Evaluation of predicted and measured energy requirements in burned children

Objective: The energy predictions of nine calculations for pediatric patients were compared with measured resting energy expenditure (MREE) by means of indirect calorimetry to determine the optimal means of energy projection in the burn population younger than 3 years of age. Methodology: Nutritional sufficiency and maintenance of preburn weight were factors in the confirmation of energy needs. Demographic factors were also studied: preburn weight, percent burn, percent third-degree burn, and age. Group I consisted of 24 patients younger than 3 years of age (range=7 months to 2.6 years) with a percent burn of 30.6 +/- 2.0 and percent third-degree burn of 21.9 +/- 2.6. Group 2, consisting of 24 patients 5 to 10 years old matched bv percent burn and percent third-degree burn, was included to determine whether differences between actual and projected needs were evident in older, prepubescent patients. Statistical analysis: Analysis of variance was used to ascertain the most reliable multiplier for MREE needed to maintain at least 95% of preburn weight at discharge while ensuring adequate nutrition. Multiple regression analysis was used to determine the relationship between energy requirement and body weight, percent burn, and age. Results: An additional 30% of MREE provided a consistent ratio of actual energy intake to required intake. MREE X 1.3 was used as a guide to study the existing calculations. For both groups, the four equations that predicted energy in healthy children most often underestimated MREE X 1.3, whereas the five formulas for children with burns tended to overpredict energy. Regression analysis yielded two new sets of equations using age, preburn weight, and percent burn (<3 years=Mayes 1 [r2=.71], 5 to 10 years=Mayes 3 [r=.70] or percent third-degree burn (<3 years=Mayes 2 [r=.68], 5 to 10 years=Mayes 4 [r2=.67]). Conclusions: The application of a 30% factor to MREE is supported in burn patients younger than 10 years of age. Standard energy projections do not provide an accurate assessment of energy needs in the pediatric burn population: thus, two sets of equations that more closely predict energy needs are proposed.