Aspects of protein metabolism in children in acute and chronic illness

In critically ill children, a negative protein balance is associated with an increased incidence of infections, fewer ventilator-free days, and increased length of stay in the pediatric intensive care unit. Additionally, a malnourished state due to chronic illness increases the risk of respiratory infections, length of hospitalization, and is associated with an increase in economic burden.
The principal aim of this thesis was to investigate the effect of high (5 g/kg/d) versus age-related, normal protein intake on whole-body protein synthesis (WBPS), -breakdown (WBPB), and net balance in children with acute or chronic disease.
In this thesis, we demonstrated that in young children following cardiac surgery, early enteral nutrition with normal protein (NP) intake of 2 g/kg/d, but not high carbohydrate intake-induced hyperinsulinemia, can reverse negative net whole-body protein balance in the immediate postoperative phase. High protein (HP) intake of 5 g/kg/d does not serve to improve WBPS or net protein balance, and therefore cannot be recommended over standard protein intake.
In contrast, in school-age children with chronic illness (CF with stunted growth), WBPS and net protein balance can be improved by provision of a higher (5 g/kg/d) than currently recommended intake of protein. Further studies are necessary to demonstrate a possible effect on increased LBM and improved linear growth and body composition.
Finally, the implementation of a nurse-driven feeding algorithm, together with the institution of an NST, increases early prescription and consecutive delivery of calories and macronutrients to patients in the first days following admission to a PICU.