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Table 4 Highlight of key metabolic processes requiring nutritional assessment and intervention during the rehabilitative phase of care

From: Nutrition and metabolism in the rehabilitative phase of recovery in burn children: a review of clinical and research findings in a speciality pediatric burn hospital

Nutrition state or metabolic condition Characteristic during rehabilitation Nutritional assessment Nutritional intervention
Protein synthesis and breakdown Increased synthesis and breakdown. Skeletal muscle breakdown is normal. Exogenous protein can diminish protein breakdown rate. Nitrogen balance Provide 2.5 g/kg of protein to cover obligatory losses. Maintain nitrogen balance in the positive by 2 g protein/kg day.
Pre-albumin, CRP
Weekly
Energy expenditure Resting energy expenditure declines for most patients. Increased total energy expenditure due to increased physical activity. Indirect calorimetry Hypermetabolic: REE × 1.2
Normal REE/intensive physical therapy: REE × 1.5 or 65 kcal/kg (to meet increased needs with physical activity)
Weekly
Bone mineral density Altered vitamin D metabolism and bed rest results in large majority of burn patients to have mild to moderate bone loss following severe burn injury. Malnutrition increases the odds of having severe bone depletion. DXA every 6 weeks For bone mineral density z-scores
>−1.0: no intervention
Weekly <−1.0: vitamin D3/calcium supplementation
4–8 years: 1,000 mg/600+ IU
9–18 years: 1,500 mg/600+ IU
<−2.0 as above with 0.1–0.2 mg/kg oxandrolone
Growth Growth delay is apparent in children with massive burn injury, effecting height more than weight. Height and weights Energy and protein as above to promote age appropriate rate of weight gain.
Weekly
  1. REE resting energy expenditure, CRP C-reactive protein, DXA dual-energy X-ray absorptiometry, IU international units.