Arch Dis Child 96:817-822 doi:10.1136/adc.2010.185637
  • Original articles

Increased protein-energy intake promotes anabolism in critically ill infants with viral bronchiolitis: a double‑blind randomised controlled trial

Open Access
  1. Koen F Joosten8
  1. 1Department of Paediatrics, Maastricht University Medical Center, Maastricht, The Netherlands
  2. 2Department of Paediatric Surgery, Erasmus MC– Sophia Children's Hospital, Rotterdam, The Netherlands
  3. 3Currently working: Department of Paediatric Surgery, ErasmusMC-Sophia Children's Hospital, Rotterdam, The Netherlands
  4. 4Department of Surgery, Maastricht University Medical Center, Maastricht, the Netherlands
  5. 5Currently working: Center for Translational Research in Aging and Longevity, Donald W Reynolds Insitute on Aging, University of Arkansas for Medical Sciences, Little Rock, AR, USA
  6. 6Department of Paedatrics, VU University Medical Center, Amsterdam, the Netherlands
  7. 7Department of Paediatrics, Emma Children's Hospital-AMC, Amsterdam, the Netherlands
  8. 8Department of Paediatrics, ErasmusMC-Sophia Children's Hospital, Rotterdam, the Netherlands
  1. Correspondence to Dick A van Waardenburg, Department of Paediatrics, Maastricht University Medical Center, PO Box 5800, 6202 AZ Maastricht, The Netherlands; d.vanwaardenburg{at}
  • Accepted 27 April 2011
  • Published Online First 14 June 2011


Objective The preservation of nutritional status and growth is an important aim in critically ill infants, but difficult to achieve due to the metabolic stress response and inadequate nutritional intake, leading to negative protein balance. This study investigated whether increasing protein and energy intakes can promote anabolism. The primary outcome was whole body protein balance, and the secondary outcome was first pass splanchnic phenylalanine extraction (SPEPhe).

Design This was a double-blind randomised controlled trial. Infants (n=18) admitted to the paediatric intensive care unit with respiratory failure due to viral bronchiolitis were randomised to continuous enteral feeding with protein and energy enriched formula (PE-formula) (n=8; 3.1±0.3 g protein/kg/24 h, 119±25 kcal/kg/24 h) or standard formula (S-formula) (n=10; 1.7±0.2 g protein/kg/24 h, 84±15 kcal/kg/24 h; equivalent to recommended intakes for healthy infants <6 months). A combined intravenous-enteral phenylalanine stable isotope protocol was used on day 5 after admission to determine whole body protein metabolism and SPEPhe.

Results Protein balance was significantly higher with PE-formula than with S-formula (PE-formula: 0.73±0.5 vs S-formula: 0.02±0.6 g/kg/24 h) resulting from significantly increased protein synthesis (PE-formula: 9.6±4.4, S-formula: 5.2±2.3 g/kg/24 h), despite significantly increased protein breakdown (PE-formula: 8.9±4.3, S-formula: 5.2±2.6 g/kg/24 h). SPEPhe was not statistically different between the two groups (PE-formula: 39.8±18.3%, S-formula: 52.4±13.6%).

Conclusions Increasing protein and energy intakes promotes protein anabolism in critically ill infants in the first days after admission. Since this is an important target of nutritional support, increased protein and energy intakes should be preferred above standard intakes in these infants.

Dutch Trial Register number: NTR 515.


  • C T de Betue and D A van Waardenburg are joint first authors

  • Funding This study was financially supported by a grant from Nutricia Advanced Medical Nutrition, Zoetermeer, The Netherlands. Nutricia was not involved in the study design, in the collection, analysis and interpretation of data or in the decision to submit the paper.

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the Central Committee on Research Involving Human Subjects (CCMO, The Hague, The Netherlands) and the local ethics committees of Maastricht University Medical Center, Maastricht, The Netherlands and Erasmus Medical Center–Sophia Children's Hospital, Rotterdam, The Netherlands.

  • Provenance and peer review Not commissioned; externally peer reviewed.

This paper is freely available online under the BMJ Journals unlocked scheme, see