Estimating resting energy expenditure by simple lean-body-mass indicators in children on total parenteral nutrition

Article Abstract:

When a child is fed by total parenteral nutrition, in which all nutrients are supplied intravenously, it is very important to accurately define and provide the individual child's caloric requirements. Excess calories, especially when given as glucose, can alter liver function, while calorie deficiency leads to malnutrition. Generally, calculations of energy expenditure by adults have been based on height, weight, and body surface area, but the few studies of these factors in children have not been applicable to children who were sick or receiving parenteral nutrition. The relationships between energy expenditure and factors such as weight, lean body mass, and 24-hour urinary creatinine (which is an index of muscle mass) in children on total parenteral nutrition were evaluated in this study. There were two groups, one of which included 14 children whose weight-for-height index was below 90 percent (the children were thin), while the other group of 23 children had a weight-for-height index over 90 percent. The study determined that the resting energy expenditure (REE), which is the number of calories burned while at rest, can be predicted from lean body mass and urinary creatinine. The equation representing this relationship accommodated the characteristics of both subject groups. However, equations which used weight or height did not, since both factors could be altered by the malnutrition of the first group of children. The study provides a technique for estimating the caloric needs of children with diverse nutritional conditions, thereby allowing for delivery of the correct amount of parenteral nutrition. Further study is needed concerning children with special needs which might result from infection or surgery. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Pediatric diseases, Children, Diseases, Energy metabolism, Malnutrition in children, Child malnutrition, Chronically ill children

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Cysteine usage increases the need for acetate in neonates who receive total parenteral nutrition

Article Abstract:

Total parenteral nutrition (TPN) is used in neonatal intensive care units for premature infants. Cysteine is an essential amino acid for newborn infants and it must be supplied in the diet. However, most TPN formulas for infants do not contain cysteine. Cysteine can be added to TPN formulas, but it lowers the pH of the formula. Lower pH increases the solubility of calcium and phosphate are, and thus increases the concentrations of these substances. However, infant feeding with TPN formulas that are acidic can cause metabolic acidosis (acidic body fluids) in the infant. The addition of acetate to the diet can correct metabolic acidosis by removing hydrogen ions (acid). A study was performed to determine if TPN with added cysteine caused metabolic acidosis and required treatment with acetate for newborn infants. Thirty-five infants were fed TPN formulas with added cysteine (pH 5.1) and 31 received TPN without cysteine (pH 5.5). The amount of carbon dioxide in the blood was measured after one week and two weeks of TPN feeding. Very low levels of carbon dioxide in the blood indicate metabolic acidosis. The infants who were given TPN with cysteine had lower levels of carbon dioxide in their blood than those receiving the formula without added cysteine. It is concluded that cysteine lowers the pH of TPN formulas, increases the risk of metabolic acidosis, and increases the need for acetate. Infants receiving TPN with added cysteine should be monitored carefully for metabolic acidosis. (Consumer Summary produced by Reliance Medical Information, Inc.)

Acidosis, Acetates, Cysteine

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Total-body protein turnover in parenterally fed neonates: effects of energy source studied by using /15N~glycine and /1-13C~leucine

Article Abstract:

Newborn infants needing intensive care may receive parenteral (intravenous) nutrition; this method is particularly valuable for babies with digestive disorders or congenital anomalies. Research is underway to determine the optimal combination of protein (supplied as amino acids), glucose, and lipid (fat) in parenteral nutrition solutions for neonates. The proportions of these nutrients are important because they interact. For example, amino acids may be more efficiently utilized in building body tissue if the mixture of glucose and lipid is optimal. An important goal of nutritional therapy in sick infants is protein retention; if the amount of protein ingested exceeds the amount excreted, the baby is using protein to build tissues and grow. A study was conducted with 20 newborns fed parenterally. All the babies were given the same amount of amino acids and total calories, but some received only glucose as a non-protein fuel, while others received both glucose and lipids. Protein retention was measured using isotopes that indicate protein metabolism. The two groups did not differ in protein retention; growth was equivalent with the glucose-only and glucose-plus-lipid solutions. However, the glucose-plus-lipid formula had advantages over the glucose-only formula. The former promoted better energy storage, which supports growth, and improved reutilization of amino acids for protein synthesis. (Consumer Summary produced by Reliance Medical Information, Inc.)

Research, Neonatal intensive care, Growth, Protein metabolism, Amino acid metabolism

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