpha-1-antitrypsin (FA-1-AT) as a marker.
- To correlate protein loss with burn severity (percentage of body surface area affected).
Main Methods:
- Fecal alpha-1-antitrypsin (FA-1-AT) was measured in 10 children with burns covering ≥10% of their body surface area (BSA).
- Patients were grouped by burn extent (<20% BSA vs. >20% BSA).
- Results were compared to 12 healthy controls.
Main Results:
- Children with burns >20% BSA showed significantly higher maximal FA-1-AT excretion compared to those with <20% BSA burns and controls.
- Maximal FA-1-AT excretion positively correlated with the percentage of BSA burned (r=0.83).
- No correlation was found between FA-1-AT levels and enteral caloric/protein intake.
Conclusions:
- Significant intestinal protein loss occurs in pediatric burn patients.
- Burn severity (BSA percentage) is a key factor influencing protein loss.
- FA-1-AT is a valuable marker for assessing postburn intestinal protein loss in children.
Abstract:
Qualitative gastrointestinal protein loss was evaluated in 10 children with second- and/or third-degree burns covering 10% or more of their body surface area (BSA) by using fecal alpha-1-antitrypsin (FA-1-AT) as a marker. Patients were subdivided according to the extent of the burned area: group I (5 patients) had burns covering less than 20% of BSA; group II (5 patients) had burns covering more than 20% of BSA (mean, 37.2% = 24.9%). Results were compared with those of 12 healthy normal controls. Mean maximal FA-1-AT excretion in group II patients (2.71 +/- 1.35 mg/g) was significantly greater than that found in group I children (0.43 +/- 0.26 mg/g; P = .006) and in the controls (0.62 +/- 0.25 mg/g; P = .004). The mean maximal FA-1-AT excretion positively correlated to the percent of BSA covered with burns (r = 0.83). Although the mean septic score (SS) of group I patients (7 +/- 2.9) was significantly greater than that calculated for group II children (3 +/- 2.45; P = .047), only 2 patients in group II had positive microbiological cultures. Patients in both groups had received more than the recommended enteral caloric and protein allowance during the 96 hours prior to the maximal FA-1-AT measurements. Within this range, no correlation was found between the amount of FA-1-AT and the number of calories per kilogram protein consumed. By using the method of FA-1-AT quantification, this study provides the first report on postburn intestinal protein loss in children.