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Nutritional management for burn patients

  • Department of Nutrition and Food Services

    Royal Children's Hospital, May 2000


    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

    1. To promote optimal wound healing and rapid recovery from burn injuries
    2. To minimise risk of complications, including infections during the treatment period
    3. To attain and maintain normal nutritional status
    4. To minimise metabolic disturbances during the treatment process

    Objectives of nutritional management

    1. Provide nutrition via enteral route within 6 - 18 hours post burn injury
    2. Maintain weight within 5 % - 10 % of pre-burn weight
    3. Prevent signs and symptoms of micronutrient deficiency
    4. Minimise hyperglycaemia
    5. Minimise hypertriglyceridaemia    

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    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

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    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.

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