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Sarcopenia in critically ill children: A bedside assessment using point-of-care ultrasound and anthropometry
Ruane S de Figueiredo1, Roberto J N Nogueira2, Alice M M Springer3
1Pediatric Intensive Care Unit, Department of Pediatrics, Clinics Hospital of the State University of Campinas (UNICAMP), Campinas, SP, Brazil.
Insights
Critically ill children experience significant muscle wasting early in their stay, linked to protein deficits. Point-of-care ultrasound (POCUS) and anthropometry are valuable for assessing sarcopenia in the pediatric intensive care unit (PICU).
Area of Science:
- Pediatric critical care medicine
- Clinical nutrition
- Diagnostic imaging
Background:
- Sarcopenia assessment in critically ill children is limited by a lack of validated methods.
- Muscle wasting is a significant concern in pediatric intensive care unit (PICU) patients.
Purpose of the Study:
- To assess muscle wasting using point-of-care ultrasound (POCUS) and anthropometry in critically ill children.
- To investigate the association between muscle wasting and nutrition delivery in the PICU.
Main Methods:
- A single-center, prospective cohort study included consecutive children admitted to the PICU.
- Quadriceps femoris muscle thickness (QFMT) and anthropometrics were measured at baseline (T0), day 7 (T1), and day 14 (T2).
- Nutritional intake was tracked until discharge or for the first 14 days.
Main Results:
- Significant muscle wasting (decrease in QFMT) was observed between T0 and T1 in both study subgroups (p < 0.001).
- No significant difference in QFMT was found between T1 and T2 (p = 0.936).
- Decreased QFMT at T1 correlated significantly with cumulative protein deficit but not energy deficit.
Conclusions:
- Critically ill children experience substantial early muscle wasting, potentially linked to inadequate protein delivery.
- Anthropometric measurements and POCUS are valuable tools for sarcopenia assessment in the PICU setting.
Background & Aims:
Due to the lack of validated methods of muscle assessment, sarcopenia is not well described in critically ill children. The main objectives of this study were to assess muscle wasting using point-of-care ultrasound (POCUS) and anthropometry, as well as its association with nutrition delivery in PICU.
Methods:
This was a single-center, prospective cohort study, including consecutive children admitted to the PICU. Quadriceps femoris muscle thickness (QFMT) and anthropometrics measurements were performed at admission and then weekly until the 14th day of the PICU stay. The three moments of assessment were defined as T0 (baseline), T1 (7th day) and T2 (14th day). For analysis purposes, participants assessed only in T0 and T1 were defined as Subgroup 1, while those assessed in T0, T1 and T2 were defined as Subgroup 2. Actual total daily intake was determined by patient intake records until discharge or during the first 14 full days of PICU admission.
Results:
In all, 119 patients were included with a median age of 12.0 months (IQR 4.0-42.5). In Subgroup 1, QFMT significantly decreased between T0 and T1 (-12.93 ± 14.07 %; p < 0.001), and the same was observed in Subgroup 2 (-13.81 ± 13.05 %; p < 0.001). However, no differences in QFMT was observed between T1 and T2 (-2.06 ± 13.80 %; p = 0.936). Triceps skinfold thickness, mid-upper arm circumference, and upper arm muscle area presented a similar pattern of changes between periods in both groups. Decrease of QFMT at T1 was significantly correlated with the cumulative protein deficit in both subgroups, but not with the cumulative energy deficit.
Conclusion:
Substantial muscle wasting occurs early in critically ill children and may be related to insufficient protein delivery. Anthropometric measurements are valuable in PICU and POCUS has the potential to play a major role in sarcopenia assessment during critical illnesses.
Trial Registration:
Brazilian Clinical Trials registry, registration number: RBR-85YYGN.
