Amino acids intake in critically ill children on nutritional support

Introduction: In critically ill children, proteins in nutritional support are very important, especially to preserve skeletal muscle mass and immune function. However, proteins can only be used optimally if amino acids meet the qualitative and quantitative needs for the organism. Currently no recommendation exists for this population.

Objectives: The aim of this observational study was to assess essential amino acids (EAAs) and nonessential amino acids (ENAAs) intakes in critically ill children.

Methods: Children with a nutritional support and length of stay in the Pediatric Intensive Care Unit ≥72 hours were consecutively included. Energy, protein and amino acids intakes were recorded daily using a clinical information system. In the absence of recommendations for critically ill children, EAAs were compared to the Dietary References Intakes for healthy children (DRI, 2005). For NEAAs, we used breast milk in young children (0 – 12 months) and mixed muscle protein content in older children (1 – 18 years) as reference values. Protein intake was also compared to the DRI.

Results: Thirteen children, 10 boys and 3 girls, with a median age [IQR)] of 2.5 [1 – 7] years were included in the study. 114 days were analyzed. Twelve children received enteral nutrition and only one received mixed nutrition. Two children received mother's milk, 3 received infant formulas, 7 received enteral solutions for children and 1 for adults. Mean (± SD) protein intake was 1.0 ± 0.5 g/kg/d and 31% of children reached the recommended protein intake. EAAs intake exceeded the DRI, especially for isoleucine (194%± 74% of DRI), tryptophane (173%± 79 of DRI) and threonine (169%± 66 of DRI). The NEAAs intake was lower or higher than the reference values. Infant formulas and enteral solutions are low in glutamine and taurine but rich in cysteine and tyrosine. In an expected way, EEAs and NEAAs intake were close to the reference values for children fed with breast milk.

Conclusion: Although protein intake was lower than the recommendations in this group of critically ill children, EAAs intake exceeded the reference values whereas NEAAs varied considerably. Further studies are needed to determine amino acids requirements in this population and to assess the risk of toxicity.

Disclosure of Interest: None Declared