Department of Nutrition and Food Services
Royal Children's Hospital, May 2000
Assessment
All inpatients with a deep burn injury are assessed by a
dietitian, in order to establish whether a need exists for
nutritional intervention.
Goals of nutritional
management
- To promote optimal wound healing and rapid recovery from burn
injuries
- To minimise risk of complications, including infections during
the treatment period
- To attain and maintain normal nutritional status
- To minimise metabolic disturbances during the treatment
process
Objectives of
nutritional management
- Provide nutrition via enteral route within 6 - 18 hours post
burn injury
- Maintain weight within 5 % - 10 % of pre-burn weight
- Prevent signs and symptoms of micronutrient deficiency
- Minimise hyperglycaemia
- Minimise hypertriglyceridaemia
Nutritional Management
Enteral Feeding Should Be Commenced Early
Appropriate nutritional management of the severely burned
patient is necessary to ensure optimal outcome. Initiation of early
enteral feeding, within 6 to 18 hours post-burn injury, is
recognised as beneficial, and has been shown to be safe in children
as well as adults. Advantages of utilising the enteral route, as
opposed to the parenteral route, include improved nitrogen balance,
reduced hypermetabolic response, reduced immunological
complications and mortality.
Aggressive Nutritional Support is Often
Required
Although oral nutrition is encouraged, young children with
severe burn injuries often require naso-gastric feeding as they
tend to have difficulty meeting their nutritional goals with oral
intake alone.
Energy Requirements are Elevated by the Burn
Injury
The hypermetabolic response associated with severe burn injury
results in high calorie requirements to allow optimal healing and
outcome. Several predictive equations exist which enable
estimations of energy requirements. Changes in management of these
patients in the past decade have resulted in some reduction in the
metabolic response and care must be taken to avoid over-feeding.
Variation in energy needs between individuals, as well as with
time, means that indirect calorimetry is recommended where
practical to aid in determining energy expenditure.
Protein Requirements are Substantially
Increased
Aggressive protein delivery, providing approximately 20 % of
calories from protein, has been associated with improved mortality
and morbidity.
An Increased Requirement Exists for Nutrients Associated
with Healing and Immune Function
Provision of those nutrients known to be associated with healing
and immune function, particularly vitamins A, C, E, some B vitamins
and zinc, is especially important. Recent studies have indicated
that benefits may also be achieved by supplementation with various
additives, including fish-oil and arginine.