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Caloric Requirements of Patients With Brain Impairment and Cerebral Palsy Who Are Dependent on Chronic Ventilation
Rena Gale1, Julia Namestnic1, Pierre Singer2
11 Children's Respiratory Unit, Herzog Hospital, Jerusalem, Israel.
Insights
Children requiring chronic ventilator support have significantly lower caloric needs than healthy peers. Indirect calorimetry can guide feeding to prevent overnutrition and obesity in this vulnerable population.
Area of Science:
- Pediatric critical care medicine
- Clinical nutrition
- Neurorehabilitation
Background:
- Israeli law mandates long-term mechanical ventilation for severely brain-impaired children with minimal responses.
- Current feeding protocols use adjusted caloric requirements of healthy children, leading to excessive weight gain.
- The precise caloric needs of this patient group remain undetermined.
Purpose of the Study:
- To determine the actual caloric requirements of children and adolescents requiring chronic mechanical ventilation and artificial nutrition.
- To establish evidence-based feeding guidelines to prevent overfeeding and associated complications like obesity.
Main Methods:
- A cohort of 16 pediatric patients (3-24 years) on mechanical ventilation and gastrostomy feeding was studied.
- Resting energy expenditure (REE) was measured using indirect calorimetry.
- REE was compared to estimated needs of healthy children and actual caloric intake; statistical analyses included t-tests, correlation, and regression.
Main Results:
- Patients' measured REE was 46% lower than estimated caloric needs for healthy children.
- Actual caloric intake exceeded measured REE by 32%, indicating overfeeding.
- These discrepancies were independent of age, weight, diagnosis, or duration of ventilation.
Conclusions:
- Children and adolescents on chronic mechanical ventilation exhibit substantially reduced caloric expenditure.
- Indirect calorimetry is recommended for precise energy assessment to guide nutritional support.
- Implementing indirect calorimetry can help prevent overnutrition and obesity in this specialized pediatric population.
Background And Objective:
Israeli law mandates chronic ventilator support for children and adolescents who are severely brain impaired and show minimal responses. Feeding protocols in these cases have been based on the caloric requirements of healthy children, deducting calories for lack of activity as well as an individual adjustment according to the cerebral palsy growth curves. However, patients are still inclined to gain excessive weight. Our objective was to determine the caloric requirements of these patients.
Design And Method:
Sixteen patients hospitalized in a dedicated unit who were ventilated through tracheostomies and fed via gastrostomies were included. Patients were aged 3-24 years; duration of ventilation was 1-7.5 years; and diagnoses included congenital genetic or brain malformations (n = 9), hypoxic accidents (n = 4), and postbacterial or postviral encephalitis (n = 3). Resting energy expenditure (REE) was determined by indirect calorimetry. REE values were compared with the caloric requirements of age-comparable healthy children and the calories actually delivered. Data were analyzed with paired t tests, Pearson correlations, and linear regression.
Results:
The REE of our patients was 46% lower than the estimated caloric requirements of healthy children. In practice, patients received 32% more calories than that measured by REE. These findings were not affected by age, weight, diagnosis, or length of hospitalization.
Conclusions:
The caloric expenditure of these patients is very low. A diet guided by indirect calorimetry is proposed to aid in providing optimal nutrition support for this unique population to avoid overfeeding and obesity.
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