title: Enteral nutrition in the critically ill child: comparison of standard and protein-enriched diets.
abstract: OBJECTIVE
  To compare a standard diet and a protein-enriched diet in critically ill children.
  
  
  METHODS
  In this prospective randomized controlled trial in critically ill children, all patients received enteral nutrition exclusively and were randomly assigned to a standard diet or a protein-enriched diet (1.1 g protein/100 mL of feeding formula). Blood and urine tests, nitrogen balance assessment, and energy expenditure testing by indirect calorimetry were performed before the beginning of the nutrition regimen and at 24 hours, 72 hours, and 5 days after initiation. Demographic data and pediatric mortality risk scores were recorded.
  
  
  RESULTS
  Fifty-one children were randomized, and 41 completed the study. Of these, 21 patients received standard formula and 20 received a protein-enriched formula. There were no between-group differences in terms age, sex, diagnosis, or mortality risk scores. There was a greater positive trend in levels of prealbumin, transferrin, retinol-binding protein, and total protein in the protein-enriched diet group. These differences were significant only for retinol-binding protein. The positive nitrogen balance trend was also higher in the protein-enriched diet group; however, this difference did not reach statistical significance. No adverse effects or hyperproteinemia were detected in the protein-enriched diet group.
  
  
  CONCLUSIONS
  The standard diet provides insufficient protein delivery to critically ill children. Enteral protein supplementation is safe and can improve some biochemical parameters of protein metabolism.
authors.affiliation: Pediatric Intensive Care Department, General Hospital of Gregorio Marañón University, Madrid, Spain.
authors.forename: Marta
authors.initials: M
authors.lastname: Botrán
authors.forename: Jesús
authors.initials: J
authors.lastname: López-Herce
authors.forename: Santiago
authors.initials: S
authors.lastname: Mencía
authors.forename: Javier
authors.initials: J
authors.lastname: Urbano
authors.forename: Maria José
authors.initials: MJ
authors.lastname: Solana
authors.forename: Ana
authors.initials: A
authors.lastname: García
mesh_terms: D000418:Albumins / Q000378:metabolism; D002648:Child; D016638:Critical Illness / Q000628:therapy*; D004044:Dietary Proteins / Q000008:administration & dosage*; D004734:Energy Metabolism; D004750:Enteral Nutrition / Q000379:methods*; D005260:Female; D005526:Food, Formulated; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric; D008297:Male; D009584:Nitrogen / Q000378:metabolism; D011228:Prealbumin / Q000378:metabolism; D011446:Prospective Studies; D012177:Retinol-Binding Proteins / Q000378:metabolism; D014168:Transferrin / Q000378:metabolism
chemical_list: D000418:Albumins; D004044:Dietary Proteins; D011228:Prealbumin; D012177:Retinol-Binding Proteins; D014168:Transferrin; D009584:Nitrogen