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Protein Requirements of the Critically Ill Pediatric Patient
Jorge A Coss-Bu1,2, Jill Hamilton-Reeves3, Jayshil J Patel4
11 Section of Critical Care, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA.
Insights
Determining protein needs in children, especially critically ill ones, is complex. Critically ill children require higher protein intake for better clinical outcomes and survival benefits, necessitating careful monitoring.
Area of Science:
- Pediatric Nutrition
- Critical Care Medicine
- Metabolism
Background:
- Protein requirements in children differ significantly from adults due to growth needs.
- Critically ill children experience increased protein turnover, risking lean body mass loss and malnutrition.
- Accurate assessment and delivery of protein are crucial for pediatric critical care.
Purpose of the Study:
- To review protein requirements in healthy and critically ill children.
- To discuss protein metabolism, nitrogen balance, and delivery methods in pediatric critical illness.
- To highlight challenges and future research directions in pediatric protein nutrition.
Main Methods:
- Review of existing literature on protein needs and metabolism in children.
- Analysis of protein balance studies in critically ill pediatric populations.
- Examination of recent findings on enteral protein delivery and survival benefits.
Main Results:
- Protein requirements vary by age, with infants and younger children needing more per body weight.
- Higher protein intake in critically ill children is associated with improved survival.
- Enteral protein delivery achieving higher goal percentages correlates with survival benefits.
Conclusions:
- Optimizing protein intake is vital for growth, lean body mass preservation, and clinical outcomes in critically ill children.
- Further research, including randomized trials, is needed to define optimal protein dosing strategies across pediatric age groups.
- Monitoring for side effects of increased protein intake is essential.
Abstract:
This article includes a review of protein needs in children during health and illness, as well as a detailed discussion of protein metabolism, including nitrogen balance during critical illness, and assessment and prescription/delivery of protein to critically ill children. The determination of protein requirements in children has been difficult and challenging. The protein needs in healthy children should be based on the amount needed to ensure adequate growth during infancy and childhood. Compared with adults, children require a continuous supply of nutrients to maintain growth. The protein requirement is expressed in average requirements and dietary reference intake, which represents values that cover the needs of 97.5% of the population. Critically ill children have an increased protein turnover due to an increase in whole-body protein synthesis and breakdown with protein degradation leading to loss of lean body mass (LBM) and development of growth failure, malnutrition, and worse clinical outcomes. The results of protein balance studies in critically ill children indicate higher protein needs, with infants and younger children requiring higher intakes per body weight compared with older children. Monitoring the side effects of increased protein intake should be performed. Recent studies found a survival benefit in critically ill children who received a higher percentage of prescribed energy and protein goal by the enteral route. Future randomized studies should evaluate the effect of protein dosing in different age groups on patient outcomes, including LBM, muscle structure and function, duration of mechanical ventilation, intensive care unit and hospital length of stay, and mortality.