La reflexión resalta la adaptación del soporte nutricional a fases metabólicas en pediatría crítica. En fase ebb, el catabolismo reduce gasto energético; aporte >80% genera sobrealimentación con sustratos no oxidados (Mehta et al., 2011). En fase flow, hipermetabolismo requiere incremento calórico progresivo, monitorizado por calorimetría (Veldscholte et al., 2020).
Proteína prioriza balance nitrogenado (1.5-3 g/kg/día), reduce atrofia muscular y mortalidad; calorías excesivas inhiben autofagia (Tume et al., 2020).
Riesgos incluyen hiperglucemia, resistencia insulínica, disfunción mitocondrial, prolongación ventilatoria e infecciones (Briassoulis et al., 2024).
En caso clínico, niño con trauma recibe 120% gasto en ebb, induce hiperglucemia y UCI extendida; ajuste a 60% con proteína elevada resuelve en 72 horas (Wang et al., 2025).
Referencias
Briassoulis, G., Ilia, S., & Briassouli, E. (2024). Personalized nutrition in the pediatric ICU: Steering the shift from acute stress to metabolic recovery and rehabilitation. Nutrients, 16(20), 3523. https://doi.org/10.3390/nu16203523
Mehta, N. M., Bechard, L. J., Dolan, M., Ariagno, K., Jiang, H., & Duggan, C. (2011). Energy imbalance and the risk of overfeeding in critically ill children. Pediatric Critical Care Medicine, 12(4), 398–405. https://doi.org/10.1097/PCC.0b013e3181fe279c
Tume, L. N., Valla, F. V., Joosten, K., Jotterand Chaparro, C., Latten, L., Marino, L. V., Macleod, I., Moullet, C., Pathan, N., Rooze, S., van Rosmalen, J., & Verbruggen, S. C. A. T. (2020). Nutritional support for children during critical illness: European Society of Pediatric and Neonatal Intensive Care (ESPNIC) metabolism, endocrine and nutrition section position statement and clinical recommendations. Intensive Care Medicine, 46(3), 411–425. https://doi.org/10.1007/s00134-019-05922-5
Veldscholte, K., Joosten, K., & Jotterand Chaparro, C. (2020). Energy expenditure in critically ill children. Pediatric Medicine, 3, 17. https://doi.org/10.21037/pm-20-47
Wang, Y., Li, Y., Li, N., Li, Y., Li, H., & Zhang, D. (2025). Protective nutrition strategy in the acute phase of critical illness: Why, what and how to protect. Frontiers in Nutrition, 12, 1555311. https://doi.org/10.3389/fnut.2025.1555311
Proteína prioriza balance nitrogenado (1.5-3 g/kg/día), reduce atrofia muscular y mortalidad; calorías excesivas inhiben autofagia (Tume et al., 2020).
Riesgos incluyen hiperglucemia, resistencia insulínica, disfunción mitocondrial, prolongación ventilatoria e infecciones (Briassoulis et al., 2024).
En caso clínico, niño con trauma recibe 120% gasto en ebb, induce hiperglucemia y UCI extendida; ajuste a 60% con proteína elevada resuelve en 72 horas (Wang et al., 2025).
Referencias
Briassoulis, G., Ilia, S., & Briassouli, E. (2024). Personalized nutrition in the pediatric ICU: Steering the shift from acute stress to metabolic recovery and rehabilitation. Nutrients, 16(20), 3523. https://doi.org/10.3390/nu16203523
Mehta, N. M., Bechard, L. J., Dolan, M., Ariagno, K., Jiang, H., & Duggan, C. (2011). Energy imbalance and the risk of overfeeding in critically ill children. Pediatric Critical Care Medicine, 12(4), 398–405. https://doi.org/10.1097/PCC.0b013e3181fe279c
Tume, L. N., Valla, F. V., Joosten, K., Jotterand Chaparro, C., Latten, L., Marino, L. V., Macleod, I., Moullet, C., Pathan, N., Rooze, S., van Rosmalen, J., & Verbruggen, S. C. A. T. (2020). Nutritional support for children during critical illness: European Society of Pediatric and Neonatal Intensive Care (ESPNIC) metabolism, endocrine and nutrition section position statement and clinical recommendations. Intensive Care Medicine, 46(3), 411–425. https://doi.org/10.1007/s00134-019-05922-5
Veldscholte, K., Joosten, K., & Jotterand Chaparro, C. (2020). Energy expenditure in critically ill children. Pediatric Medicine, 3, 17. https://doi.org/10.21037/pm-20-47
Wang, Y., Li, Y., Li, N., Li, Y., Li, H., & Zhang, D. (2025). Protective nutrition strategy in the acute phase of critical illness: Why, what and how to protect. Frontiers in Nutrition, 12, 1555311. https://doi.org/10.3389/fnut.2025.1555311