Hulst Jessie M, van Goudoever Johannes B, Zimmermann Luc J, Hop Wim C, Büller Hans A, Tibboel Dick, Joosten Koen F M
Department of Pediatric Surgery, Erasmus MC, Sophia Children's Hospital, Rotterdam, The Netherlands.
Nutrition. 2005 Feb;21(2):192-8. doi: 10.1016/j.nut.2004.05.020.
We determined incidences of underfeeding and overfeeding in children who were admitted to a multidisciplinary tertiary pediatric intensive care and evaluated the usefulness of the respiratory quotient (RQ) obtained from indirect calorimetry to assess feeding adequacy.
Children 18 y and younger who fulfilled the criteria for indirect calorimetry entered our prospective, observational study and were studied until day 14. Actual energy intake was recorded, compared with required energy intake (measured energy expenditure plus 10%), and classified as underfeeding (<90% of required), adequate feeding (90% to 110% of required), or overfeeding (>110% of required). We also evaluated the adequacy of a measured RQ lower than 0.85 to identify underfeeding, and an RQ higher than 1.0 to identify overfeeding.
Ninety-eight children underwent 195 calorimetric measurements. Underfeeding, adequate feeding, and overfeeding occurred on 21%, 10%, and 69% of days, respectively. An RQ lower than 0.85 to identify underfeeding showed low sensitivity (63%), high specificity (89%), and high negative predictive value (90%). An RQ higher than 1.0 to indicate overfeeding showed poor sensitivity (21%), but a high specificity (97%) and a high positive predictive value (93%). Food composition, notably high-carbohydrate intake, was responsible for an RQ exceeding 1.0 in the overfed group.
Children admitted to the intensive care unit receive adequate feeding on only 10% of measurement days during the first 2 wk of admission. The usefulness of RQ to monitor feeding adequacy is limited to identifying (carbohydrate) overfeeding and excluding underfeeding.
我们确定了入住多学科三级儿科重症监护病房的儿童中喂养不足和喂养过度的发生率，并评估了通过间接测热法获得的呼吸商（RQ）对评估喂养充足性的有效性。
符合间接测热法标准的18岁及以下儿童进入我们的前瞻性观察性研究，并持续研究至第14天。记录实际能量摄入量，并与所需能量摄入量（测量的能量消耗加10%）进行比较，分为喂养不足（<所需量的90%）、喂养充足（所需量的90%至110%）或喂养过度（>所需量的110%）。我们还评估了测量的RQ低于0.85以识别喂养不足，以及RQ高于1.0以识别喂养过度的有效性。
98名儿童接受了195次热量测定。喂养不足、喂养充足和喂养过度分别发生在21%、10%和69%的天数。RQ低于0.85以识别喂养不足时，敏感性较低（63%），特异性较高（89%），阴性预测值较高（90%）。RQ高于1.0以表明喂养过度时，敏感性较差（21%），但特异性较高（97%），阳性预测值较高（93%）。食物成分，尤其是高碳水化合物摄入量，是导致喂养过度组RQ超过1.0的原因。
入住重症监护病房的儿童在入院的前2周内，仅在10%的测量日得到充足喂养。RQ用于监测喂养充足性的有效性仅限于识别（碳水化合物）喂养过度和排除喂养不足。
