In the hemodynamic model of a child with heart failure,
stroke volume is low, heart rate is high, and work of the
heart is increased, contributing to an increased BMR.
Increased work of breathing increases stimulation of the
sympathetic nervous system and also contributes to
increased BMR and TEE in children with CHD. Infections
also increase BMR because of the high basal temperature
and metabolic stress (15, 21-23).