High-calorie nutrition for infants with chronic renal disease
Abstract Objective : This report describes the administration of high-calorie formula (HCF), with caloric densities between 40 kcal/oz and 60 kcal/oz, to children with renal disease and severe fluid restrictions. Design : Retrospective Descriptive Analyses. Setting : Children's Hospital, Harvard Medical School, Boston, Massachusetts. Patients : Records of all infants with chronic renal disease treated at Children's Hospital between 1984 and 1991 and who received supplemental formulas with a minimal caloric density of 40 kcal/oz were reviewed. Intervention : Commercial formulas were modified with glucose polymers and corn oil to attain caloric densities of 40 kcal/oz to 60 kcal/oz. The target caloric density for each patient was selected based on each infant's fluid restrictions and recommended daily allowance requirements. Patients were evaluated monthly for compliance, and formula changes were adjusted to ensure adequate caloric intake and fluid balance. Main outcome measures : Patient tolerance of the HCF was defined by the absence of noninfectious diarrhea and vomiting while receiving the HCF. Progression of formula advancement (either in volume or concentration) required the stools be tested negative for reducing substances. The review was discontinued when the following occurred: fluid liberalization, transplantation, or death. Results : Seventeen infants given the HCF were reviewed. Sixteen infants required nasogastric feedings (usually given continuously at night). The mean average daily caloric intake achieved was 113.2 kcal/kg/d. Fifty-nine percent of the patients were tolerant of the HCF. The type and duration of dialysis did not affect tolerance of the HCF. Conclusion : The HCF was well tolerated with minimal side effects and should be considered for any infant with severe fluid restrictions.