Effect of postoperative enteral protein supplementation on nitrogen balance in critically ill children

Critically ill children are at risk of postoperative malnutrition. Thus, optimal nutritional therapy is essential for preventing morbidity development and reducing mortality rates among this population. An adequate protein intake increases anabolism. However, data on the effect of enteral protein supplementation on nitrogen balance (NB) and intestinal fatty acid-binding protein (I-FABP) levels in postoperative critically ill children remain limited.

This study aimed to analyze whether an increased protein intake via enteral nutrition improves NB and reduces serum I-FABP levels among postoperative critically ill children.

This double-blind randomized controlled trial examined critically ill children aged 1-5 years who received early postoperative enteral nutrition. A total of 76 subjects were randomized into a standard-protein group (3.0 g/100 mL) or a high-protein group (4.35 g/100 mL). NB was assessed on days 1 and 3, while I-FABP levels were measured before and after 72 h of enteral feeding.

The high-protein group showed a significantly greater increase in average NB (283.4 [standard deviation, 82.5] mg/kg/day) compared to the standard-protein group (114.7 [standard deviation, 53] mg/kg/day) (P<0.0001). However, no significant decrease in I-FABP levels was noted in either group despite the above- and below-average NB improvements.

High-protein enteral supplementation improves NB in postoperative critically ill children without causing adverse side effects.