Impact of Malnutrition on the Outcome of Critically Ill Children

Bagri, Narendra Kumar; Jose, Bipin; Shah, Satish; Bhutia, Tsultem D.; Kabra, S. K.; Lodha, Rakesh

doi:10.1007/s12098-015-1738-y

Cited by 64 publications

(70 citation statements)

References 19 publications

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“…Comparisons of these and other studies to each other and to the present study are difficult; however, because of the wide variation in their definitions of malnutrition and the outcomes they measured . One advantage of our study is the use of standardized ASPEN definitions of malnutrition severity, which are derived from expert consensus, conform to World Health Organization (WHO) standard growth curves, and have been used in several patient populations, including critically ill children . Moreover, use of standardized malnutrition definitions allows for appropriate comparisons within groups over time and with other studies utilizing the same methodology .…”

Section: Discussionmentioning

confidence: 99%

Impact of ventricular assist device implantation on the nutritional status of children awaiting heart transplantation

Hollander

Schultz

Dennis

et al. 2019

Pediatric Transplantation

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Background Malnutrition is common in pediatric heart failure and is associated with mortality. The effect of VAD support on malnutrition in children is unknown. We sought to compare the prevalence and severity of malnutrition at HT in children on VAD support vs OMT to inform decisions regarding support strategies. Methods Retrospective chart review involving all patients <18 years who underwent HT at Stanford between 1/1/2011 and 3/1/2018. Malnutrition diagnosis and severity were defined by ASPEN guidelines using the lowest age‐adjusted z‐score for weight (WAZ), height (HAZ), and BMI (BMIZ) when the patient was euvolemic. Changes in z‐scores from baseline to HT and across groups were analyzed. Results A total of 104 patients (52 in each group) were included. Among all patients, WAZ (−0.9 vs 0.3, P < 0.001) and BMIZ (0 vs 0.6, P < 0.001) improved while HAZ (−0.9 vs −0.9, P = 0.4) did not. Compared to children on OMT, children on VAD experienced greater increases in WAZ (0.8 vs 0.3, P < 0.001) and BMIZ (0.7 vs 0.2, P < 0.003) at HT. The prevalence of moderate‐to‐severe malnutrition decreased in VAD patients (40% to 19%, P < 0.001) and increased in OMT patients (37% to 46%, P < 0.001), leading to a lower prevalence of moderate‐to‐severe malnutrition at HT (19% vs 46%, P = 0.003). Conclusions Malnutrition is common in pediatric HT candidates. Compared to children on OMT, children on VAD support had greater improvement in nutritional status while awaiting HT, and a lower prevalence of malnutrition at HT.

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Section: Discussionmentioning

confidence: 99%

Impact of ventricular assist device implantation on the nutritional status of children awaiting heart transplantation

Hollander

Schultz

Dennis

et al. 2019

Pediatric Transplantation

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“…Similarly, a prospective cohort study of children admitted to a Brazilian PICU, malnutrition was significantly associated with duration of mechanical ventilation [23]. In a cohort of children admitted to an Indian PICU, malnutrition was associated with increased risk of acquired infections and length of stay [7]. In children with congenital heart defects underweight is a significant predictor of lengthier hospital stay [22, 24, 25].…”

Section: Discussionmentioning

confidence: 99%

“…Documentation of weight and height is recommended in PICU settings [6], but few studies have examined the relationships between a range of nutritional status categories (i.e. underweight, normal weight, overweight and obesity) and clinical outcomes in critically ill children [4, 7–10]. The quality of some of these studies has been limited due to retrospective design [9], single center observations, or small sample size [4, 9], and nutritional status determined by weight alone [4].…”

Section: Introductionmentioning

confidence: 99%

Nutritional Status Based on Body Mass Index Is Associated With Morbidity and Mortality in Mechanically Ventilated Critically Ill Children in the PICU*

Bechard

Duggan

Touger‐Decker

et al. 2016

Critical Care Medicine

138

108

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Objective To determine the influence of admission anthropometry on clinical outcomes in mechanically ventilated children in the pediatric intensive care unit (PICU). Design Data from 2 multicenter cohort studies were compiled to examine the unique contribution of nutritional status, defined by BMI Z-score, to 60-day mortality, hospital-acquired infections, length of hospital stay, and ventilator free days (VFD), using multivariate analysis. Setting 90 PICUs from 16 countries with 8 beds. Patients Children aged 1 month to 18 years, admitted to each participating PICU and requiring mechanical ventilation for more that 48 hours Measurements and Main Results Data from 1622 eligible patients, 54.8% male and mean (SD) age 4.5 (5.1) years, were analysed. Subjects were classified as underweight (17.9%), normal weight (54.2%), overweight (14.5%), and obese (13.4%) based on BMI Z-score at admission. After adjusting for severity of illness and site, the odds of 60-day mortality were higher in underweight (OR 1.53, P<0.001) children. The odds of hospital-acquired infections were higher in underweight (OR 1.88, P=0.008) and obese (OR 1.64, P<0.001) children. Hazard ratios for hospital discharge were lower among underweight (HR 0.71, P<0.001) and obese (HR 0.82, P=0.04) children. Underweight was associated with 1.3 (P=0.001) and 1.6 (P<0.001) fewer VFD, compared to normal weight and overweight, respectively. Conclusions Malnutrition is prevalent in mechanically ventilated children on admission to PICUs worldwide. Classification as underweight or obese was associated with higher risk of hospital-acquired infections and lower likelihood of hospital discharge. Underweight children had a higher risk of mortality and fewer ventilator-free days.

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“…Moreover, the detection of biochemical abnormalities cannot predict decreases in anthropometric nutrition parameters during ICU admission in critically ill children . Several studies have investigated the predictive role of an extremely low body weight on disease prognosis and outcomes among general and critically ill children . They enrolled all patients consecutively admitted to a neonatal ICU (NICU) and pediatric ICU (PICU); therefore, being underweight may have resulted from endocrine diseases, genetic syndromes, or other systemic underlying illnesses.…”

mentioning

confidence: 99%

“…10 Several studies have investigated the predictive role of an extremely low body weight on disease prognosis and outcomes among general and critically ill children. [13][14][15][16] They enrolled all patients consecutively admitted to a neonatal ICU (NICU) and pediatric ICU (PICU); therefore, being underweight may have resulted from endocrine diseases, genetic syndromes, or other systemic underlying illnesses. The impact of a low body weight on outcomes of acutely critically ill but previously healthy children is still unknown.…”

mentioning

confidence: 99%

Being Underweight Is an Independent Risk Factor for Poor Outcomes Among Acutely Critically Ill Children

Chen

Yang

2017

Nut in Clin Prac

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Impact of Malnutrition on the Outcome of Critically Ill Children

Abstract: After stabilization of the initial critical phase, PICU outcome is influenced by the nutritional status of the children.

Cited by 64 publications

References 19 publications

Impact of ventricular assist device implantation on the nutritional status of children awaiting heart transplantation

Impact of ventricular assist device implantation on the nutritional status of children awaiting heart transplantation

Nutritional Status Based on Body Mass Index Is Associated With Morbidity and Mortality in Mechanically Ventilated Critically Ill Children in the PICU*

Being Underweight Is an Independent Risk Factor for Poor Outcomes Among Acutely Critically Ill Children

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