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Estimation of CO2 Production in Enterally Fed Preterm Infants Using an Isotope Dilution Stable Tracer Technique

Divisions of Nutrition, Gastroenterology, and Neonatology, Department of Pediatrics, The Ohio State University, and Children's Hospital Research Foundation, Columbus, Ohio

Richard E. McClead, MD

Divisions of Nutrition, Gastroenterology, and Neonatology, Department of Pediatrics, The Ohio State University, and Children's Hospital Research Foundation, Columbus, Ohio

Background: Estimates of the rate of CO., production may be useful in preterm infants, but assessment of the rate of respiratory excretion of CO₂ (Vco₂) may not always be practical in infants requiring constant care. We hypothesized that the rate of dilution of ¹³CO ₂ (Raco₂) would be a valid index of CO₂ production in preterm infants. Methods: Twelve studies of Raco₂ and VCO₂ were performed in six enterally fed preterm infants. Raco ₂ was measured using a 2-hour, primed, constant, orogastric infusion of NaH¹³CO₃ with formula and an assessment of the plateau ¹³C enrichment of expired CO₂. VCO₂ was measured over two 10-minute intervals during the infusion using a flow-through system. Energy expenditure was estimated from these data and the food quotient. Results: Mean (± SD) rate of CO₂ production using Raco ₂ (348 ± 32 µmol/kg/min) was 114% of that estimated using VCO ₂ (304 ± 51 µmol/kg/min). The ratio of VCO₂/RaCO ₂ is equal to the fractional recovery of tracer CO₂ in the expired air during the course of the tracer infusion. In studies of short duration, this ratio is generally less than 100% because of isotope exchange. For five pairs of studies performed on consecutive days, each individual value of Raco₂ on day 2 was multiplied by the mean of the individual ratios of VCO₂/RaCO₂, on day 1 (0.78); corrected Raco ₂ was 306 ± 19 µmol/kg/min compared with 307 ± 59 µmol/kg/min for Vco₂. Conclusions: Thus, Raco₂, particularly when corrected for isotope recovery, may be a useful index of group mean CO₂ production and energy expenditure in preterm infants. (journal of Parenteral and Enteral Nutrition 20:389-393, 1996)

Journal of Parenteral and Enteral Nutrition, Vol. 20, No. 6, 389-393 (1996)
DOI: 10.1177/0148607196020006389


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