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Updated: May 4, 2026
Systems Analysis of the Neuroinflammatory and Hemodynamic Response to Traumatic Brain Injury
Published on: May 27, 2022
Energy expenditure in children after severe traumatic brain injury
Haifa Mtaweh1, Rebecca Smith, Patrick M Kochanek
11Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA. 2Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, PA. 3Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA. 4Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA. 5Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, AZ. 6Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA.
Insights
Energy expenditure in children with severe traumatic brain injury is lower than previously thought. Modern neurocritical care may reduce the hypermetabolic response, impacting nutritional support goals.
Area of Science:
- Pediatric critical care medicine
- Neuroscience
- Metabolic research
Background:
- Severe pediatric traumatic brain injury (TBI) was historically associated with hypermetabolism.
- Accurate assessment of energy expenditure is crucial for optimizing nutritional support in critically ill children.
Purpose of the Study:
- To evaluate energy expenditure in children with severe TBI.
- To compare measured energy expenditure with predicted values using the Harris-Benedict equation.
Main Methods:
- Prospective observational study in a pediatric neurotrauma center.
- Indirect calorimetry performed in mechanically ventilated children with severe TBI (Glasgow Coma Scale < 9).
- Data analyzed from 13 children with 32 assessments within the first week post-injury.
Main Results:
- Measured energy expenditure averaged 70.2% of predicted resting energy expenditure.
- No significant difference in energy expenditure between hypothermic and normothermic states.
- Energy expenditure did not differ between children with favorable and unfavorable neurologic outcomes.
Conclusions:
- Contemporary neurocritical care practices may blunt the hypermetabolic response in severe pediatric TBI.
- Understanding current metabolic requirements is essential for developing evidence-based nutritional support strategies.
- Further research is needed to establish optimal nutritional goals for improved outcomes in this population.
Objective:
To evaluate energy expenditure in a cohort of children with severe traumatic brain injury.
Design:
A prospective observational study.
Setting:
A pediatric neurotrauma center within a tertiary care institution.
Patients:
Mechanically ventilated children admitted with severe traumatic brain injury (Glasgow Coma Scale < 9) with a weight more than 10 kg were eligible for study. A subset of children was co-enrolled in a phase 3 study of early therapeutic hypothermia. All children were treated with a comprehensive neurotrauma protocol that included sedation, neuromuscular blockade, temperature control, antiseizure prophylaxis, and a tiered-based system for treating intracranial hypertension.
Interventions:
Within the first week after injury, indirect calorimetry measurements were performed daily when the patient's condition permitted.
Measurements And Main Results:
Data from 13 children were analyzed (with a total of 32 assessments). Measured energy expenditure obtained from indirect calorimetry was compared with predicted resting energy expenditure calculated from Harris-Benedict equation. Overall, measured energy expenditure/predicted resting energy expenditure averaged 70.2% ± 3.8%. Seven measurements obtained while children were hypothermic did not differ from normothermic values (75% ± 4.5% vs 68.9% ± 4.7%, respectively, p = 0.273). Furthermore, children with favorable neurologic outcome at 6 months did not differ from children with unfavorable outcome (76.4% ± 6% vs 64.7% ± 4.7% for the unfavorable outcome, p = 0.13).
Conclusions:
Contrary to previous work from several decades ago that suggested severe pediatric traumatic brain injury is associated with a hypermetabolic response (measured energy expenditure/predicted resting energy expenditure > 110%), our data suggest that contemporary neurocritical care practices may blunt such a response. Understanding the metabolic requirements of children with severe traumatic brain injury is the first step in development of rational nutritional support goals that might lead to improvements in outcome.
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