Measures of Total Energy Expenditure and Its Components Using the Doubly Labeled Water Method in Rehabilitating Burn Children.

Background: A persistent hypermetabolic state delays anabolism and growth in burned children. However, our own clinical experience has been that resting energy expenditure (REE) is not increased during the rehabilitative phase, suggesting other contributing factors. We measured total energy expenditure (TEE) and its components in rehabilitating pediatric burn patients to identify the basis for accelerated energy metabolism in this population.

Nutrition and metabolism in the rehabilitative phase of recovery in burn children: a review of clinical and research findings in a speciality pediatric burn hospital.

During the rehabilitation phase of burn injury, patient care transitions from critical care medicine to restorative treatment strategies that encompass physical and occupational therapies, nutrition repletion, and psychosocial support for community reintegration. As pediatric burn patients undergo rehabilitation, nutrition assessment remains ongoing to define nutritional status and any alterations in metabolism that may take place. For some, a persistent hypermetabolic state appears evident, and weight loss may continue.

The safety and efficacy of parenteral nutrition among pediatric patients with burn injuries.

Objective: Although enteral nutrition is the ideal mode of nutritional support following burn injury, it is often interrupted during episodes of severe sepsis and hemodynamic instability, leading to significant energy and protein deficits. Parenteral nutrition is not commonly used in burn centers due to concerns that it will lead to hyperglycemia, infection, and increased mortality. However, parenteral nutrition is often utilized in our burn unit when goal rate enteral nutrition is not feasible.

Bone mineral density in elite adolescent female figure skaters.

Unlabelled: Elite adolescent figure skaters must accommodate both the physical demands of competitive training and the accelerated rate of bone growth that is associated with adolescence, in this sport that emphasizes leanness. Although, these athletes apparently have sufficient osteogenic stimuli to mitigate the effects of possible low energy availability on bone health, the extent or magnitude of bone accrual also varies with training effects, which differ among skater disciplines.

Purpose: We studied differences in total and regional bone mineral density in 36 nationally ranked skaters among 3 skater disciplines: single, pairs, and dancers.

Eating attitudes and food intakes of elite adolescent female figure skaters: a cross sectional study.

Background: Elite adolescent female figure skaters compete in an aesthetic-based sport that values thin builds and lithe figures. To conform to the sport's physical requirements, skaters may alter their eating patterns in unhealthful directions. This study assesses the eating attitudes and dietary intakes of elite adolescent female figure skaters to assess the potential nutritional risks among them.

The selenium status of pediatric patients with burn injuries.

Background: Dietary selenium (Se) requirements during critical illness are not well known. The objective of this study was to assess the longitudinal Se status of pediatric patients with burns.

Methods: Twenty patients admitted to our hospital with burns exceeding 10% of their total body surface area were studied longitudinally during the first 8 weeks of admission or until 95% wound closure was achieved.

Malnutrition among pediatric burn patients: A consequence of delayed admissions.

Early definitive burn treatment is assumed to improve prognosis, in part because open wounds rapidly stimulate muscle catabolism and systemic inflammation. This study describes the incidence and management of injury associated malnutrition among pediatric burn patients transferred for definitive care 21-166 days following burn injury. Medical records of patients admitted to our hospital between January 2003 and January 2009, at least 3 weeks after burn injury, were retrospectively reviewed.

Asymptomatic hyperamylasemia and hyperlipasemia in pediatric patients with toxic epidermal necrolysis.

Although pancreatitis is rare in pediatric burn patients, elevated pancreatic enzymes have been recently observed among toxic epidermal necrolysis (TEN) patients. This clinical phenomenon has implications particularly for the nutritional management of patients involved. The objective of this study was to assess the frequency of sustained, elevated amylase, and lipase enzymes among children with TEN or Stevens Johnson Syndrome (SJS) and to evaluate the utilization of enteral nutrition support in this population.

Growth deceleration and restoration after serious burn injury.

There is a common perception that burned children are at risk for growth deceleration. However, because the prevalence, duration, and degree of this stereotypic growth are poorly described, making informed decisions about treatment is difficult. This article describes the natural history of growth after burn injury, according to the findings of a retrospective review conducted in a regional pediatric burn center.

Practical guidelines for nutritional management of burn injury and recovery.

Nutrition practice in burn injury requires a multifaceted approach aimed at providing metabolic support during a heightened inflammatory state, while accommodating surgical and medical needs of the patient. Nutritional assessment and determination of nutrient requirements is challenging, particularly given the metabolic disarray that frequently accompanies inflammation. Nutritional therapy requires careful decision making, regarding the safe use of enteral or parenteral nutrition and the aggressiveness of nutrient delivery given the severity of the patient's illness and response to treatment.

Body water in children during recovery from severe burn injury using a combined tracer dilution method.

Useful information about hydration and the size of the body cell mass (BCM) can be obtained by monitoring changes in the amount of total body water (TBW) and its components, extracellular water (ECW) and intracellular water (ICW). A combined tracer dilution method with deuterium to measure TBW and bromide to measure ECW was used to assess changes in ICW (as a proxy for the BCM) and in the ECW/ICW ratio (an indicator of water distribution) over the course of recovery in nine severely burned children. During the acute phase of recovery, ICW losses averaged (mean +/- SD) 2.

Sodium bromide by instrumental neutron activation analysis quantifies change in extracellular water space with wound closure in severely burned children.

Background: The ability to measure extracellular water (ECW) in critically ill patients can significantly enhance current methods of assessing fluid homeostasis, body composition, and response to nutritional therapy. We measured corrected bromide space to determine change in ECW with wound closure among acutely burned children.

Methods: Fifteen children with burns over 30% of their total body surface area had their ECW determined following hemodynamic stabilization and when wound closure was complete.