Double-blind, parallel, randomised study to investigate the effect of an energy- and protein-enriched formula on whole body protein turnover, substrate utilization, growth and tolerance in mechanically ventilated, critically ill infants.

Adequate nutrition is essential part of threatment of critically ill infants and children but often receives little attention in the acute phase of the disease. Undernutrition however is present in 15-20% of all children admitted to pediatric intensive cares. Undernutrition is associated with decreased woundhealing, decreased immunefunction and increased mortality and morbidity. Requirements of critically ill infants and children are not known.

In the present study we investigate the requirement of these children by comparing an energy and protein enriched infant formula (Infatrini, Nutricia, Zoetermeer, The Netherlands) with the standard infant formula (Nutrilon 1, Nutricia, Zoetermeer Netherlands) during 7 days in a randomised double blind manner. Our hypothesis is that the protein and energy enriched formula has positive effects on protein metabolism (as measured with stable isotope methods on the 4th day of enteral nutrition), substrate utilization (daily indirect calorimetry), and growth (body weight, knee-heel length, skinfolds day 1, 4 and 7)) during critical illness and does not lead to overfeeding gewichtsgroei.

The hypothesis is that increasing energy and protein intake in these children will stimulate the rate of protein synthesis, decrease the rate of (muscle)protein breakdown, lead to increased net protein accretion, avoids weight loss and promotes growth. The second hypothesis is that it will be well tolerated by these infants and not lead to sign and symptoms of overfeeding. Also the caloric intake achieved with these feeding regimen compared to the energy expenditure will be assessed.

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Energy and protein enriched enteral feeding; Infatrini (Nutricia, Zoetermeer, The Netherlands).