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 Vol. 7 No. 8, August 2006
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NeoReviews Vol.7 No.8 2006 e410
© 2006 American Academy of Pediatrics

Metabolic Response to Stress in the Neonate Who Has Surgery

Kasper S. Wang, MD*
Henri R. Ford, MD*
Jeffrey S. Upperman, MD*

* Childrens Hospital Los Angeles, University of Southern California, Keck School of Medicine, Los Angeles, Calif

The first 300 words of the full text of this article appear below.


   Objectives
 
After completing this article, readers should be able to:

  1. Describe the basic metabolic pathways involved in neonatal nutrition.
  2. Describe the effect of stress on nutrition and metabolism in the neonate undergoing surgery.
  3. Describe the differences in the metabolic response to stress between an adult and a neonate.


   Introduction
 
Over the past 4 decades, there have been remarkable improvements in our ability to care for critically ill infants. Progress in surgical and critical care of neonates has led to improved survival rates. Our understanding of the nutritional requirements of infants continues to advance. In contrast to years past, practitioners caring for critically ill infants undergoing surgery today have various nutritional options, including specialized parenteral and enteral formulations. Although our understanding of host defense and nutritional support continues to evolve, the interplay between the immune system and metabolism is being investigated. Hence, we are improving the match between the infant’s energy expenditure and nutritional requirements. Critical to further progress is additional understanding of the metabolic response of a neonate to surgical stress.

All living organisms require energy to survive. Fuel sources enter into complex metabolic cascades to form the ultimate energy substrate, adenosine triphosphate (ATP), a fuel needed to drive and maintain all physiologic systems. Under stressful conditions, intrinsic substrate mobilizes to synthesize additional energy substrate. In essence, host substrate is mobilized for the promotion of healing after injury. Cytokines, released in response to injury, drive the catabolic response to stress, but in abundance, as with the systemic inflammatory response syndrome (SIRS), cytokines are detrimental to the organism. The nutritional requirements of a neonate are significantly greater than those of an adult because not only are there requirements for substrate intake to fulfill basic metabolic needs, but there are metabolic needs to maintain rapid and continued growth and development. Furthermore, the metabolic response . . . [Full Text of this Article]


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Copyright © 2006 by the American Academy of Pediatrics.