Results of the implementation of a nutritional support protocol for major burn pediatric patients hospitalized in the Intensive Care Unit.

: Introduccion: "Gran quemado" es quien sufre lesiones por dano termico que afectan mas del 30% de su superficie corporal (SC). El hipercatabolismo secundario causa perdida de masa magra y retraso de la cicatrizacion de heridas. Objetivo: Describir y analizar los resultados de la implementacion de un protocolo de soporte nutricional en ninos quemados graves internados en una Unidad de Cuidados Intensivos durante las primeras 6 semanas evolutivas. Poblacion y metodos: Diseno analitico, prospectivo, observacional y longitudinal. Se midieron peso, talla, porcentaje de SC quemada, dias de internacion en la Unidad de Cuidados Intensivos y mortalidad. Se analizaron tasa metabolica basal por calorimetria indirecta y formula de Schofield, cobertura de aporte energetico y proteico, prealbumina, proteina C reactiva, vitaminas A, D, E, cobre y zinc semanales. Resultados: Se incluyeron 18 pacientes (media: 3,9 anos, 49% de SC quemada). Se alcanzo la media de objetivo energetico en la segunda semana y el requerimiento proteico en la semana 6. Doce pacientes requirieron nutricion parenteral complementaria sin complicaciones. Se hallaron parametros de hipermetabolismo, que se normalizaron a las 4-6 semanas del ingreso, excepto la proteina C reactiva. Las vitaminas A y E y elementos traza (zinc y cobre) estaban descendidos al ingreso con mejoria posterior. La vitamina D persistio en valores bajos. Un paciente fallecio. Conclusiones: La implementacion del protocolo permitio lograr el aporte de la totalidad del requerimiento energetico; la cobertura del requerimiento proteico se postergo hasta la semana 6. Es necesario hacer hincapie en resolver las limitaciones para alcanzar este ultimo. OBJECTIVE: To describe and analyze the results of implementing a nutritional support protocol for pediatric burn patients hospitalized in the intensive care unit in the first 6 weeks. POPULATION AND METHODS: Analytical, prospective, observational, and longitudinal design. Weight, height, %TBSA, length of stay in the intensive care unit, and mortality were measured. The basal metabolic rate was measured by indirect calorimetry and the Schofield equation, and protein and energy intake, prealbumin, C-reactive protein, vitamins A, D, E, copper, and zinc levels were analyzed every week. RESULTS: Eighteen patients were included (mean: 3.9 years old, 49%TBSA). The mean energy target was achieved by week 2 and protein requirements were met by week 6. Twelve patients required complementary parenteral nutrition and there were no complications. Hypermetabolism parameters were observed, which returned to normal 4-6 weeks after hospitalization, except for C-reactive protein. Vitamins A and E and trace elements (zinc and copper) were reduced at the time of admission and showed a subsequent improvement. Vitamin D remained low. One patient died. CONCLUSIONS: Implementing the protocol was useful to cover the total energy requirement; the coverage of protein requirements was delayed until week 6. It is necessary to focus on solving limitations to achieve the latter.