Measurement of resting energy expenditure in infants

OBJECTIVE: The method for measurement of basal metabolic rate (BMR) using indirect calorimetry in adults is well established but is impractical in infants. METHODS: In this prospective study energy expenditure was measured using indirect calorimetry in 14 infants when sleeping and when lying quietly awake. RESULTS: Sleeping metabolic rate (SMR) was lower than energy expenditure (EE) measured in the same infants in a quiet resting state (mean difference [SD]: 297 [162] kJ/d; P < 0.005; 55 [33.4] kJ/kg per day; P < 0.005). The correlation within individuals suggests that these differences are related to the level of arousal. Awake EE, but not SMR, was significantly greater than estimated BMR using the FAO/WHO/UNU predictive equation. CONCLUSIONS: In infants, the level of arousal during measurement of EE can significantly impact on the interpretation of EE results. A standardized method for the measurement of EE in infants using indirect calorimetry is proposed.     

Total energy expenditure in infants with bronchopulmonary dysplasia is associated with respiratory status

Growth failure is a well-known problem in infants with bronchopulmonary dysplasia (BPD). We studied BPD infants' total daily energy expenditure (Ee), nutritional balance, and growth in relation to their past and current clinical status. Applying the doubly labelled water technique, Ee was measured in nine preterm infants with BPD receiving supplemental oxygen (postnatal age 61 ± 13 days) and nine matched controls (36 ± 21 days) during a 6-day period. Energy and protein balance, past and present respiratory status, and growth were assessed as well. The results show that Ee was higher in the BPD infants compared to controls (73 ± 9 vs 63 ± 8 kcal/kg/day, P < 0.05), but their faecal energy loss was lower (P < 0.01). Weight gain, energy intake, energy cost of growth, protein retention, and physical activity were not different. The respiratory frequency (RR) in the BPD infants was elevated in comparison with controls (P < 0.01). Within the BPD group, RR was positively correlated with energy expenditure (regression equation: Ee [kcal/kg/day] = 26.3 + 0.71*RR [min⁻¹]; r ² = 0.82, P < 0.001), and was the single most significant determinant of Ee. Conclusion Total energy expenditure in BPD infants is elevated and is strongly associated with their respiratory status. These findings could be of practical value for the nutritional management in infants with severe BPD. Received: 17 January 1996 / Accepted: 23 July 1996     

Resting energy expenditure is not increased in prepubertal children with Alagille syndrome

Increased resting energy expenditure (REE) is a possible explanation for the negative energy balance seen in children with Alagille syndrome (AGS). We evaluated 16 subjects with AGS and 37 healthy controls and did not find a significant difference in REE (101% +/- 12%, 105% +/- 13%, respectively).     

Total and resting energy expenditure in children with sickle cell disease

OBJECTIVE: To investigate energy balance in children with sickle cell disease (SCD) as the possible cause of impaired growth and undernutrition. STUDY DESIGN: Growth, resting (REE), total (TEE), and activity-related (AEE) energy expenditure and dietary intake were examined in 36 African American children with SCD (20 girls and 16 boys) and 30 control subjects (15 girls and 15 boys) of similar age (mean, 11.2 years) and ethnicity. TEE was measured by means of the doubly labeled water technique and REE by indirect calorimetry. AEE was calculated as TEE minus REE. Fat free mass (FFM) was calculated from skinfold prediction equations. RESULTS: REE was significantly increased (131 kcal/d) in children with SCD (P =.001), after adjusting for sex and FFM. Children with SCD tended to have lower TEE (214 kcal/d) than control subjects, but there was no difference after adjusting for FFM and sex (P =.57). Children with SCD had significantly (P =.025) lower AEE (268 kcal/d) but only marginally (P =.08) lower AEE after adjusting for FFM and sex. CONCLUSIONS: The elevated REE and lower AEE, in combination with poor growth status, indicate chronic energy deficiency in children with SCD. Further studies are needed to determine the best approaches to the treatment and prevention of undernutrition in children with SCD.     

新生儿静息能量消耗测定研究

为探讨测定新生儿静息能量消耗(REE)的方法并对健康新生儿REE进行测定研究,本文应用间接能量测定仪对19例健康新生儿进行REE检测.结果表明健康新生儿REE为(189.2±27.4)kJ/kg,并与测定时体重、体表面积、预测值均呈显著相关关系,其中日龄和体表面积是REE主要决定因素.研究显示REE测定对新生儿营养支持有重要的临床应用价值.     

Total energy expenditure in small for gestational age infants.

AIM: To measure total energy expenditure and body composition in small for gestational age (SGA) infants in order to investigate proposed hypermetabolism in such babies. METHODS: A cross sectional study of 52 SGA infants measured at 5 weeks of age was made, using existing data from appropriate for gestational age (AGA) infants as controls. The double labelled water technique was used to assess both total energy expenditure and body composition. RESULTS: Multiple regression analysis showed that expressing energy expenditure per kg fat free mass adjusts for body composition in infants of this age. The relation between total energy expenditure and fat free mass differed between the two groups. CONCLUSION: These data indicate that for a given fat free mass the total energy expenditure of SGA infants is greater than that of AGA infants. Such data should be taken into account when energy requirements for SGA infants are being considered.     

Total energy expenditure in small for gestational age infants.

OBJECTIVE: To measure total energy expenditure and body composition in small for gestational age (SGA) infants, to investigate hypermetabolism. METHODS: A cross-sectional study was performed in 52 small for gestational age (SGA) measured at 5 weeks of age, using existing data from appropriate for gestational age (AGA) infants as controls. The doubly-labelled water technique was used to assess both total energy expenditure and body composition in both cohorts of infants. RESULTS: Multiple regression analysis revealed that expressing energy expenditure per kg fat free mass adjusts for body composition in infants of this age. Regression analysis also showed that the relation between total energy expenditure and fat free mass differed between the two groups. CONCLUSION: These data indicate that for a given fat free mass, the total energy expenditure of SGA infants is greater than that of AGA infants. Such data should be taken into account when energy requirements for SGA infants are being considered.     

婴儿大型室间隔缺损并发肺炎和呼吸衰竭的早期手术治疗

目的 探讨婴儿大型室间隔缺损（VSD）并发肺炎和呼吸衰竭早期手术治疗的可行性、手术时机和适应证以及术中和术后处理。方法 1999年10月～2004年1月，我院收治大型VSD并发肺炎和呼吸衰竭29例婴儿，19例进行带机早期手术治疗，10例行内科保守治疗。结果 手术病例中，18例婴儿手术成功、脱离呼吸机出院，术后主要并发症有肺不张、气胸、气管再插管，无全身感染、肺动脉高压危象以及严重低心排病例；1例婴儿死于气管狭窄，病死率5．3％。内科保守治疗病例中，8例在治疗途中因心肺衰竭死亡，病死率80Uo；2例好转撤离呼吸机出院。结论 把握手术时机和适应证，防治术中和术后肺损伤，带机早期手术治疗可提高和改善大型VSD并发肺炎和呼吸衰竭婴儿治疗效果和预后。     

Evaluation of resting energy expenditure in children with cystic fibrosis

The aim of the investigation was to assess resting energy expenditure (REE) and substrate utilisation rate in children with cystic fibrosis. Body mass coefficient was below normal limits in 2 out of 14 controls and in 9 out of 10 patients with cystic fibrosis (p < 0.001). REE and basal energy expenditure (BEE) in the patient group were respectively 52.2 +/- 8.7 kcal/kg and 45.7 +/- 8.9 kcal/kg (p < 0.006). REE/BEE ratios in relation to total body mass were 115.34 +/- 12.27% and 93.54 +/- 4.47% (p < 0.001). REE / BEE ratio in relation to lean body mass 102.95 +/- 11.5% and 92.94 +/- 5.74% (p < 0.007). Substrate oxidation rate in the patient group and control group (g/kg) were: glycogen: 4.13 +/- 2.32 and 1.91 +/- 0.81 (p < 0.004); fat: 2.76 +/- 1.39 and 1.51 +/- 0.59 (p < 0.006); protein: 1.98 +/- 0.45 and 1.32 +/- 0.40 (p < 0.001). In conclusion: In children with cystic fibrosis, malnutrition was found with increase REE which resulted from higher substrate utilisation rate as compared with the control group.     

Predicting resting energy expenditure in boys with Duchenne muscular dystrophy

BackgroundUnderstanding how best to predict energy needs in Duchenne muscular dystrophy (DMD) is fundamental to weight management in clinical practice; however there is a large gap in the literature regarding information on the most appropriate method. We aimed to ascertain the most valid predictive equation that can be used to predict REE in steroid treated ambulatory boys with DMD.MethodsREE was measured in 9 boys with DMD using indirect calorimetry after an overnight fast. REE was predicted using five different equations, based on height, weight, or body composition variables.ResultsMean measured REE was 5.4 (SD 0.4) MJ/day. The inclusion of fat free mass in the prediction equation provided no benefit over body weight. The exclusion of height, when compared with weight alone, improved predictive performance, as seen with the Schofield equations, in which a minimal bias and root means squared error is seen.ConclusionsThe most accurate and precise equation was the Schofield weight equation (Bias ?0.2 MJ, 95% CI: ?1.3–0.9 MJ), which can easily be calculated in a clinical setting and provides a solid foundation from which clinicians can establish energy requirements to support nutritional management in boys with DMD.     

39例大型房间隔缺损 室间隔缺损并发肺炎婴儿早期手术治疗的临床分析

目的：婴儿大型房间隔缺损(ASD)室间、隔缺损(VSD)难以自愈,需要尽早手术纠治,以免影响发育甚至导致死亡。但是这类患儿往往并发严重的肺部感染,且反复发作,很难等到肺部感染完全治愈时进行手术纠治。同时患儿需要反复治疗肺炎,费用较高且易延误手术时机。因此,该文研究婴儿大型房间隔缺损、室间隔缺损并发肺炎的早期手术治疗的手术时机选择、治疗的可行性以及减少并发症的处理。方法：2003年1月至2008年 1月,收治大型ASD, VSD并发肺炎39例婴儿,36例在肺炎控制后进行早期手术治疗,3例再行儿科保守治疗。结果：手术病例中, 33例婴儿手术成功, 2例婴儿死于气管狭窄, 1例死于严重低心排, 死亡率8.3%。儿科保守治疗病例中,1例在治疗中因心肺衰竭死亡 ;2 例好转出院,择期行手术治疗成功。结论：把握手术时机和适应证,做好围术期处理,在肺炎控制后对大型ASD,VSD的婴儿进行早期手术治疗是可行的,可提高和改善治疗效果并减少患者费用     

Calculation of resting energy expenditure in obese children

For the calculation of resting energy expenditure, which is the main part of total energy expenditure in children with low physical activity, Fusch et al. have developed an equation.
Conclusion : This equation might be useful for research but not in daily work with obese patients.     

Decreased energy expenditure is caused by abnormal body composition in infants with Prader-Willi Syndrome

OBJECTIVE: Infants with Prader-Willi syndrome (PWS) are hypotonic and underweight before the onset of childhood obesity. This study evaluates body composition in the PWS infant and its relationship to energy expenditure. STUDY DESIGN: Sixteen infants and toddlers with PWS (mean age, 12.4+/-6 months; eight female subjects) underwent analysis of body composition with dual-energy x-ray absorptiometry and deuterium dilution, and energy expenditure with both doubly labeled water and indirect calorimetry. RESULTS: Percent body fat was significantly increased (male subjects, P<.001; female subjects, P<.001) and fat-free mass (FFM) was significantly decreased (male subjects, P<.001; female subjects, P=.04) in infants with PWS when compared with age-matched published data for normal infants. Meanwhile, total energy expenditure was significantly decreased (male subjects, P=.025; female subjects, P<.001) in infants with PWS when compared with published normative data. There was a normal relationship between FFM and total energy expenditure in infants with PWS. CONCLUSION: Compared with published data for infants without PWS, infants with PWS demonstrate increased percent body fat, decreased FFM, and decreased energy expenditure. Importantly, total energy expenditure per kilogram of FFM appears similar in infants with and without PWS. We conclude that lower energy expenditure in infants with PWS is caused by decreased FFM.     

危重病患儿静息能量消耗研究进展

静息能量消耗能较好地反映机体每天总能量消耗,是临床研究能量消耗的常用指标.机体在不同的生理或病理状态下,能量代谢特点也不同.危重病患儿由于机体对应激、创伤、手术、炎症的代谢反应不同,其能量消耗具有特殊性.危重病患儿的静息能量消耗还受到疾病类别、疾病的危重程度、呼吸机通气时间、呼吸机模式等影响.该文就近年来危重病患儿的静...