title: Increased protein-energy intake promotes anabolism in critically ill infants with viral bronchiolitis: a double-blind randomised controlled trial.
abstract: OBJECTIVE
  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)).
  
  
  METHODS
  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).
  
  
  RESULTS
  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%).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Paediatrics, Maastricht University Medical Center, PO Box 5800, 6202 AZ Maastricht, The Netherlands.
authors.forename: Carlijn T
authors.initials: CT
authors.lastname: de Betue
authors.forename: Dick A
authors.initials: DA
authors.lastname: van Waardenburg
authors.forename: Nicolaas E
authors.initials: NE
authors.lastname: Deutz
authors.forename: Hans M
authors.initials: HM
authors.lastname: van Eijk
authors.forename: Johannes B
authors.initials: JB
authors.lastname: van Goudoever
authors.forename: Yvette C
authors.initials: YC
authors.lastname: Luiking
authors.forename: Luc J
authors.initials: LJ
authors.lastname: Zimmermann
authors.forename: Koen F
authors.initials: KF
authors.lastname: Joosten
mesh_terms: D000596:Amino Acids / Q000097:blood; D001990:Bronchiolitis, Viral / Q000378:metabolism / Q000628:therapy*; D016638:Critical Illness / Q000628:therapy; D004044:Dietary Proteins / Q000008:administration & dosage*; D004311:Double-Blind Method; D002149:Energy Intake / Q000502:physiology*; D004750:Enteral Nutrition / Q000379:methods; D005260:Female; D006801:Humans; D007223:Infant; D041943:Infant Formula / Q000737:chemistry*; D007227:Infant Nutritional Physiological Phenomena / Q000502:physiology; D008297:Male; D018529:Nutritional Support; D014176:Protein Biosynthesis / Q000187:drug effects; D011506:Proteins / Q000378:metabolism; D016896:Treatment Outcome
chemical_list: D000596:Amino Acids; D004044:Dietary Proteins; D011506:Proteins