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Nutritional status, intake, and outcomes in critically ill children with bronchiolitis
Glenn Y H Ng1,2, Chengsi Ong3,4, Judith J M Wong5
1Department of Pediatrics, General Paediatrics Service, KK Women's and Children's Hospital, Singapore.
Insights
Children with severe bronchiolitis in the pediatric intensive care unit (PICU) who have low weight-for-length Z-scores (WLZ) experience longer stays. Protein adequacy in nutrition is linked to extended PICU and mechanical ventilation (MV) duration.
Area of Science:
- Pediatric critical care medicine
- Pediatric nutrition
- Respiratory infections
Background:
- Optimal nutrition for severe bronchiolitis in pediatric intensive care units (PICU) is not well-defined.
- Nutritional status and practices in critically ill children with severe bronchiolitis require further investigation.
- Understanding nutritional impacts on outcomes is crucial for clinical management.
Purpose of the Study:
- To describe nutritional status and feeding practices in children with severe bronchiolitis admitted to the PICU.
- To explore the association between nutritional status, feeding practices, and PICU outcomes.
- To identify potential nutritional targets for improving care in severe bronchiolitis.
Main Methods:
- Retrospective study of patients with bronchiolitis requiring PICU admission (2009-2014).
- Collected demographics, medical data, and baseline weight-for-length Z-scores (WLZ).
- Assessed nutritional intake (energy and protein) for patients with ≥48 hours PICU stay, defining underfeeding, overfeeding, and protein adequacy.
Main Results:
- Low baseline WLZ was associated with significantly longer PICU stays and mechanical ventilation (MV) days.
- Protein adequacy (intake >1.5 g/kg/d) was linked to increased PICU and MV duration in patients with ≥48 hours PICU stay.
- No significant associations were found for underfeeding or overfeeding with PICU or MV days.
Conclusions:
- Low weight-for-length Z-scores at PICU admission are a predictor of prolonged PICU stay and mechanical ventilation in children with severe bronchiolitis.
- Achieving protein adequacy in nutrition is associated with longer PICU and MV durations for these patients.
- Further research is needed to optimize nutritional strategies for children with severe bronchiolitis in the PICU.
Background:
Optimal nutrition in children with severe bronchiolitis remains poorly described. We aimed to describe nutritional status and practices in children with severe bronchiolitis requiring admission to the pediatric intensive care unit (PICU), and explore their associations with outcomes.
Methods:
We conducted a retrospective study on patients with bronchiolitis requiring PICU stay from 2009 to 2014. Demographics, medical data, and baseline weight-for-length Z-scores (WLZ) were collected. In patients requiring more than 48 hours of PICU stay, nutritional intake data in the first 3 days of PICU stay were collected. Underfeeding and overfeeding were defined as the median energy intake of less than 80% and more than 120% of requirements, respectively. Protein adequacy was defined as intake of more than 1.5 g/kg/d. Primary and secondary outcomes of interest were the duration of PICU stay and mechanical ventilation (MV), respectively.
Results:
Seventy-four patients were included, with a median PICU stay of 4.9 days (interquartile range 2.0-8.2). Low WLZ at baseline was associated with longer duration of PICU stay (adjusted β: 4.33 [95% confidence interval [CI], 0.49-8.18]; P = .028) and MV days (adjusted β: 4.87 [95% CI, 1.56-8.18]; P = .008) compared to appropriate WLZ. In patients with ≥48 hours PICU stay, protein adequacy was significantly associated with greater PICU (adjusted β coefficient, 6.35 [95% CI, 1.66-11.0]; P = .009) and MV days (adjusted β coefficient, 5.22 [95% CI, 1.06-9.38]; P = .015).
Conclusion:
Among bronchiolitis patients admitted to the PICU, low WLZ at admission was associated with a longer duration of PICU stay and MV. Protein adequacy was associated with longer PICU and MV days in children with ≥48 hours of PICU stay.
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