Protein and energy-enriched formula enhances weight gain in critically ill infants


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Weight improvement with the use of protein and energy enriched nutritional formula in infants with a prolonged PICU stay

Eveleens et al., JHND Early View  Unknown.jpeg


Reaching an optimal nutritional intake is challenging in critically ill infants. One possible way to minimise nutritional deficits is the use of protein and energy‐enriched (PE)‐formulas. We aimed to describe weight achievement and gastrointestinal symptoms in infants admitted to the paediatric intensive care unit (PICU) while receiving PE‐formula for a prolonged period.


Records from infants admitted to a multidisciplinary PICU and using PE‐formula were analysed retrospectively. Infants were eligible if they received PE‐formula daily for at least 2 weeks. Weight achievement was determined as the difference between weight‐for‐age (WFA) Z‐scores at the start and end of PE‐formula use. Gastrointestinal symptoms, including gastric residual volume, constipation and vomiting, were evaluated as tolerance parameters.


Seventy infants with a median [interquartile range (IQR)] age of 76 (30–182) days were eligible. The PICU duration was 50 (35–83) days during which they received PE‐formula for 30 (21–54) days. Predominant admission diagnoses were post‐cardiac surgery, respiratory and cardiac diagnosis. A significant mean (SD) WFA Z‐score increase of 0.48 (1.10) (P < 0.001) and a median (IQR) weight gain of 5.80 (3.28–9.04) g kg−1 day−1 was observed. Multivariate regression showed that a lower WFA Z‐score at start was associated with a higher WFA Z‐score increase during PE‐formula use (β −0.35 (95% confidence interval =  −0.50 to −0.19); P < 0.001). The maximum 24‐h gastric residual volume was 8.1 mL (IQR = 2.2–14.3) for each 1 kg in bodyweight. Three (4%) infants were treated for diarrhoea and three infants were treated for vomiting.


The majority of infants with a prolonged PICU stay showed weight improvement when using PE‐formula. PE‐formula was well tolerated because gastrointestinal symptoms only occurred in few infants.


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