Undernutrition at PICU Admission Is Predictor of 60-Day Mortality and PICU Length of Stay in Critically Ill Children

Ventura, Julia Carvalho; Hauschild, Daniela Barbieri; Barbosa, Eliana; Bresolin, Nilzete Liberato; Kawai, Kosuke; Mehta, Nilesh M.; Moreno, Yara Maria Franco

doi:10.1016/j.jand.2019.06.250

Cited by 34 publications

(40 citation statements)

References 38 publications

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“…Thus, we utilized each study's method of classification to define the weight categories; there were 8,044 (75.61%) normal weight and 2,594 (24.38%) underweight patients. Of the studies, 11 trials included participants up to 18 years of age ( n = 1,330), while the remaining studies set the maximum age at 16 years or less ( 10 , 26 , 29 , 35 – 37 ).…”

Section: Resultsmentioning

confidence: 99%

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: Resultsmentioning

confidence: 99%

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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“…Independent studies in India, China, and Brazil showed 51.2, 51.7, and 18% of critically ill children were undernourished respectively [ 13 – 15 ]. On the other hand, a study from sixteen countries among children aged 1 month to 18 years admitted to PICU revealed that 17.9% were wasted [ 16 ].…”

Section: Introductionmentioning

confidence: 99%

Wasting and associated factors among critically ill children admitted to pediatric intensive care unit in Ethiopia

et al. 2022

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Background Nutritional problems are increasingly associated with acute infections. It is also related to further complications of illnesses and poor treatment outcomes of medical conditions. This study aimed to assess wasting and associated factors among critically ill children admitted to intensive care units at the time of admission. Methods An institution-based prospective observational study was employed among children admitted to pediatric intensive care of the University of Gondar Comprehensive Specialized Hospital from February 1, 2018, to July 30, 2019. Data about socio-demographic, clinical, and anthropometric measurements were taken from children at the time of admission and length of hospital stay and treatment-related data were collected by chart review at discharge. Summary measures were computed and presented in the form of text, tables, and graphs. A p-value of less than 0.2 was used to select candidate variables for multivariable analysis. A binary logistic regression model was fitted to identify factors associated with wasting. Adjusted odds ratio with 95% confidence interval (CI) was calculated and variables with a p-value less than 0.05 in the multi-variable analysis were considered to declare factors associated with wasting. Results The median age at admission was 48 (IQR: 12 to 122) months. Of the total admitted children to ICU, 47.97% were undernourished, of which 32% (95%CI: (26.8% to 37.4%) were severely wasted. Caregivers who had no formal education (AOR=4.43, 95%CI 1.62 12.10), transferred from wards (AOR=2.98, 95%CI: 1.02 8.69), duration of illness ≥6 days before health facility visit (AOR=2.14, 95%CI: 1.22 3.72) and comorbidity (AOR=6.85, 95%CI: 2.93 16.05) were statistically significant factors associated with wasting. Conclusion Wasting was high among children admitted to the intensive care unit. No formal education, transferred from wards and operation rooms, longer duration of illness before health facility visits, and comorbidity were factors associated with wasting. Wasted patients had higher mortality as compared to patients with no wasting. A multicenter study with larger sample size is recommended for a more generalizable result.

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“…In addition, both acute illnesses (e.g., trauma, burns, and infections) and chronic diseases (e.g., cystic fibrosis, congenital heart disease) are usually associated with increased nutrient loss and altered nutrient utilization (13). Conversely, undernutrition in hospitalized pediatric patients has been shown to be associated with delayed recovery (12), increased length of hospital stay, higher mortality and complication rates, and decreased quality of life (14)(15)(16). Hence, adequate nutritional support for these patients is of utmost importance.…”

Section: Introductionmentioning

confidence: 99%

Case Report: Energy- and Nutrient-Dense Formula for Growth Faltering: A Report of Two Cases From India

Kareem¹,

Panuganti²,

Bhatia³

2021

Front. Nutr.

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Infants hospitalized for critical illnesses are at a high risk of undernutrition because of increased nutrient requirements (due to increased metabolism) and decreased nutrient intake (due to disease-related problems such as anorexia or feeding difficulties). This can result in a slowing down of their normal growth, referred to as “growth faltering.” Appropriate nutritional management of these infants is extremely important to avoid long-term adverse outcomes. Administration of energy- and nutrient-dense formula (ENDF; 100 kcal energy and 2.6 g protein per 100 mL, with added micronutrients) can be an effective means of increasing the nutrient and energy intake of these children. Despite the high prevalence of undernutrition and growth faltering among pediatric patients in India, there is a paucity of literature on the use of ENDF in Indian infants. Herein, we report the successful use of ENDF for the nutritional management of two infants hospitalized for growth faltering because of severe upper airway obstruction. The aim of nutritional management was to achieve satisfactory weight gain, which can lead to spontaneous resolution of upper airway obstruction. ENDF was initially administered to provide 50–100 kcal/kg/day, and the dose was gradually increased to 160–185 kcal/kg/day. Both infants tolerated the formula well and showed satisfactory weight gain. These cases clearly demonstrate that early administration of ENDF is an effective means of increasing nutrient and energy intake of critically ill infants, thereby facilitating catchup growth, without any notable adverse effects.

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Undernutrition at PICU Admission Is Predictor of 60-Day Mortality and PICU Length of Stay in Critically Ill Children

Cited by 34 publications

References 38 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

Wasting and associated factors among critically ill children admitted to pediatric intensive care unit in Ethiopia

Case Report: Energy- and Nutrient-Dense Formula for Growth Faltering: A Report of Two Cases From India

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