Proposed Topic (Most preferred): :
Research and Innovations (new projects / technology / innovations / service models)
Proposed Topic (Second preferred): :
Clinical Safety and Quality Service III (Projects aiming at quality service to patients and their carers)
Authors (including presenting author) :
Sit J, Cheung KS, Fan TY, Chiu TH, Yu MW
Affiliation :
Department of Dietetics, Queen Mary Hospital
Introduction :
Children on ventilation require careful estimation of their energy requirement as weight management is essential in their care. Indirect calorimetry (IC) has been the gold standard for such estimation for adults but its application for children has been limited.
Objectives :
To pioneer the use of IC for weight management for a 15 years old boy on ventilatory support.
Methodology :
The boy with post traumatic brain injury and epilepsy was admitted to PICU for ventilatory support after epistasis with desaturation. He was referred for weight reduction to facilitate ventilatory support.
At admission, patient’s body height was 140cm(50-75th % CP GMFCS V growth chart), body weight was 44.2kg(75-90th % CP GMFCS V growth chart) and BMI was 22.5kg/m2(75-90th % CP GMFCS V growth chart). His body height remained the same for years while his body weight kept similar after previous feed reduction.
His usual feed provided 889kcal(20kcal/kg) and 39g(0.88g/kg). Per European ESPGHAN Guidelines, energy requirement was 1401kcal, 1540kcal and 1426kcal per Basel Energy Expenditure method, per height method and per Schofield method respectively while Estimated Average Requirement for age was 2387kal. All the above overestimated his requirement.
COSMED Q-NRG Indirect Calorimeter was thus introduced for assessing his requirement. The child was fasted over 8hours before measurement. Measurement was carried out according to protocol for 30 minutes.
Resting energy requirement was measured as 746kcal. After adjusting with activity factor and muscle tone, energy requirement was 739kcal, which was 130kcal less than current feed.
Feed was reduced with addition of protein powder to boost up protein to keep muscle mass. A deduction of 79kcal(10%) and increment of protein from 39 to 45g/day(13.5%) was set. Adequacy of micronutrients was secured by daily multi-vitamin and mineral supplement.
The child was soon discharged from PICU with ventilatory support back to usual settings. After 1 month of feed adjustment, the boy’s body weight successfully reduced from 44.2kg to 43.5kg(-1.6%).
Result & Outcome :
This case study has shown that IC is effective and more accurate than the commonly adopted equation-based approaches. Supporting an individualized assessment, IC should be considered for ventilated children in the future.
