Energy metabolism of infants and children with systemic inflammatory response syndrome and sepsis.
OBJECTIVE
To evaluate whether critically ill children with systemic inflammatory response syndrome (SIRS) or sepsis have altered resting energy expenditure (REE) and substrate utilization.


BACKGROUND
Studies in adults with sepsis have shown increased energy expenditure and mobilization of endogenous fat. In infants and children, energy metabolism and substrate utilization during sepsis have not been characterized.


METHODS
Metabolic studies were performed in 21 critically ill children with SIRS or sepsis. Twenty-one stable control children, matched for weight, were also studied. Seven patients required inotropic support and 17 received mechanical ventilation. Fifteen patients with SIRS had evidence of bacterial, fungal, or viral infection and were considered septic. Respiratory gas exchange was measured by computerized indirect calorimetry for 1 to 2 hours continuously.


RESULTS
The REE of patients with SIRS or sepsis was not different from that of controls. Similarly, there were no differences in carbon dioxide production and oxygen consumption. Resting energy metabolism was not different between patients with SIRS and patients with sepsis. In addition, the presence of low platelet count or inotropic support did not affect resting energy metabolism. The median respiratory quotient of patients with SIRS or sepsis was 0.88 (range 0.75-1.12), indicating mixed utilization of fat and carbohydrate; this was not significantly different from that of controls. The Pediatric Risk of Mortality Score was not significantly correlated with REE or respiratory quotient.


CONCLUSIONS
The energy requirements of children with SIRS or sepsis are not increased. Their resting metabolism is based on both carbohydrate and fat utilization. The authors speculate that these children divert the energy for growth into recovery processes.
Turi
R A
RA
Department of Paediatric Surgery, Institute of Child Health and Great Ormond Street Hospital for Children NHS Trust, University College London, London, United Kingdom.
Petros
A J
AJ
Eaton
S
S
Fasoli
L
L
Powis
M
M
Basu
R
R
Spitz
L
L
Pierro
A
A
D016022:Case-Control Studies; D002675:Child, Preschool; D002149:Energy Intake; D004734:Energy Metabolism; D006801:Humans; D007223:Infant; D011659:Pulmonary Gas Exchange; D018805:Sepsis / Q000378:metabolism*; D012720:Severity of Illness Index; D018746:Systemic Inflammatory Response Syndrome / Q000378:metabolism*