title: Monitoring of protein catabolism in neonates and young infants post-cardiac surgery.
abstract: OBJECTIVE
  To evaluate cell catabolism by balance of nitrogen and phosphate, and creatinine excretion in children post-cardiac surgery; to establish protein and energy requirements to minimize catabolism; and to assess nutritional therapy by following these parameters and serial anthropometric measurements.
  
  
  METHODS
  A prospective observational study of children with congenital heart disease undergoing cardiac surgery. Blood samples and 24-h urine collections were obtained postoperatively for creatinine measurement and nitrogen and phosphate balance. Anthropometric measurements (weight, mid-arm muscle circumference and triceps skinfold thickness) were obtained preoperatively and at paediatric intensive care unit and hospital discharge.
  
  
  RESULTS
  Eleven children were studied for 3-10 postoperative days. Anabolism was associated with higher protein and energy intakes compared to catabolism (1.1 vs. 0.1 g/kg/day and 54 vs. 17 kcal/kg/day, respectively). On days with anabolism, phosphate balance was greater compared with that on days with catabolism. Daily creatinine excretion did not correlate with protein balance. Anthropometric measurements did not change significantly over time.
  
  
  CONCLUSIONS
  Children with congenital heart disease undergoing cardiac surgery achieved anabolism with >55 kcal/kg/day and >1 g/kg/day of protein. Balance of phosphate was useful to monitor cell breakdown. Anthropometric measurements were not valuable to evaluate nutritional therapy in this population.
authors.affiliation: Department of Pediatrics, Hospital das Clínicas, Faculty of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil.
authors.forename: Monica Akissue Camargo
authors.initials: MA
authors.lastname: Teixeira-Cintra
authors.forename: Jacqueline Pontes
authors.initials: JP
authors.lastname: Monteiro
authors.forename: Marina
authors.initials: M
authors.lastname: Tremeschin
authors.forename: Tânia Maria Beltramini
authors.initials: TM
authors.lastname: Trevilato
authors.forename: Mitchell Lewis
authors.initials: ML
authors.lastname: Halperin
authors.forename: Ana Paula
authors.initials: AP
authors.lastname: Carlotti
mesh_terms: D000886:Anthropometry; D003404:Creatinine / Q000652:urine; D002149:Energy Intake; D005260:Female; D006330:Heart Defects, Congenital / Q000097:blood / Q000601:surgery / Q000652:urine; D006801:Humans; D007223:Infant; D007227:Infant Nutritional Physiological Phenomena; D007231:Infant, Newborn; D008297:Male; D008991:Monitoring, Physiologic / Q000379:methods; D009584:Nitrogen / Q000097:blood; D044623:Nutrition Therapy; D009751:Nutritional Requirements; D010710:Phosphates / Q000097:blood; D011182:Postoperative Care; D011446:Prospective Studies; D011506:Proteins / Q000008:administration & dosage / Q000378:metabolism*; D016896:Treatment Outcome
chemical_list: D010710:Phosphates; D011506:Proteins; D003404:Creatinine; D009584:Nitrogen