title: Caloric Requirements of Patients With Brain Impairment and Cerebral Palsy Who Are Dependent on Chronic Ventilation.
abstract: Israeli law mandates chronic ventilator support for children and adolescents who are severely brain impaired and show minimal responses. Feeding protocols in these cases have been based on the caloric requirements of healthy children, deducting calories for lack of activity as well as an individual adjustment according to the cerebral palsy growth curves. However, patients are still inclined to gain excessive weight. Our objective was to determine the caloric requirements of these patients.
  
  
  
  Sixteen patients hospitalized in a dedicated unit who were ventilated through tracheostomies and fed via gastrostomies were included. Patients were aged 3-24 years; duration of ventilation was 1-7.5 years; and diagnoses included congenital genetic or brain malformations (n = 9), hypoxic accidents (n = 4), and postbacterial or postviral encephalitis (n = 3). Resting energy expenditure (REE) was determined by indirect calorimetry. REE values were compared with the caloric requirements of age-comparable healthy children and the calories actually delivered. Data were analyzed with paired t tests, Pearson correlations, and linear regression.
  
  
  
  The REE of our patients was 46% lower than the estimated caloric requirements of healthy children. In practice, patients received 32% more calories than that measured by REE. These findings were not affected by age, weight, diagnosis, or length of hospitalization.
  
  
  
  The caloric expenditure of these patients is very low. A diet guided by indirect calorimetry is proposed to aid in providing optimal nutrition support for this unique population to avoid overfeeding and obesity.
authors.affiliation: 1 Children's Respiratory Unit, Herzog Hospital, Jerusalem, Israel.
authors.forename: Rena
authors.initials: R
authors.lastname: Gale
authors.affiliation: 1 Children's Respiratory Unit, Herzog Hospital, Jerusalem, Israel.
authors.forename: Julia
authors.initials: J
authors.lastname: Namestnic
authors.affiliation: 2 General Intensive Care Department and Institute for Nutrition Research, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel.
authors.forename: Pierre
authors.initials: P
authors.lastname: Singer
authors.affiliation: 2 General Intensive Care Department and Institute for Nutrition Research, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel.
authors.forename: Ilya
authors.initials: I
authors.lastname: Kagan
mesh_terms: D000293:Adolescent; D000328:Adult; D001481:Basal Metabolism; D001835:Body Weight; D002547:Cerebral Palsy / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D002149:Energy Intake; D005260:Female; D006801:Humans; D007557:Israel; D016014:Linear Models; D008297:Male; D009751:Nutritional Requirements; D009752:Nutritional Status; D012121:Respiration, Artificial; D012189:Retrospective Studies; D055815:Young Adult
keywords: brain impaired; caloric requirements; cerebral palsy; children; chronic ventilation; gastrostomy feeding; resting energy expenditure