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Nutritional Status Deterioration Occurs Frequently During Children's ICU Stay
Frédéric V Valla1,2, Florent Baudin1,3, Bénédicte Gaillard Le Roux4
1Pediatric Intensive Care, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, 59 bd Pinel 69500 Lyon-Bron, France.
Insights
Nutritional status decline is common in critically ill children staying longer than five days in the pediatric intensive care unit (PICU). Most children recover nutritional status within three months after discharge.
Area of Science:
- Pediatric intensive care
- Clinical nutrition
- Critical illness
Background:
- Malnutrition and faltering growth at pediatric intensive care unit (PICU) admission are linked to poor outcomes.
- Limited data exist on nutritional status deterioration during PICU stays.
- Critical illness causes significant metabolic shifts affecting energy and protein metabolism.
Purpose of the Study:
- To investigate the occurrence of faltering growth in critically ill children during their PICU stay.
- To describe the extent of nutritional status deterioration in this population.
Main Methods:
- Prospective observational study in a 23-bed general PICU.
- Included critically ill children aged 0-18 years with PICU stays exceeding 5 days.
- Measured weight and height/length at admission; monitored weight during PICU stay to calculate body mass index for age z-score.
Main Results:
- Analyzed 579 admissions; 10.2% showed a body mass index z-score decline >1 SD, and 27.8% showed a decline >0.5 SD.
- Severity scores and prolonged PICU stay explained only 4% of nutritional status deterioration variability.
- Most children demonstrated nutritional recovery within 3 months post-discharge.
Conclusions:
- Nutritional deterioration is frequent and significant in critically ill children with extended PICU stays (>5 days).
- Further research is needed on targeted nutritional therapies to mitigate PICU faltering growth.
- Improving nutritional support may enhance post-PICU rehabilitation outcomes.
Objectives:
Malnutrition and faltering growth at PICU admission have been related to suboptimal outcomes. However, little is known about nutritional status deterioration during PICU stay, as critical illness is characterized by a profound and complex metabolism shift, which affects energy requirements and protein turnover. We aim to describe faltering growth occurrence during PICU stay.
Design:
Single-center prospective observational study.
Setting:
Twenty-three-bed general PICU, Lyon, France.
Patients:
All critically ill children 0-18 years old with length of stay longer than 5 days were included (September 2013-December 2015).
Interventions:
Weight and height/length were measured at admission, and weight was monitored during PICU stay, in order to calculate body mass index for age z score. Faltering growth was defined as body mass index z score decline over PICU stay. Children admitted during the first year of the study and who presented with faltering growth were followed after PICU discharge for 3 months.
Measurements And Main Results:
We analyzed 579 admissions. Of them, 10.2% presented a body mass index z score decline greater than 1 SD and 27.8% greater than 0.5. Admission severity risk scores and prolonged PICU stay accounted for 4% of the variability in nutritional status deterioration. Follow-up of post-PICU discharge nutritional status showed recovery within 3 months in most patients.
Conclusions:
Nutritional deterioration is frequent and often intense in critically ill children with length of stay greater than 5 days. Future research should focus on how targeted nutritional therapies can minimize PICU faltering growth and improve post-PICU rehabilitation.