Few studies have tried to characterize the efficacy of parenteral support of
critically ill infants during short period of
intensive care. We studied seventeen infants during five days of total
parenteral hyperalimentation. Subsequently, according to the clinical conditions, the patients received
nutritional support by parenteral, enteral route or both up to the 10th day. Evaluations were performed on the 1st, 5th, and 10th days. These included: clinical data (food intake and anthropometric measurements), haematological data (lymphocyte count), biochemical tests (
albumin,
transferrin,
fibronectin,
prealbumin,
retinol-binding protein) and
hormone assays (
cortisol,
insulin,
glucagon). Anthropometric measurements revealed no significant difference between the first and second evaluations.
Serum albumin and
transferrin did not change significantly, but mean values of
fibronectin (8.9 to 16 mg/dL),
prealbumin (7.7 to 18 mg/dL), and
retinol-binding protein (2.4 to 3. 7 mg/dL) increased significantly (p < 0.05) from the 1st to the 10th day. The hormonal study showed no difference for
insulin,
glucagon, and
cortisol when the three evaluations were compared. The mean value of the
glucose/
insulin ratio was of 25.7 in the 1st day and 15. 5 in the 5th day, revealing a transitory supression of this
hormone.
Cortisol showed values above normal in the beginning of the study. We conclude that the anthropometric parameters were not useful due to the short time of the study;
serum proteins,
fibronectin,
prealbumin, and
retinol-binding protein were very sensitive indicators of nutritional status, and an elevated
glucose/
insulin ratio, associated with a slight tendency for increased
cortisol levels suggest hypercatabolic state. The
critically ill patient can benefit from an early metabolic support.