Department of Paediatrics, Maastricht University Medical Center, PO Box 5800, 6202 AZ Maastricht, The Netherlands.
Arch Dis Child. 2011 Sep;96(9):817-22. doi: 10.1136/adc.2010.185637. Epub 2011 Jun 14.
The preservation of nutritional status and growth is an important aim in critically ill infants, but difficult to achieve due to the metabolic stress response and inadequate nutritional intake, leading to negative protein balance. This study investigated whether increasing protein and energy intakes can promote anabolism. The primary outcome was whole body protein balance, and the secondary outcome was first pass splanchnic phenylalanine extraction (SPE(Phe)).
This was a double-blind randomised controlled trial. Infants (n=18) admitted to the paediatric intensive care unit with respiratory failure due to viral bronchiolitis were randomised to continuous enteral feeding with protein and energy enriched formula (PE-formula) (n=8; 3.1 ± 0.3 g protein/kg/24 h, 119 ± 25 kcal/kg/24 h) or standard formula (S-formula) (n=10; 1.7 ± 0.2 g protein/kg/24 h, 84 ± 15 kcal/kg/24 h; equivalent to recommended intakes for healthy infants <6 months). A combined intravenous-enteral phenylalanine stable isotope protocol was used on day 5 after admission to determine whole body protein metabolism and SPE(Phe).
Protein balance was significantly higher with PE-formula than with S-formula (PE-formula: 0.73 ± 0.5 vs S-formula: 0.02 ± 0.6 g/kg/24 h) resulting from significantly increased protein synthesis (PE-formula: 9.6 ± 4.4, S-formula: 5.2 ± 2.3 g/kg/24 h), despite significantly increased protein breakdown (PE-formula: 8.9 ± 4.3, S-formula: 5.2 ± 2.6 g/kg/24 h). SPE(Phe) was not statistically different between the two groups (PE-formula: 39.8 ± 18.3%, S-formula: 52.4 ± 13.6%).
Increasing protein and energy intakes promotes protein anabolism in critically ill infants in the first days after admission. Since this is an important target of nutritional support, increased protein and energy intakes should be preferred above standard intakes in these infants. Dutch Trial Register number: NTR 515.
营养状况和生长的维持是危重症婴儿的重要目标，但由于代谢应激反应和营养摄入不足，导致负氮平衡，这一目标难以实现。本研究旨在探讨增加蛋白质和能量摄入是否能促进合成代谢。主要结局指标为全身蛋白质平衡，次要结局指标为首次通过内脏的苯丙氨酸提取率（SPE（Phe））。
这是一项双盲随机对照试验。因病毒性毛细支气管炎导致呼吸衰竭而入住儿科重症监护病房的婴儿（n=18），被随机分配至接受富含蛋白质和能量的肠内喂养配方（PE 配方）（n=8；3.1±0.3 g 蛋白质/kg/24 h，119±25 kcal/kg/24 h）或标准配方（S 配方）（n=10；1.7±0.2 g 蛋白质/kg/24 h，84±15 kcal/kg/24 h；相当于健康婴儿＜6 个月的推荐摄入量）。入院后第 5 天，采用静脉-肠内苯丙氨酸稳定同位素方案，以确定全身蛋白质代谢和 SPE（Phe）。
与 S 配方相比，PE 配方的蛋白质平衡显著更高（PE 配方：0.73±0.5 vs S 配方：0.02±0.6 g/kg/24 h），这是由于蛋白质合成显著增加（PE 配方：9.6±4.4，S 配方：5.2±2.3 g/kg/24 h），尽管蛋白质分解也显著增加（PE 配方：8.9±4.3，S 配方：5.2±2.6 g/kg/24 h）。两组间 SPE（Phe）无统计学差异（PE 配方：39.8±18.3%，S 配方：52.4±13.6%）。
在入院后最初几天，增加蛋白质和能量摄入可促进危重症婴儿的蛋白质合成代谢。由于这是营养支持的重要目标，因此与标准摄入量相比，这些婴儿应优先增加蛋白质和能量摄入。荷兰临床试验注册编号：NTR 515。
