Challenges of nutritional assessment in pediatric ICU

Feferbaum, Rubens; Delgado, Artur Figueiredo; Zamberlan, Patrícia; Leone, Cláudio

doi:10.1097/mco.0b013e32832a3f43

Cited by 35 publications

(24 citation statements)

References 51 publications

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“…Anthropometry is a basic component of the nutrition assessment because it presents standardized reference values by age group, unlike biochemical indicators . Furthermore, anthropometry is very useful for classifying nutrition status, as well as for planning nutrition therapy (NT) and nutrition monitoring . Usually, critically ill children present with edema, electrolyte imbalance, intense protein catabolism, and changes in body composition due to loss of muscle mass and total body water redistribution, which makes the anthropometric assessment difficult to interpret.…”

Section: Introductionmentioning

confidence: 99%

Bioelectrical Impedance Phase Angle and Morbidity and Mortality in Critically Ill Children

et al. 2018

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Background Nutrition markers may be useful for diagnosis and monitoring and, also, as additional indicators of estimating death risk. We tested the association of body composition indicators (mid–upper arm circumference and phase angle) with pediatric intensive care unit (PICU) length of stay and mortality in critically ill pediatric patients. Methods Data from children aged 2 months–18 years were collected, and bioelectrical impedance was performed to obtain phase angle. Severity was evaluated by scoring the Pediatric Index of Mortality. Descriptive statistics were reported for nominal variables. Receiver operating characteristic curve was used to analyze the association of phase angle with 30‐day mortality and to find the best cutoff. Survival probabilities and PICU length of stay were estimated using the Kaplan‐Meier method. Results We evaluated 247 children with a median age of 4.8 years whose main cause of admission was sepsis. Survival curves showed higher survival in patients with phase angle >2.8° compared with patients with phase angle ≤2.8° (P < .0001). Kaplan‐Meier time‐to‐event analysis showed that children with lower phase angle values were more likely to remain in the PICU (hazard ratio, 1.84; P = .003). Lower survival was also observed in patients who presented mid–upper arm circumference values ≤5th percentile (P < .03). Conclusions Mid–upper arm circumference and phase angle were associated with mortality and morbidity in critically ill children, suggesting that these parameters may be useful not only for nutrition diagnosis and monitoring, but also as an additional indicator in estimating prognosis.

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Section: Introductionmentioning

confidence: 99%

Bioelectrical Impedance Phase Angle and Morbidity and Mortality in Critically Ill Children

et al. 2018

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“…If confirmed in the first 72 hours after admission, it is partly or entirely due to external causes; after that, it is more related to several factors during hospitalization. In both cases, hospital malnutrition is a known risk factor for child morbidity and mortality (18,19) . Hospital malnutrition is common in children and recent research shows that its prevalence reaches about 40% of hospitalized children (5,20) .…”

Section: Discussionmentioning

confidence: 99%

Tradução e adaptação cultural da ferramenta Strongkids para triagem do risco de desnutrição em crianças hospitalizadas

Carvalho¹,

Lopes²,

Vilela³

et al. 2013

Rev. paul. pediatr.

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OBJETIVO: Realizar a tradução para o português e a adaptação cultural da ferramenta para triagem de desnutrição Strongkids, em crianças hospitalizadas. MÉTODOS: Estudo documental no qual foi realizada a tradução da ferramenta da versão original (inglês) para a língua portuguesa. A tradução e a adaptação cultural do conteúdo de tal instrumento consistiram de seis etapas, segundo a metodologia proposta por Beaton et al (tradução inicial, síntese das traduções, retrotradução, verificação do processo de equivalência cultural, pré-teste e avaliação do processo de adaptação cultural). Na primeira etapa, a tradução foi realizada por dois tradutores independentes; na segunda, envolveu síntese e reconciliação das mesmas; na terceira, a reconciliada foi retrotraduzida e, na quarta, elaborou-se versão pré-final, de forma a manter as equivalências linguísticas. Na quinta etapa, foi realizado o pré-teste da versão pré-final para verificar a compreensão dos itens e, na última, foram feitas as correções necessárias e uma versão final da ferramenta foi elaborada. RESULTADOS: A versão pré-final da ferramenta foi aplicada a 30 pais e/ou responsáveis e a 20 profissionais da saúde para esclarecer o entendimento da mesma por ambos os públicos. As principais alterações realizadas foram adequações de termos técnicos, visando a atender às recomendações dos profissionais da área da saúde, e adequação dos termos para os pais e/ou responsáveis. CONCLUSÕES: A ferramenta em português mostrou-se de simples entendimento para os pais/responsáveis e profissionais da saúde a fim de triar o risco de desnutrição em crianças hospitalizadas.

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“…Body composition techniques, such as dual‐energy x‐ray absorptiometry (DXA), computed tomography, and magnetic resonance imaging, provide information related to tissue density or volume of the protein compartments but lack practicality or validation in the intensive care unit (ICU) 65 , 67 , 78 . Air displacement plethysmography, 79 bioelectrical impedance analysis (BIA), 80 and the use of tracer dilution with stable isotopes 68 may allow measurement of body composition in critically ill children, but careful consideration should be given when using these modalities with the presence of major fluid shifts.…”

Section: Assessment Of Body Composition and Protein Turnover During Cmentioning

confidence: 99%

Protein Requirements of the Critically Ill Pediatric Patient

et al. 2017

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This article includes a review of protein needs in children during health and illness, as well as a detailed discussion of protein metabolism, including nitrogen balance during critical illness, and assessment and prescription/delivery of protein to critically ill children. The determination of protein requirements in children has been difficult and challenging. The protein needs in healthy children should be based on the amount needed to ensure adequate growth during infancy and childhood. Compared with adults, children require a continuous supply of nutrients to maintain growth. The protein requirement is expressed in average requirements and dietary reference intake, which represents values that cover the needs of 97.5% of the population. Critically ill children have an increased protein turnover due to an increase in whole‐body protein synthesis and breakdown with protein degradation leading to loss of lean body mass (LBM) and development of growth failure, malnutrition, and worse clinical outcomes. The results of protein balance studies in critically ill children indicate higher protein needs, with infants and younger children requiring higher intakes per body weight compared with older children. Monitoring the side effects of increased protein intake should be performed. Recent studies found a survival benefit in critically ill children who received a higher percentage of prescribed energy and protein goal by the enteral route. Future randomized studies should evaluate the effect of protein dosing in different age groups on patient outcomes, including LBM, muscle structure and function, duration of mechanical ventilation, intensive care unit and hospital length of stay, and mortality.

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Challenges of nutritional assessment in pediatric ICU

Cited by 35 publications

References 51 publications

Bioelectrical Impedance Phase Angle and Morbidity and Mortality in Critically Ill Children

Bioelectrical Impedance Phase Angle and Morbidity and Mortality in Critically Ill Children

Tradução e adaptação cultural da ferramenta Strongkids para triagem do risco de desnutrição em crianças hospitalizadas

Protein Requirements of the Critically Ill Pediatric Patient

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