Nutritional support for children with spinal cord injury at the I—II stages of rehabilitation

The article presents an individual approach to the correction of nutritional status based on the assessment of the need for macronutrients and the degree of motor activity of a patient with a spinal cord injury

Objective. To study the needs for macronutrients (energy and protein) and to develop an algorithm of nutritional support for children with spinal cord injury, taking into account their motor activity.

Children characteristics and research methods. The study included 44 patients with spinal cord injury from 2 to 18 years old who were admitted to the Research Institute of Emergency Pediatric Surgery and Traumatology in 2015-2019. All patients underwent anthropometric examination, laboratory monitoring and energy consumption using indirect calorimetry and the Harris — Benedict equations. To determine the true energy consumption, the study was carried out at rest, with passive and active loads.

Results. The indirect calorimetry method is the most objective method to determine the energy consumption at rest; if it is impossible to use, the Harris — Benedict calculation equations without correction factors are used. The indirect calorimetry method for various types of load helps to calculate correction factors for true energy consumption. Passive motor exercises in the rehabilitation program do not require an increase in nutritional support. The increase in the patient’s motor activity is the critical factor for increasing the volume of nutritional support. To calculate the true energy consumption, it is necessary to take into account the time of patient’s activity and the correction factors obtained. It is necessary to correct protein losses during the period of hypercatabolism (1 month after injury); in the future it is enough to maintain age-related protein needs.

Conclusion. The proposed algorithm of nutritional support for children with spinal cord injury can adequately meet the needs for macronutrients and avoid complications associated with their insufficient or excessive consumption.

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