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Background Early identification of patients in the pediatric intensive care unit (PICU) at risk of nutritional status (NS) deterioration and poor outcomes is desirable. We aimed to identify factors associated with NS deterioration and prolonged PICU stay. Methods Prospective cohort study in eight Brazilian PICUs with children <18 years with a PICU stay >72h. We used multivariable logistic regression to identify the clinical, laboratory, and nutrition variables at admission that were associated with outcomes. NS deterioration was defined as the reduction in weight‐for‐age, body mass index–for‐age or mid‐upper arm circumference–for‐age z‐score ≥1 during PICU stay. Prolonged PICU stay was defined as ≥13 days. Results We enrolled 363 eligible patients, median age 11.3 months (interquartile range:3.1–45.6) and 46% had at least one complex chronic condition (CCC). NS deterioration was observed in 23% of participants and was associated with CCC (odds ratio [OR]:2.71; 95% confidence interval [CI]:1.44–5.09), after adjusting for severity risk score, leukocyte count, obesity, and PICU site. Prolonged PICU stay was associated with age <2 years (OR:1.95; 95%CI:1.03–3.66), fluid overload (>10%) over the first 72h (OR:2.66; 95%CI:1.50–4.73), and hypoalbuminemia (<3.0 g/dL) (OR:2.05; 95%CI:1.12–3.76), after adjusting for CCC, severity risk score, undernutrition, early nutrition therapy, and PICU site. Conclusions CCC at admission was associated with NS deterioration. Age <2 years, fluid overload, and hypoalbuminemia at PICU admission were associated with prolonged PICU stay. These factors must be further evaluated as part of an admission nutrition screening tool for critically ill children.

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