Admission factors associated with nutritional status deterioration and prolonged pediatric intensive care unit stay in critically ill children: PICU‐ScREEN multicenter study

Abstract

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.

Pediatric malnutrition screening and assessment tools: Analyzing the gaps

“…Ventura et al 27 found an association with complex chronic conditions, age of <2 years, fluid overload and hypoalbuminemia at admission, and prolonged PICU stays. 27 To address this concern, they developed and trialed a nutrition risk screen for this population. This screen is, in a broader sense, a nutrition risk screen vs a malnutrition risk screen.…”

“…Patients in the pediatric ICU (PICU) need early identification for risk of NS deterioration. Ventura et al 27 found an association with complex chronic conditions, age of <2 years, fluid overload and hypoalbuminemia at admission, and prolonged PICU stays 27 . To address this concern, they developed and trialed a nutrition risk screen for this population.…”

Effects of COVID-19 Pandemic on Nutritional Status, Feeding Practices, and Access to Food Among Infants and Children in Lower and Middle-Income Countries: a Narrative Review

“…The evidence of malnutrition correlation with COVID-19 outcomes in the pediatric population is very scarce, but it is well established that malnutrition is associated with poor outcomes including longer hospital stay, longer mechanical support, and overall higher risk of mortality [ 55 – 58 ]. Several studies have reported that children with comorbidities including obesity are at greater risk of developing symptomatic illness or requiring admission to the hospital [ 59 , 60 ].…”

Nutrition therapy and outcomes in hospitalized children

“…The prevalence of malnutrition, specifically undernutrition, in hospitalized children has been reported to be between 6% and 51%, with vulnerable populations, such as children with critical illness, experiencing further nutrition deterioration and poor outcomes during their hospital stay. 1,2 Clinical outcomes specific to hospitalized children who are undernourished include longer hospital stay, 3,4 higher rates of infections, 5 and greater healthcare costs. 6 The additional in-hospital costs associated with malnutrition have been estimated to be three times higher in a US-based study 4 and 80 million euros per year in a European study of hospitalized children with malnutrition.…”

“…The challenges facing patients on either end of this spectrum of malnutrition can be quite diverse. The prevalence of malnutrition, specifically undernutrition, in hospitalized children has been reported to be between 6% and 51%, with vulnerable populations, such as children with critical illness, experiencing further nutrition deterioration and poor outcomes during their hospital stay 1,2 . Clinical outcomes specific to hospitalized children who are undernourished include longer hospital stay, 3,4 higher rates of infections, 5 and greater healthcare costs 6 .…”