Assessment of Micronutrient Status in Critically Ill Children: Challenges and Opportunities

Abstract

Micronutrients refer to a group of organic vitamins and inorganic trace elements that serve many functions in metabolism. Assessment of micronutrient status in critically ill children is challenging due to many complicating factors, such as evolving metabolic demands, immature organ function, and varying methods of feeding that affect nutritional dietary intake. Determination of micronutrient status, especially in children, usually relies on a combination of biomarkers, with only a few having been established as a gold standard. Almost all micronutrients display a decrease in their serum levels in critically ill children, resulting in an increased risk of deficiency in this setting. While vitamin D deficiency is a well-known phenomenon in critical illness and can predict a higher need for intensive care, serum concentrations of many trace elements such as iron, zinc, and selenium decrease as a result of tissue redistribution in response to systemic inflammation. Despite a decrease in their levels, supplementation of micronutrients during times of severe illness has not demonstrated clear benefits in either survival advantage or reduction of adverse outcomes. For many micronutrients, the lack of large and randomized studies remains a major hindrance to critically evaluating their status and clinical significance.

Serum Concentrations of Trace Elements Zinc, Copper, Selenium, and Manganese in Critically Ill Patients

“…Plasma zinc is a good indicator of zinc intake in the absence of systemic inflammation [10]. In the present study, low serum levels of Zn were observed in 76% of patients at the time of ICU admission.…”

Влияние На Доступность Ионов Марганца И Цинка Для Патогенных Бактерий

“…Согласно результатам не-скольких исследований, применение препаратов цинка внутрь способствует сокращению продолжительности тяжелой пневмонии у детей (табл. 1) [15,37].…”

Clinical Nutrition Approaches to Medical Management of Children with Obesity and Critical Illnesses

“…Although obesity in children may lead to vitamin B-12 deficiency, the dietary assessment of obese patients before admission in addition to laboratory assessments should be considered in PICUs (49). Some studies reported that high vitamin B-12 level is associated with high inflammation and mortality rate in critically ill adult patients (50). More studies are needed to identify the state of vitamin B-12 in critically ill obese children.…”

“…Most critically ill patients are at the increased risk of vitamin A deficiency development according to their nutrition and metabolic states. The deficiency can be severe in patients with lower hepatic retinol storage that probably occurs in obese patients due to recent dietary restrictions for weight reduction such as skimmed dairy products and eggs as two of the best sources of retinol (50).…”