Magdalena EF Sahetapy E*, Antonius Pudjiadi*, Abdul Latief*, Yusrina Istanti*, Sri Martuti*, Moh. Supriatna**, Pudjiastuti*** *Departemen Ilmu Kesehatan Anak FKUI/RS Cipto Mangunkusumo Jakarta **Departemen Ilmu Kesehatan Anak FK UNDIP/RS Dr. Kariadi Semarang ***Bagian Ilmu Kesehatan Anak FK UNS/RSUD Dr Muwardi Surakarta
Background Malnutrition is common at the time of hospital admission Prevalence malnutrition post surgery : 52% acute surgery and 38% elective surgery Malnutrition in post surgery patients, the amount of protein required for optimally enhance protein accretion which is higher in critically ill than in healthy children, because of metabolism response to surgery. Prolonged metabolism stress without provision of adequate calories and protein leads to impaired body function and ultimately malnutrition. Malnutriton causes a number of deleterious consequences like increased susceptibility to infection, poor wound healing, increased frequency of decubitus ulcer, overgrowth bacteria in git. Damayanti RS,Endang DL,Maria, et all. 2011Malnutrisi di Rumah Sakit. dalam Buku Ajar Nutrisi Pediatrik dan Penyakit Metabolik, jiid 1, 2011, 165-176. Kahokehr AA, Sammour T,et all. The European e-journal of clinical Nutrition and Metabolism. 2010;5:e21-5. Indiana Journal of aanasthesia 2008;52:suppl (5):642-651.
Objective To observe the calorie & protein intake in post surgery children To determine the role of retinol binding protein detecting the adequacy of energy intake, calorie and protein intake.
a. Methodology Study observation analytic Ruang rawat PICU dan rawat bangsal bedah RS Cipto Mangunkusumo Jakarta, RSUP Dr Kariadi Semarang dan RSUD Dr Moewardi Surakarta. Pasien pasca pembedahan SPSS version 17 The normality of distribution of the variables Kolmogrov- Smirnov test. Uji statistik Spearmans rho to compare
Results Demographic pictures: 27 children : 16 boys(57,1%), 11 girls (42,9%) Status gizi : 15 ( 55,6%)good, 12 (44,4%) malnutrition Surgery case : neurology surgery 15 (57,1%) abdominal surgery 10 (35,7%) orthopedic surgery 2 ( 7,1%)
Caloric Intake According to REE from day 1-5
Protein Intake from day 1-5
Rethinol Binding Protein level at day 1-5
REE achievement from day 1-5 Persentase Pencapaian REE (%) 100.00 90.00 80.00 70.00 60.00 50.00 40.00 30.00 20.00 10.00 Pencapaian REE Hari I-V 0.00 Hari 1 Hari 2 Hari 3 Hari 4 Hari 5 Mean Prot/REE 3.72 6.69 9.90 11.28 13.35 Mean REE Enteral 30.69 43.20 56.15 67.71 79.02 Mean REE Parenteral 40.47 40.17 33.52 21.29 17.58 Total REE 71.17 83.37 89.67 89.01 96.60
ANALYSIS The prevalence of malnutrition among critically ill patient. The profound and failure to provide optimal nutritional support during ICU stay are the principal factors contributing to malnutrition. Accurate individual assessment of energy requirements and provision of optimal nutrition support through the appropriate route is an important goal of pediatric critical care. Hulst J et all. Clin Nutr2004. Pollack MM et all.jpen 1985
Children, similar to adults, rely on the metabolic breakdown and transfer of protein, carbohydrates, and lipid to meet the catabolic demands of critical illness. A careful appraisal of energy requirements in critically ill pediatrics patients is mandatory. The components of TEE for a sedentary individual are REE -- 70%, DIT 10%, EE PA 20%. Energy requirements were based on BMR or REE. Niles M Mehta et allnutritional Aspects of Specific states
Children severe burns, initial REE during flow phase increased by 50% but then returns to normal convalescense. Neonates, bronchodysplasia, REE increase 25%. Newborn undergoing major surgery, only 20% increase in REE, returns to baseline in 12 hours post op. Actual meassurement of REE is recommended. JahoorF et allmetabolism 1988, Weinstein MR,J Pediatric 1981
Calorie intake and presents calorie intake to REE increase from day 1 to day 5, seems the increase on day 2,3 and 5. Our study : calorie intake 70,17 % REE on the 1 st day and increase to 96,60% REE on day 5 th. Calorie intake to REE can achieve 70% to 96%, it is impact of Enteral Nutrition. 12 patient Enteral Nutrition route(en) and ENPN 19 patients. Parenteral Nutrition route are 14 patients.
Nutrition care studies have proposed that an early interventions that targets nutrition assessment can prevent or minimize the complication of the malnutrition. Gramlich et all. Nutirition 2004
Protein intake also increased from day 1 to day 5. Although the protein only 0,41 up to 1,47 g/kg/day. Feeding critically ill children diet design for healthy children can provide adequate energy delivery but with low protein delivery.
Our study the RBP level on 1 st day was increase till on 5 th day Calorie and protein intake and Retinol Binding Protein level were quiet the same tends increases. Statistic : there is no correlation between protein intake to Retinol Binding Protein level.
Retinol Binding Protein is one of the protein serum which can be a good nutritional indicators in critically ill patient. Retinol Binding Protein has a very short half-life of 12 hours, and its levels fall with malnutrition. However also fall with liver disease, infection, and with intense stress. It is not of value in patients with renal failure.
No correlation maybe because of the protein intake too low to be responsed bye RBP. Marta Botran study, >90% of the patients had a low baseline of retinol-binding protein, and increases in levels were greater in the protein-enriched group. Although this protein has no impact on clinical parameters or physiology, because it enables detection of effects of nutritional changes within a few days. J Pedatr 2011;159:27-32
The American Society for Parenteral and Enteral Nutritions recommended protein requirement for injured children 2 3g/kg/day children age < 2years 1,5-2g/kg/day aged 2 to 13 years 1,5g/kg/day aged 13-18 years. Botran M etall. Br J Nutr 2011;28:1-7.
Conclusion Our study. No correlation or impact between protein intake and Retinol Binding Protein post surgery children PICU. Protein requirement in critically ill is higher than healthy children. We need next study with more sample.
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