Protein and energy requirements of children with burn trauma

Abstract

The Sutherland Formula is widely used in the United Kingdom to determine protein and energy requirements of burned children. Achieving the target of this formula can be difficult because of the high levels of protein and energy intake that are inherent in the Sutherland formula calculation. An alternative formula was devised using new parameters, i.e., normal daily nitrogen requirements, wound nitrogen losses and urinary nitrogen losses, which may more closely match the requirements of children with burns. The aim of the study was to evaluate the new formula and to reappraise the Sutherland Formula using current liquid enteral feeds and feeding methods. The study was randomly controlled in design, the Sutherland Fed (SF) Group received enteral feeds according to the Sutherland Formula and East Grinstead Formula (EGF) Group received enteral feeds according to the new East Grinstead Formula. Subjects entered the study on day zero of burn injury. Burn size, using the method of Lund and Browder, was used, to indicate the percentage of body surface area burned. All nutritional intakes were recorded, nutritional parameters, clinical assessments, wound status, medication, body weight changes, serum and urine analysis were assessed. Nine subjects were recruited into the Sutherland Formula Group, mean age 3 years, (range 1-5 years) mean burn size 19% Body Surface Area (BSA), range 10-40%. Eight subjects were recruited into East Grinstead fed Group, mean age 4 years, range 1-13 years mean burn size 15% BSA, range 10-30%. The Sutherland Formula Group achieved 80% of energy targets and 85% of protein targets. The East Grinstead Group achieved 95% of energy targets and 90% of protein targets. Total serum protein and albumin remained within the normal ranges for both groups. Serum Retinol binding protein and thyroxine binding protein showed an upward trend for both groups. Serum IGF-1 and growth hormone remained within the normal range for both groups. A larger number of patients in Sutherland Formula Group required antibiotics than in East Grinstead Formula Group. The Sutherland Formula Group had a negligible weight change -1.3%, whilst the East Grinstead Formula group had a weight gain +2.4%. An intake of 3g/kg/day protein is adequate to meet the requirements of young burned children, as was supplied by the EGF formula. A target protein intake at 4g/kg/day as provided by the Sutherland Formula is probably too high and did not appear necessary in the group of children studied. Children can be successfully and comfortably sustained on enteral feeding for 1-3 week periods and this mode of feeding can be instigated within hours of injury. Enteral feeding may be the only way to achieve EGF targets due to the rigorous demands of the surgical and clinical management procedures endured by these patients. From this work the researcher concluded that the East Grinstead Formula is appropriate for feeding children with burn trauma from a clinical and practical point of view. This study supports the findings of other studies in burned adults in that early enteral feeding of burned children is beneficial in promoting good nutritional status. In addition the low volume, isotonic, high protein enteral feed, with a protein energy ratio of 2 0 %, used in this study, was tolerated by the children studied. Simplification of the East Grinstead Formula for burned children is: Protein 3g/kg BW/day with a protein energy ratio of 17-20%.