Background & aims: To evaluate the course of hormonal parameters in relation to clinical parameters, illness severity and nutritional intake in children admitted to the pediatric ICU during the first week of admission. Methods: Prospective, observational study. Levels of triiodothyronine (T3), reverse T3 (rT3), ratio T3/rT3 and insulin-like growth factor I (IGF-1) were evaluated in 84 critically ill children (50 term neonates and 34 children aged 32 d-15 yr) admitted to our multidisciplinary tertiary pediatric intensive care unit within 24 h after admission, on days 4 and 6 after admission. Changes in hormones levels over time were related to illness severity, C-reactive protein-levels and the adequacy of feeding. Results: For both age groups IGF-1 levels remained low until day 4, but at day 6 IGF-1 levels were significantly higher than admission level. In 88% and 89% of the older children, T3 levels remained below normal at days 4 and 6, respectively. In both age groups, rT3 levels declined significantly over time, whereas the ratio T3/ rT3 increased. The increases in IGF-1, T3 and ratio T3/rT3 and decrease in rT3 were significantly associated with decreases in CRP-levels. No significant relations were found between changes in IGF-1 and thyroid hormone levels during admission and the adequacy of energy and protein intake. Conclusions: During the first week of ICU-admission, abnormalities in levels of IGF-1, T3 and rT3 were frequently observed in critically ill children, especially in the children aged >1 month. The adequacy of feeding did not seem to affect the normalization of IGF-1 and thyroid hormone levels.

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Keywords Children, Critical illness, Insulin-like growth factor I, Nutritional intake, Thyroid hormones
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Journal Clinical Nutrition
Hulst, J.M, van Goudoever, J.B, Visser, T.J, Tibboel, D, & Joosten, K.F.M. (2006). Hormone levels in children during the first week of ICU-admission: Is there an effect of adequate feeding?. Clinical Nutrition, 25(1), 154–162. doi:10.1016/j.clnu.2005.10.006