• Marta Botrán, Jesús López-Herce, Santiago Mencía, Javier Urbano, Maria José Solana, and Ana García.
• Pediatric Intensive Care Department, General Hospital of Gregorio Marañón University, Madrid, Spain.
• J. Pediatr. 2011 Jul 1; 159 (1): 27-32.e1.

ObjectiveTo compare a standard diet and a protein-enriched diet in critically ill children.Study DesignIn this prospective randomized controlled trial in critically ill children, all patients received enteral nutrition exclusively and were randomly assigned to a standard diet or a protein-enriched diet (1.1 g protein/100 mL of feeding formula). Blood and urine tests, nitrogen balance assessment, and energy expenditure testing by indirect calorimetry were performed before the beginning of the nutrition regimen and at 24 hours, 72 hours, and 5 days after initiation. Demographic data and pediatric mortality risk scores were recorded.ResultsFifty-one children were randomized, and 41 completed the study. Of these, 21 patients received standard formula and 20 received a protein-enriched formula. There were no between-group differences in terms age, sex, diagnosis, or mortality risk scores. There was a greater positive trend in levels of prealbumin, transferrin, retinol-binding protein, and total protein in the protein-enriched diet group. These differences were significant only for retinol-binding protein. The positive nitrogen balance trend was also higher in the protein-enriched diet group; however, this difference did not reach statistical significance. No adverse effects or hyperproteinemia were detected in the protein-enriched diet group.ConclusionsThe standard diet provides insufficient protein delivery to critically ill children. Enteral protein supplementation is safe and can improve some biochemical parameters of protein metabolism.Copyright © 2011 Mosby, Inc. All rights reserved.

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