title: Protein Requirements of the Critically Ill Pediatric Patient.
abstract: This article includes a review of protein needs in children during health and illness, as well as a detailed discussion of protein metabolism, including nitrogen balance during critical illness, and assessment and prescription/delivery of protein to critically ill children. The determination of protein requirements in children has been difficult and challenging. The protein needs in healthy children should be based on the amount needed to ensure adequate growth during infancy and childhood. Compared with adults, children require a continuous supply of nutrients to maintain growth. The protein requirement is expressed in average requirements and dietary reference intake, which represents values that cover the needs of 97.5% of the population. Critically ill children have an increased protein turnover due to an increase in whole-body protein synthesis and breakdown with protein degradation leading to loss of lean body mass (LBM) and development of growth failure, malnutrition, and worse clinical outcomes. The results of protein balance studies in critically ill children indicate higher protein needs, with infants and younger children requiring higher intakes per body weight compared with older children. Monitoring the side effects of increased protein intake should be performed. Recent studies found a survival benefit in critically ill children who received a higher percentage of prescribed energy and protein goal by the enteral route. Future randomized studies should evaluate the effect of protein dosing in different age groups on patient outcomes, including LBM, muscle structure and function, duration of mechanical ventilation, intensive care unit and hospital length of stay, and mortality.
authors.affiliation: 1 Section of Critical Care, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA.|2 Texas Children's Hospital, Houston, Texas, USA.
authors.forename: Jorge A
authors.initials: JA
authors.lastname: Coss-Bu
authors.affiliation: 3 Department of Dietetics & Nutrition, University of Kansas Medical Center, Kansas City, Kansas, USA.
authors.forename: Jill
authors.initials: J
authors.lastname: Hamilton-Reeves
authors.affiliation: 4 Division of Pulmonary & Critical Care Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
authors.forename: Jayshil J
authors.initials: JJ
authors.lastname: Patel
authors.affiliation: 5 Department of Pediatrics, Emory-Children's Center for Cystic Fibrosis and Airways Disease Research, Emory University School of Medicine, Atlanta, Georgia, USA.
authors.forename: Claudia R
authors.initials: CR
authors.lastname: Morris
authors.affiliation: 6 Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Ryan T
authors.initials: RT
authors.lastname: Hurt
mesh_terms: D001835:Body Weight; D002648:Child; D016638:Critical Illness; D004044:Dietary Proteins / Q000378:metabolism; D002149:Energy Intake; D006801:Humans; D015278:Intensive Care Units, Pediatric; D009751:Nutritional Requirements
chemical_list: D004044:Dietary Proteins
keywords: catabolism; child; critical illness; intensive care; nitrogen balance; pediatrics; protein; protein balance