Precise measurement of BMR requires very strict conditions i.e. As a result, TEE is high in young children in comparison to older children and adults, as illustrated in Figure 1.įigure 1 Total energy expenditure in children aged 3–24 months and REE in critically ill children on mechanical ventilation measured by indirect calorimetry. This expenditure is particularly important in rapidly growing infants (approximately up to the age of 12 months) and during puberty ( 6). The energy needed for growth results from energy expenditure of protein and lipid synthesis and energy deposition in newly formed tissues ( 4). BMR-expressed in kcal/kg of body weight per day-is high in infants and young children due to their body composition with a relatively large proportion of organs with high metabolic rate. The BMR is the main component of TEE, and can be considered as the sum of the energy expenditure of the various organs and tissues of the body ( 4, 5). In healthy children, the TEE expended by children over 24 hours is made up by the basal metabolic rate (BMR), the thermic effect of food, physical activity, growth and, rarely, cold-induced thermogenesis ( 4). Measurements of REE by IC in critically ill children Components of total energy expenditure (TEE) in healthy children To determine the energy requirements of critically ill children, resting energy expenditure (REE) is measured with indirect calorimetry (IC) or otherwise calculated using a predictive equation, and if needed, disease and activity factors are considered. Energy requirements are depending on the different phases of illness (i.e., the acute, stable and recovery phase) and may be affected by the severity of illness and by factors such as sedation, muscle relaxants, mechanical ventilation and fever. The determination of energy requirements throughout stay in the pediatric intensive care unit (PICU) is challenging and both underfeeding and overfeeding have to be avoided. In critically ill children, adequate energy intake is associated with improved clinical outcome ( 1- 3). Received: 20 June 2020 Accepted: 18 August 2020 Published: 30 November 2020. Keywords: Critical care pediatrics energy expenditure indirect calorimetry (IC) nutrition The available evidence will be synthesized and practical recommendations will be provided for guiding energy intake during the different phases of illness. The principles of measurement or calculation of REE will be described. The aim of this review is to give an overview of the current knowledge concerning REE in critically ill children and factors that may affect REE.
After the acute phase, energy intake has to be increased to enable recovery and growth. The latter may be estimated using the Schofield equation or ideally be measured using a validated indirect calorimeter. During the acute phase, energy intake has to be increased gradually while not exceeding resting energy expenditure (REE). Energy expenditure is affected by the illness itself, but also by the conditions of the PICU such as mechanical ventilation, sedation, fever and the lack of physical activity. In addition, energy requirements vary during the different phases of critical illness i.e. The assessment of energy requirements is difficult during critical illness because of lack of devices to measure it. During stay in the pediatric intensive care unit (PICU), both underfeeding and overfeeding have to be avoided. Abstract: In critically ill children, optimal nutritional intake can improve recovery.
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