Nutrition in Pediatric Burns

Abstract

Nutrition and modulation of the hypermetabolic response to acute burns are reviewed in this article. Methods to determine caloric requirements are evaluated, including indirect calorimetry and predictive equations. Individual nutritional components of carbohydrates, fat, protein, vitamins, and trace elements are discussed specifically in relation to acute burn care. Selection of formula and route of administration are outlined, with an enteral high-carbohydrate, low-fat diet being preferable. Awareness and recognition of the signs and symptoms of malnutrition is critical in the management of variable caloric needs throughout hospitalization. Lastly, the catabolic state of acute burns is addressed through early excision and grafting and implementation of various pharmacologic agents, including growth hormone, insulin-like growth factor-1, insulin-like growth factor-binding protein-3, insulin, propranolol, and oxandrolone. Through a multipronged approach to nutrition, pediatric burn patients are provided the substrates for successful recovery and rehabilitation.

Keywords

indirect calorimetry - enteral and parenteral nutrition - malnutrition - growth hormone - insulin-like growth factor binding protein-3 - insulin - propranolol - oxandrolone

Publikationsverlauf

Artikel online veröffentlicht:
04. April 2024

• References

• 1 Hart DW, Wolf SE, Mlcak R. et al. Persistence of muscle catabolism after severe burn. Surgery 2000; 128 (02) 312-319
• 2 Rutan RL, Herndon DN. Growth delay in postburn pediatric patients. Arch Surg 1990; 125 (03) 392-395
• 3 Tredget EE, Yu YM. The metabolic effects of thermal injury. World J Surg 1992; 16 (01) 68-79
• 4 Rodriguez NA, Jeschke MG, Williams FN, Kamolz LP, Herndon DN. Nutrition in burns: Galveston contributions. JPEN J Parenter Enteral Nutr 2011; 35 (06) 704-714
• 5 Jeschke MG, Chinkes DL, Finnerty CC. et al. Pathophysiologic response to severe burn injury. Ann Surg 2008; 248 (03) 387-401
• 6 Weir JB. New methods for calculating metabolic rate with special reference to protein metabolism. J Physiol 1949; 109 (1-2): 1-9
• 7 Herndon DN. Total Burn Care. 5th ed.. New York: Elsevier; 2018
• 8 Wolf SE, Debroy M, Herndon DN. The cornerstones and directions of pediatric burn care. Pediatr Surg Int 1997; 12 (5-6): 312-320
• 9 Hildreth MA, Herndon DN, Desai MH, Duke MA. Caloric needs of adolescent patients with burns. J Burn Care Rehabil 1989; 10 (06) 523-526
• 10 Chan MM, Chan GM. Nutritional therapy for burns in children and adults. Nutrition 2009; 25 (03) 261-269
• 11 Bier DM, Brosnan JT, Flatt JP. et al; International Dietary Energy Consultative Group. Report of the IDECG Working Group on lower and upper limits of carbohydrate and fat intake. Eur J Clin Nutr 1999; 53 (Suppl. 01) S177-S178
• 12 Sheridan RL, Yu YM, Prelack K, Young VR, Burke JF, Tompkins RG. Maximal parenteral glucose oxidation in hypermetabolic young children: a stable isotope study. JPEN J Parenter Enteral Nutr 1998; 22 (04) 212-216
• 13 Pierre EJ, Barrow RE, Hawkins HK. et al. Effects of insulin on wound healing. J Trauma 1998; 44 (02) 342-345
• 14 Waitzberg DL, Torrinhas RS, Jacintho TM. New parenteral lipid emulsions for clinical use. JPEN J Parenter Enteral Nutr 2006; 30 (04) 351-367
• 15 Heyland DK, Wibbenmeyer L, Pollack JA. et al; RE-ENERGIZE Trial Team. A randomized trial of enteral glutamine for treatment of burn injuries. N Engl J Med 2022; 387 (11) 1001-1010
• 16 Holliday MA, Segar WE. The maintenance need for water in parenteral fluid therapy. Pediatrics 1957; 19 (05) 823-832
• 17 Mehta NM, Skillman HE, Irving SY. et al. Guidelines for the provision and assessment of nutrition support therapy in the pediatric critically ill patient: Society of Critical Care Medicine and American Society for Parenteral and Enteral Nutrition. JPEN J Parenter Enteral Nutr 2017; 41 (05) 706-742
• 18 Deitch EA. Intestinal permeability is increased in burn patients shortly after injury. Surgery 1990; 107 (04) 411-416
• 19 Herndon DN, Stein MD, Rutan TC, Abston S, Linares H. Failure of TPN supplementation to improve liver function, immunity, and mortality in thermally injured patients. J Trauma 1987; 27 (02) 195-204
• 20 Hart DW, Wolf SE, Chinkes DL. et al. Determinants of skeletal muscle catabolism after severe burn. Ann Surg 2000; 232 (04) 455-465
• 21 Herndon DN, Hawkins HK, Nguyen TT, Pierre E, Cox R, Barrow RE. Characterization of growth hormone enhanced donor site healing in patients with large cutaneous burns. Ann Surg 1995; 221 (06) 649-656 , discussion 656–659
• 22 Low JF, Herndon DN, Barrow RE. Effect of growth hormone on growth delay in burned children: a 3-year follow-up study. Lancet 1999; 354 (9192) 1789
• 23 Pereira CT, Herndon DN. The pharmacologic modulation of the hypermetabolic response to burns. Adv Surg 2005; 39: 245-261
• 24 Ramirez RJ, Wolf SE, Barrow RE, Herndon DN. Growth hormone treatment in pediatric burns: a safe therapeutic approach. Ann Surg 1998; 228 (04) 439-448
• 25 Herndon DN, Ramzy PI, DebRoy MA. et al. Muscle protein catabolism after severe burn: effects of IGF-1/IGFBP-3 treatment. Ann Surg 1999; 229 (05) 713-720 , discussion 720–722
• 26 Spies M, Wolf SE, Barrow RE, Jeschke MG, Herndon DN. Modulation of types I and II acute phase reactants with insulin-like growth factor-1/binding protein-3 complex in severely burned children. Crit Care Med 2002; 30 (01) 83-88
• 27 Sakurai Y, Aarsland A, Herndon DN. et al. Stimulation of muscle protein synthesis by long-term insulin infusion in severely burned patients. Ann Surg 1995; 222 (03) 283-294 , 294–297
• 28 Ferrando AA, Chinkes DL, Wolf SE, Matin S, Herndon DN, Wolfe RR. A submaximal dose of insulin promotes net skeletal muscle protein synthesis in patients with severe burns. Ann Surg 1999; 229 (01) 11-18
• 29 Herndon DN, Hart DW, Wolf SE, Chinkes DL, Wolfe RR. Reversal of catabolism by beta-blockade after severe burns. N Engl J Med 2001; 345 (17) 1223-1229
• 30 Hart DW, Wolf SE, Chinkes DL, Lal SO, Ramzy PI, Herndon DN. Beta-blockade and growth hormone after burn. Ann Surg 2002; 236 (04) 450-456 , discussion 456–457
• 31 Hart DW, Wolf SE, Ramzy PI. et al. Anabolic effects of oxandrolone after severe burn. Ann Surg 2001; 233 (04) 556-564
• 32 Murphy KD, Thomas S, Mlcak RP, Chinkes DL, Klein GL, Herndon DN. Effects of long-term oxandrolone administration in severely burned children. Surgery 2004; 136 (02) 219-224
• 33 Food and Drug Administration. Roth LK GL, LLC, et al.; Withdrawal of approval of one new drug application for OXANDRIN (oxandrolone) tablets and four abbreviated new drug applications for oxandrolone tablets. Fed Regist 2023; 88 (123) 41970-41971