Association between admission body mass index and outcomes in critically ill children: A systematic review and meta-analysis

Toh, Samantha; Ong, Ching Ching; Sultana, Rehena; Kirk, Angela Hui Ping; Koh, Janine Cynthia; Lee, Jan Hau

doi:10.1016/j.clnu.2021.04.010

Cited by 6 publications

(6 citation statements)

References 49 publications

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“…The lack of differences in clinical outcomes demonstrated in our review differs from a systematic review conducted by Costa et al ( 13 ) and a meta-analysis review conducted by Toh et al ( 12 ). These prior reviews either did not demonstrate the association or non-significant association between mortality, PICU LOS, and admission nutrition status.…”

Section: Discussioncontrasting

confidence: 99%

“…To date, the effect of malnutrition on critically ill children has been studied by only a few previous systematic studies ( 12 ). The study conducted by Costa et al ( 13 ) investigated the relationship between UN and PICU outcomes.…”

Section: Introductionmentioning

confidence: 99%

“…They also assessed the impact of BMI on PICU outcomes across nations with varying socioeconomic levels (as defined by the World Bank). However, previous studies characterized both undernutrition and overnutrition by combining anthropometric parameters such as weight for age, BMI, and skin folds with laboratory data (e.g., albumin and C-reactive protein) or by focusing primarily on PICU entrance BMI ( 12 ). To the best of our knowledge, there are limited studies that focus on the association between UN in PICU only and outcomes in critically ill children.…”

Section: Introductionmentioning

confidence: 99%

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Is Undernutrition Associated With Deterioration of Outcomes in the Pediatric Intensive Care Unit (PICU): Systematic and Meta-Analysis Review

Albadi

Bookari

2022

Front. Pediatr.

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Background and aimUndernutrition (UN) may negatively impact clinical outcomes for hospitalized patients. The relationship between UN status at pediatric intensive care unit (PICU) admission and clinical outcomes is still not well-reported. This systematic meta-analysis review evaluated the impact of UN at admission to PICU on clinical outcomes, including mortality incidence, length of stay (LOS), and the need for and length of time on mechanical ventilation (MV).MethodsA search was conducted using relevant and multi-medical databases from inception until January 2022. We considered studies that examined the link between UN at PICU admission and clinical outcomes in patients aged 18 years or younger. Pooled risk difference estimates for the PICU outcomes were calculated using a random-effects model.ResultThere were a total of 10,638 patients included in 17 observational studies; 8,044 (75.61%) and 2,594 (24.38%) patients, respectively, were normal-nourished (NN) and undernourished (UN). In comparison to NN patients, UN patients had a slightly higher risk of mortality (RD = 0.02, P = 0.05), MV usage (RD = 0.05, P = 0.02), and PICU LOS (RD = 0.07, P = 0.007). While the duration of MV was significantly longer in UN than in NN (RD = 0.13, P < 0.0001). Sensitivity analysis of UN classification cohorts with a z-score < -2 or in the 5%, patetints age up to 18 years, and mixed diagnose for PICU admission demonstrated a 6-fold increase in the probability of PICU LOS in UN patients compared to NN patients (RD = 0.06, 95% CI = 0.01, 0.12). UN patients have a higher risk of MV usage RD = 0.07, 95% CI = 0.00, 0.14) in studies involving cohorts with a mixed primary diagnosis for PICU admission.ConclusionIn PICU, UN is linked to mortality incidence, longer PICU stay, MV usage, and duration on MV. The primary diagnosis for PICU admission may also influence clinical outcomes. Determining the prevalence of UN in hospitalized patients, as well as the subgroups of patients diagnosed at the time of admission, requires more research. This may help explain the relationship between nutritional status and clinical outcomes in PICU patients.

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Section: Discussioncontrasting

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Is Undernutrition Associated With Deterioration of Outcomes in the Pediatric Intensive Care Unit (PICU): Systematic and Meta-Analysis Review

Albadi

Bookari

2022

Front. Pediatr.

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“…Our findings align with the previous literature regarding extubation failure being associated with longer ICU stays ( 5 ). As BMI is a simple and standard measure to assess nutritional status ( 14 ), a previous study showed malnutrition was an independent association with a longer length of mechanical ventilation usage ( 15 ). Our study showed that BMI was significantly lower in the extubation failure group.…”

Section: Discussionmentioning

confidence: 99%

Predictive factors of extubation failure in pediatric cardiac intensive care unit: A single-center retrospective study from Thailand

et al. 2023

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Introduction/objectiveExtubation failure increases morbidity and mortality in pediatric cardiac patients, a unique population including those with congenital heart disease or acquired heart disease. This study aimed to evaluate the predictive factors of extubation failure in pediatric cardiac patients and to determine the association between extubation failure and clinical outcomes.MethodsWe conducted a retrospective study in the pediatric cardiac intensive care unit (PCICU) of the Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand, from July 2016 to June 2021. Extubation failure was defined as the re-insertion of the endotracheal tube within 48 hours after extubation. Multivariable log-binomial regression with generalized estimating equations (GEE) was performed to explore the predictive factors associated with extubation failure.ResultsWe collected 318 extubation events from 246 patients. Of these, 35 (11%) events were extubation failures. In physiologic cyanosis, the extubation failure group had significantly higher SpO2 than the extubation success group (P < 0.001). The predictive factors associated with extubation failure included a history of pneumonia before extubation (RR 3.09, 95% CI 1.54–6.23, P = 0.002), stridor after extubation (RR 2.57, 95% CI 1.44–4.56, P = 0.001), history of re-intubation (RR 2.24, 95% CI 1.21–4.12, P = 0.009), and palliative surgery (RR 1.87, 95% CI 1.02–3.43, P = 0.043).ConclusionExtubation failure was identified in 11% of extubation attempts in pediatric cardiac patients. The extubation failure was associated with a longer duration of PCICU stay but not with mortality. Patients with a history of pneumonia before extubation, history of re-intubation, post-operative palliative surgery, and post-extubation stridor should receive careful consideration before extubation and close monitoring afterward. Additionally, patients with physiologic cyanosis may require balanced circulation via regulated SpO2.

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“…In the pediatric intensive care literature there is very little information, except for a previous NEAR4KIDS registry dataset (2010)(2011)(2012)(2013)(2014)(2015) that identified an association between increased body weight and greater odds of needing cricoid pressure at the time of TI (15). The association between mortality in critically ill pediatric patients and BMI is unclear, with some studies finding no association and others demonstrating increased mortality in underweight patients (16,17).…”

mentioning

confidence: 99%

Adverse Tracheal Intubation Events in Critically Ill Underweight and Obese Children: Retrospective Study of the National Emergency Airway for Children Registry (2013–2020)

Gladen,

Tellez,

Napolitano

et al. 2023

Pediatric Critical Care Medicine

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Objectives: Extremes of patient body mass index are associated with difficult intubation and increased morbidity in adults. We aimed to determine the association between being underweight or obese with adverse airway outcomes, including adverse tracheal intubation (TI)-associated events (TIAEs) and/or severe peri-intubation hypoxemia (pulse oximetry oxygen saturation < 80%) in critically ill children. Design/Setting: Retrospective cohort using the National Emergency Airway for Children registry dataset of 2013–2020. Patients: Critically ill children, 0 to 17 years old, undergoing TI in PICUs. Interventions: None. Measurements and Main Results: Registry data from 24,342 patients who underwent TI between 2013 and 2020 were analyzed. Patients were categorized using the Centers for Disease Control and Prevention weight-for-age chart: normal weight (5th–84th percentile) 57.1%, underweight (< 5th percentile) 27.5%, overweight (85th to < 95th percentile) 7.2%, and obese (≥ 95th percentile) 8.2%. Underweight was most common in infants (34%); obesity was most common in children older than 8 years old (15.1%). Underweight patients more often had oxygenation and ventilation failure (34.0%, 36.2%, respectively) as the indication for TI and a history of difficult airway (16.7%). Apneic oxygenation was used more often in overweight and obese patients (19.1%, 19.6%) than in underweight or normal weight patients (14.1%, 17.1%; p < 0.001). TIAEs and/or hypoxemia occurred more often in underweight (27.1%) and obese (24.3%) patients (p < 0.001). TI in underweight children was associated with greater odds of adverse airway outcome compared with normal weight children after adjusting for potential confounders (underweight: adjusted odds ratio [aOR], 1.09; 95% CI, 1.01–1.18; p = 0.016). Both underweight and obesity were associated with hypoxemia after adjusting for covariates and site clustering (underweight: aOR, 1.11; 95% CI, 1.02–1.21; p = 0.01 and obesity: aOR, 1.22; 95% CI, 1.07–1.39; p = 0.002). Conclusions: In underweight and obese children compared with normal weight children, procedures around the timing of TI are associated with greater odds of adverse airway events.

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Association between admission body mass index and outcomes in critically ill children: A systematic review and meta-analysis

Cited by 6 publications

References 49 publications

Is Undernutrition Associated With Deterioration of Outcomes in the Pediatric Intensive Care Unit (PICU): Systematic and Meta-Analysis Review

Is Undernutrition Associated With Deterioration of Outcomes in the Pediatric Intensive Care Unit (PICU): Systematic and Meta-Analysis Review

Predictive factors of extubation failure in pediatric cardiac intensive care unit: A single-center retrospective study from Thailand

Adverse Tracheal Intubation Events in Critically Ill Underweight and Obese Children: Retrospective Study of the National Emergency Airway for Children Registry (2013–2020)

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