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Protein and nitrogen metabolism changes following closed head injury or cardiothoracic surgery in pediatric patients

Emily B Hak1, David A Rogers, Michael C Storm

  • 1Department of Pharmacy, The University of Tennessee Health Science Center, Memphis, Tennessee; The Center for Pediatric Pharmacokinetics and Therapeutics; and Le Bonheur Children's Medical Center, Memphis, Tennessee ; Department of Pediatrics, The University of Tennessee Health Science Center, Memphis, Tennessee; The Center for Pediatric Pharmacokinetics and Therapeutics; and Le Bonheur Children's Medical Center, Memphis, Tennessee ; Department of Pharmacology, The University of Tennessee Health Science Center, Memphis, Tennessee; The Center for Pediatric Pharmacokinetics and Therapeutics; and Le Bonheur Children's Medical Center, Memphis, Tennessee.

The Journal of Pediatric Pharmacology and Therapeutics : JPPT : the Official Journal of PPAG
|November 3, 2012
PubMed

Insights

Children with severe head injuries experience more significant protein breakdown than those undergoing controlled cardiothoracic surgery. Protein metabolism markers show greater catabolism in traumatic brain injury patients initially.

Area of Science:

  • Pediatric critical care medicine
  • Metabolic response to injury
  • Trauma and surgical stress

Background:

  • Acute severe injury triggers significant protein catabolism.
  • Controlled surgical injuries may result in blunted catabolic responses compared to uncontrolled trauma.
  • Understanding protein metabolism is crucial for pediatric patient recovery.

Purpose of the Study:

  • To compare protein metabolism markers in pediatric patients following controlled cardiothoracic surgery (CTS) versus acute traumatic closed head injury (CHI).
  • To investigate the impact of injury type on nitrogen balance, protein levels, and amino acid excretion.
  • To assess the time course of metabolic recovery after different injury types in children.

Main Methods:

  • Prospective observational study involving 10 children with CHI and 10 with CTS (ages 2-12).
  • Evaluated nutrient intake, nitrogen balance, serum albumin, prealbumin, and urinary 3-methylhistidine excretion/creatinine ratios on days 1, 2, 3, 4, and 10 post-injury.
  • Compared metabolic markers between the CHI and CTS groups.

Main Results:

  • Nutrient intake was insufficient in both groups initially.
  • Children with CHI exhibited lower nitrogen balance on day 1 compared to the CTS group.
  • By day 10, the CHI group showed improved nitrogen balance and prealbumin levels, indicating recovery, while most CTS patients were discharged.

Conclusions:

  • Protein metabolism markers follow similar patterns after cardiothoracic surgery and closed head injury in children.
  • However, markers indicate more severe protein catabolism occurs sooner after a closed head injury compared to controlled cardiothoracic surgery.
  • These findings highlight differences in the acute metabolic response to traumatic versus controlled injury in pediatric patients.
Abstract

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