Critically ill infants benefit from early administration of protein and energy-enriched formula: a randomized controlled trial.
OBJECTIVE
Nutritional support improves outcome in critically ill infants but is impeded by fluid restriction, gastric intolerance and feeding interruptions. Protein and energy-enriched infant formulas may help to achieve nutritional targets earlier during admission and promote anabolism.


METHODS
Randomized controlled design. Infants with respiratory failure due to RSV-bronchiolitis received a protein and energy-enriched formula (PE-formula, n=8) or a standard formula (S-formula, n=10) during 5 days after admission.


METHODS
nutrient delivery, energy and nitrogen balance and plasma amino acid concentrations. Secondary outcome: tolerance and safety.


RESULTS
Nutrient intakes were higher in PE fed infants and met population reference intake (PRI) on day 3-5 whilst in S-fed infants PRI was met on day 5 only. Cumulative nitrogen balance (cNB) and energy balance (cEB) were higher in PE-infants compared to S-infants (cNB: 866+/-113 vs. 296+/-71 mg/kg; cEB: 151+/-31 and 26+/-17 kcal/kg, both P<0.01). Essential amino acid levels were higher in PE-infants but within reference limits whereas below these limits in S-infants. Both formulas were well tolerated.


CONCLUSIONS
Early administration of a protein and energy-enriched formula in critically ill infants is well tolerated, promotes a more adequate nutrient intake and improves energy and nitrogen balance without adverse effects.
Department of Pediatrics, Maastricht University and Medical Center, P Debeyelaan 25, Maastricht, The Netherlands. d.vanwaardenburg@mumc.n
Dick A
DA
van Waardenburg
Carlijn T
CT
de Betue
Johannes B van
JB
Goudoever
Luc J
LJ
Zimmermann
Koen F
KF
Joosten
D000596:Amino Acids / Q000097:blood; D016638:Critical Illness; D004044:Dietary Proteins / Q000008:administration & dosage* / Q000009:adverse effects / Q000378:metabolism; D002149:Energy Intake / Q000502:physiology*; D004734:Energy Metabolism; D005260:Female; D006801:Humans; D007223:Infant; D041943:Infant Formula / Q000008:administration & dosage / Q000737:chemistry; D007227:Infant Nutritional Physiological Phenomena / Q000502:physiology*; D007231:Infant, Newborn; D008297:Male; D009751:Nutritional Requirements; D009753:Nutritive Value; D010084:Oxidation-Reduction; D011502:Protein-Energy Malnutrition / Q000517:prevention & control*; D018357:Respiratory Syncytial Virus Infections / Q000150:complications / Q000378:metabolism
D000596:Amino Acids; D004044:Dietary Proteins