Association between protein intake and muscle wasting in critically ill children: a prospective cohort study: A prospective cohort study

Background: Survival from pediatric critical illness in high income countries is high, the focus now must be on optimising the recovery of survivors. Muscle mass wasting during critical illness is problematic, so identifying factors that may reduce this is important. Therefore, the aim of this study was to examine the relationship between quadricep muscle mass wasting (assessed by ultrasound), with protein and energy intake during and after pediatric critical illness.
Methods: A prospective cohort study in a mixed cardiac and general pediatric intensive care unit in England, United Kingdom. Serial ultrasound measurements were undertaken at day 1,3,5,7 and 10.
Results: Thirty-four children (median age 6.65 (0.47 -57.5) months) were included, all showed a reduction in quadricep muscle thickness during critical care admission, with the mean muscle wasting 7.75%. The eleven children followed up had all recovered their baseline muscle thickness by three months after intensive care discharge. This muscle mass wasting was not related to protein (p=0.53, ρ=0.019) (95% CI -0.011, 0.049) or energy intake (p=0.138, ρ=0.375 95% CI -0.144 – 0.732) by 72 hours after admission, nor with severity of illness, highest C reactive protein or exposure of intravenous steroids. Children exposed to neuromuscular blocking drugs exhibited 7.2% (95% CI -0.13 to 14.54%) worse muscle mass wasting, but this was not statistically significant (p=0.063).
Conclusion: Our study did not find any association between protein or energy intake at 72 hours and quadricep muscle mass wasting.