PMID- 7472959
OWN - NLM
STAT- MEDLINE
DCOM- 19951204
LR  - 20190710
IS  - 0022-3468 (Print)
IS  - 0022-3468 (Linking)
VI  - 30
IP  - 7
DP  - 1995 Jul
TI  - Early postoperative alterations in infant energy use increase the risk of 
      overfeeding.
PG  - 988-92; discussion 992-3
AB  - AIM OF STUDY: Energy needs in infants are decreased after surgery because of 
      growth inhibition (resulting from catabolic stress metabolism), decreased 
      insensible losses, and inactivity. Using standardized formulas that account for 
      growth, activity, and insensible losses during this stress period can lead to 
      overfeeding in excess of 200% of the actual measured requirement. Overfeeding 
      during this acute injury period can result in increased CO2 production from 
      lipogenesis. This study determined the effects of a reduced rate of mixed caloric 
      repletion on infant energy use during the early postoperative period. METHODS: 
      C-reactive protein (CRP), oxygen consumption (VO2), carbon dioxide production 
      (VCO2), measured energy expenditure (MEE), and total urinary nitrogen (TUN) were 
      measured serially in seven infants (average age, 78 days) during the first 72 
      hours after abdominal or thoracic surgery. Nonprotein respiratory quotient 
      (RQnp), and values for oxidation of carbohydrate (Ce) and fat (Fe) were 
      calculated. Injury severity was stratified based on serum CRP concentrations of > 
      or = 6.0 mg/dL (high stress) or < 6.0 mg/dL (low stress). Recovery from acute 
      stress was analyzed by comparing studies in which CRP had decreased to < or = 2.0 
      mg/dL (resolving stress group) with those in which CRP values were greater than 
      2.0 mg/dL (acute stress group). RESULTS: Average total caloric intake (64.56 +/- 
      18.51 kcal/kg/d; approximately 50% of predicted energy requirement) exceeded 
      average MEE (42.90 +/- 9.98 kcal/kg/d) by approximately 50%. Average TUN was 0.18 
      +/- 0.07 g/kg/d (high stress 0.2 +/- 0.05 versus low stress 0.16 +/- 0.09 
      g/kg/d). Average RQnp was 1.05 +/- 0.13 and average Ce was 37.28 +/- 16.86 
      kcal/kg/d. The average calculated Fe was 0.0 +/- 12.27 kcal/kg/d, reflecting 
      approximately equal amounts of fat oxidized compared with fat generated from 
      excess glucose (lipogenesis). When individual studies were analyzed at a CRP 
      cutpoint of 2.0 mg/dL, overfeeding (RQ > 1.0) was significantly less likely in 
      the resolving (2/6 studies, 33.4%) versus acute stress (9/13 studies, 69.2%, Z 
      test P < .001) group. Five of seven (5/7) patients (9/19 individual studies) had 
      negative Fe values (average -9.89 +/- 10.02) reflecting net lipogenesis. The RQnp 
      for these nine studies was 1.14 +/- 0.11 versus 0.97 +/- 0.09 for the remaining 
      10, and this difference was significant (P < .01). A significant correlation 
      existed between carbohydrate intake and VCO2 (Pearson r = .6951, P < .01). In 
      addition, there was a good correlation between carbohydrate intake and VCO2 
      (Pearson r = .6591, P < .01). The coefficient of variation for MEE was 8.0% (low 
      stress) versus 30.2% (high stress). CONCLUSION: Lipogenesis with increased CO2 
      production is substantial, even at reduced caloric delivery rates that exceeded 
      MEE by only 50%, during the early postoperative acute metabolic stress period in 
      infants. These data suggest that caloric requirements during stress are likely 
      equal to or only minimally in excess of actual MEE. Intersubject variability, 
      especially in more severely stressed infants, underscores the importance of 
      serial measurements of energy expenditure to enable precise caloric delivery and 
      avoid overfeeding. In the absence of calorimetric measurement, the data suggest 
      that PBMR (predicted basal metabolic rate) should be used to estimate caloric 
      delivery until CRP values are < or = 2.0 mg/dL.
FAU - Letton, R W
AU  - Letton RW
AD  - Department of Surgery, Bowman Gray School of Medicine, Wake Forest University, 
      Winston-Salem, NC 27157-1095, USA.
FAU - Chwals, W J
AU  - Chwals WJ
FAU - Jamie, A
AU  - Jamie A
FAU - Charles, B
AU  - Charles B
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PL  - United States
TA  - J Pediatr Surg
JT  - Journal of pediatric surgery
JID - 0052631
RN  - 0 (Dietary Carbohydrates)
RN  - 0 (Dietary Fats)
RN  - 0 (Lipids)
RN  - 142M471B3J (Carbon Dioxide)
RN  - 9007-41-4 (C-Reactive Protein)
RN  - IY9XDZ35W2 (Glucose)
RN  - N762921K75 (Nitrogen)
SB  - IM
MH  - Abdomen/surgery
MH  - C-Reactive Protein/analysis
MH  - Carbon Dioxide/metabolism
MH  - Dietary Carbohydrates/metabolism
MH  - Dietary Fats/metabolism
MH  - Energy Intake
MH  - *Energy Metabolism
MH  - Glucose/metabolism
MH  - Growth
MH  - Humans
MH  - Infant
MH  - *Infant Food
MH  - *Infant Nutritional Physiological Phenomena
MH  - Lipids/biosynthesis
MH  - Motor Activity
MH  - Nitrogen/urine
MH  - Oxidation-Reduction
MH  - Oxygen Consumption
MH  - Postoperative Period
MH  - Respiration
MH  - Risk Factors
MH  - Stress, Physiological/metabolism
MH  - *Surgical Procedures, Operative
MH  - Thoracic Surgery
EDAT- 1995/07/01 00:00
MHDA- 1995/07/01 00:01
CRDT- 1995/07/01 00:00
PHST- 1995/07/01 00:00 [pubmed]
PHST- 1995/07/01 00:01 [medline]
PHST- 1995/07/01 00:00 [entrez]
AID - 0022-3468(95)90327-5 [pii]
AID - 10.1016/0022-3468(95)90327-5 [doi]
PST - ppublish
SO  - J Pediatr Surg. 1995 Jul;30(7):988-92; discussion 992-3. doi: 
      10.1016/0022-3468(95)90327-5.