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Evaluation of predicted and measured energy requirements in burned children
T Mayes1, M M Gottschlich, J Khoury
1Shriners Burns Institute, Cincinnati Unit, Ohio 45229-3095, USA.
Insights
Accurate energy prediction is crucial for pediatric burn patients. A 30% increase to measured resting energy expenditure (MREE) and new predictive equations improve nutritional support for children under 10.
Area of Science:
- Pediatric critical care
- Nutritional support
- Burn management
Background:
- Accurate estimation of energy needs is vital for optimal recovery in pediatric burn patients.
- Existing predictive equations often fail to accurately assess energy requirements in this vulnerable population.
- Indirect calorimetry provides measured resting energy expenditure (MREE), a key metric for nutritional assessment.
Purpose of the Study:
- To compare the accuracy of nine energy prediction methods against MREE in pediatric burn patients younger than 3 years.
- To identify the most effective method for projecting energy needs in this specific age group.
- To develop improved equations for estimating energy requirements in pediatric burn patients.
Main Methods:
- Indirect calorimetry was used to measure MREE in pediatric burn patients.
- Demographic data including preburn weight, percent burn, and age were collected.
- Analysis of variance and multiple regression analysis were employed to evaluate prediction models and develop new equations.
Main Results:
- Existing formulas for healthy children tended to underestimate MREE, while those for burn patients often overpredicted energy needs.
- An additional 30% of MREE (MREE x 1.3) provided a consistent ratio for actual to required energy intake.
- New regression equations were developed, showing good predictive accuracy (r2 values ranging from .67 to .71).
Conclusions:
- A 30% increase to MREE is a supported method for estimating energy needs in burn patients under 10 years old.
- Standard energy prediction formulas are inadequate for pediatric burn patients.
- Two new sets of equations are proposed to more accurately predict energy needs in this population.
Objective:
The energy predictions of nine calculations for pediatric patients were compared with measured resting energy expenditure (MREE) by means of indirect calorimetry to determine the optimal means of energy projection in the burn population younger than 3 years of age.
Methodology:
Nutritional sufficiency and maintenance of preburn weight were factors in the confirmation of energy needs. Demographic factors were also studied: preburn weight, percent burn, percent third-degree burn, and age. Group 1 consisted of 24 patients younger than 3 years of age (range = 7 months to 2.6 years) with a percent burn of 30.6 +/- 2.0 and percent third-degree burn of 21.9 +/- 2.6. Group 2, consisting of 24 patients 5 to 10 years old matched by percent burn and percent third-degree burn, was included to determine whether differences between actual and projected needs were evident in older, prepubescent patients.
Statistical Analysis:
Analysis of variance was used to ascertain the most reliable multiplier for MREE needed to maintain at least 95% of preburn weight at discharge while ensuring adequate nutrition. Multiple regression analysis was used to determine the relationship between energy requirement and body weight, percent burn, and age.
Results:
An additional 30% of MREE provided a consistent ratio of actual energy intake to required intake. MREE x 1.3 was used as a guide to study the existing calculations. For both groups, the four equations that predicted energy in healthy children most often underestimated MREE x 1.3, whereas the five formulas for children with burns tended to overpredict energy. Regression analysis yielded two new sets of equations using age, preburn weight, and percent burn (< 3 years = Mayes 1 [r2 = .71], 5 to 10 years = Mayes 3 [r2 = 70] or percent third-degree burn (< 3 years = Mayes 2 [r2 = .68], 5 to 10 years = Mayes 4 [r2 = .67]).
Conclusions:
The application of a 30% factor to MREE is supported in burn patients younger than 10 years of age. Standard energy projections do not provide an accurate assessment of energy needs in the pediatric burn population; thus, two sets of equations that more closely predict energy needs are proposed.