Increased nutrition risk at admission is associated with longer hospitalization in children and adolescents with COVID‐19

Abstract

Background: We investigated the association of nutritional risk and inflammatory marker level with length of stay (LOS) in children and adolescents hospitalized for COVID-19 infection in two pediatric teaching hospitals in a developing country. Methods: This was a cross-sectional analytical retrospective study performed in two pediatric hospitals. We included the data from all children and adolescents who were hospitalized with a SARS-CoV-2 infection between March and December 2020. Demographic, anthropometric, clinical, and laboratory data were extracted from electronic medical records. Nutritional risk was assessed according to the STRONGkids tool within 24 hours of admission and was categorized into two levels: ≥4 (high risk) and <4 (moderate or low risk). Means or medians were compared between nutritional risk groups using the t test and Mann-Whitney U test, respectively. The association of nutritional risk and inflammatory markers with LOS was estimated using the Kaplan-Meier method and log-rank test. Cox proportional-hazard and linear regression models were performed, and adjusted for sex, age, and respiratory symptoms. Results: From a total of 73 patients, 20 (27.4%) had a STRONGkids score ≥4 at admission, which was associated with a longer LOS even after adjusting (β = 12.30; 1.74-22.9 95% CI; P = 0.023). The same association was observed between LOS and all laboratory markers except for D-dimer.Conclusion: Among children and adolescents with COVID-19, a STRONGkids score ≥4 at admission, lower values of albumin, lymphocytes, and hemoglobin, and higher CRP values were associated with longer LOS.

Nutritional risk and clinical outcomes of COVID-19 in hospitalized children and adolescents: a multicenter cohort

“…In the present study, 34% of the evaluated patients were in intensive care, and those who were at high nutritional risk had almost 5 times more chance of ICU admission. The present result is similar to a retrospective study 11 carried out in São Paulo, where 40.5% of patients were admitted to ICU, which was associated with higher nutritional risk by STRONGkids, compared to those with lower nutritional risk [75% vs 28.3%; (p= 0.000)].…”

“…Zamberlan and colleagues 11 observed an association between longer hospital stays with higher nutritional risk assessed by STRONGkids, in children and adolescents with COVID-19, where STRONGkids ≥ 4 points was related to a later discharge date ( p = 0.0107). The association between high nutritional risk and lower chance of hospital discharge has already been described in another study 20 that evaluated 641 Brazilian individuals, in the period from 2014 to 2018.…”

“…In the context of the pandemic by COVID-19, where access to patients was sometimes restricted, nutritional risk screening tools contributed to the prediction of nutritional status. 11 In hospitalization, these tools, which are practical and fast to apply, have been widely used, helping to identify the nutritional status and enabling early nutritional intervention, preventing morbidity and mortality 12 , 13 Literature data show an association between higher risk in nutritional screening and longer hospitalization time by COVID-19 in the pediatric age group. 11 …”

Increased nutrition risk is associated with a prolonged negative conversion of viral RNA in children and adolescents with COVID‐19

“…However, extrapolations from other RNA virus infections, such as the 1918 influenza pandemic, suggest that alterations in nutrition status affected respiratory disease severity and clinical regression 16 . A previous study on COVID‐19 in children demonstrated that high nutrition risk based on STRONG kids (Screening Tool for Risk on Nutritional status and Growth) scores were associated with a longer length of stay 17 . The effect of nutrition risk on time to viral nucleic acid conversion may be that the nutrition status of the organism impairs viral clearance benefits by impairing cell‐mediated immune function, cytokine production, and phagocytosis.…”

“…16 A previous study on COVID-19 in children demonstrated that high nutrition risk based on STRONG kids (Screening Tool for Risk on Nutritional status and Growth) scores were associated with a longer length of stay. 17 The effect of nutrition risk on time to viral nucleic acid conversion may be that the nutrition status of the organism impairs viral clearance benefits by impairing cell-mediated immune function, cytokine production, and phagocytosis. In addition, adaptive immunity is influenced by nutrition status, particularly the maturation and differentiation of lymphocytes, the production of memory cells, and the production of cytokines and antibodies.…”