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Does Persistent Inflammatory Catabolic Syndrome Exist in Critically Ill Neonates?

Nicole Ellis1, Caitlin Hughes1, Vera Mazurak1

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JPEN. Journal of Parenteral and Enteral Nutrition
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Persistent inflammatory catabolic syndrome (PICS) affects 20% of critically ill infants, leading to failure to thrive and longer hospital stays. Early identification and intervention are crucial for these vulnerable neonates.

Keywords:
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Area of Science:

  • Neonatal intensive care
  • Pediatric critical care medicine
  • Clinical nutrition

Background:

  • Persistent inflammatory catabolic syndrome (PICS) is a recognized condition in adult critical illness.
  • PICS has not been previously defined or described in the infant population.
  • Critically ill neonates may experience a similar syndrome impacting growth and recovery.

Purpose of the Study:

  • To propose and validate a definition for PICS in critically ill infants.
  • To identify the prevalence of PICS in a neonatal intensive care unit (NICU) population.
  • To characterize infants with PICS regarding clinical and metabolic profiles.

Main Methods:

  • Modified adult PICS criteria using infant-specific anthropometric and biochemical data.
  • Prospective chart review of 65-day admissions to a tertiary surgical NICU.
  • Daily collection of demographic, anthropometric, biochemical, and clinical variables.

Main Results:

  • Twenty percent (15/75) of admitted infants met the proposed PICS criteria.
  • Infants with PICS were more likely to experience failure to thrive (53%) and had significantly longer NICU and hospital stays (P < .001).
  • PICS infants showed higher peak glucose (11.8 ± 7.3 mmol/L) and elevated urea (7.9 ± 4.6 mmol/L), with 100% having undergone surgery.

Conclusions:

  • Persistent inflammatory catabolic syndrome (PICS) is identifiable in critically ill neonates using the proposed definition.
  • Infants with PICS exhibit metabolic dysregulation and impaired growth, independent of initial severity scores.
  • Further research is needed to validate these findings and explore nutritional interventions for infants with PICS.