Pediatric critically ill children have an altered metabolism associated with the physiological response to injury or stress and are at risk for malnutrition. Estimating the calorie requirements of critically ill children using predictive equations is fraught with inaccuracy. Commonly used pediatric predictive equations were created from healthy populations and not intended for the critically ill or for patients with developmental disorders. The use of indirect calorimetry (IC) to measure resting energy expenditure was recently recommended by the American Society of Parenteral and Enteral Nutrition (A.S.P.E.N.) in the Pediatric Critical Care Guidelines. Despite the known faults of predictive equations and recent A.S.P.E.N. recommendations, IC is not commonly used in the pediatric intensive care unit (PICU). This is a case report on the use of IC and its effect on the nutrition support management of 2 critically ill patients with developmental disorders. The first case follows a 15-year-old critically ill boy with Down syndrome admitted to the PICU with acute respiratory failure secondary to smoke inhalation. The second case involves a 13-year-old boy with spastic cerebral palsy and acute respiratory failure secondary to viral illness. IC was used to tailor the nutrition support for both of these patients.
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