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Undernutrition and 60-day mortality in critically ill children with respiratory failure: a prospective cohort study
Sina Amirjani1, Narjes Ahmadizadeh2, Azita Behzad2
1Department of Clinical Nutrition and Dietetics, Faculty of Nutrition and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Insights
Undernutrition in children with acute respiratory failure significantly increases the risk of 60-day mortality. Malnutrition is common in pediatric intensive care units and impacts survival rates.
Area of Science:
- Pediatric critical care medicine
- Nutritional science
- Respiratory medicine
Background:
- Acute respiratory failure is a critical condition in children.
- Undernutrition is a common comorbidity in critically ill children.
- The impact of undernutrition on mortality in pediatric acute respiratory failure requires investigation.
Purpose of the Study:
- To investigate the association between undernutrition and 60-day mortality in pediatric patients with acute respiratory failure.
- To identify specific nutritional parameters linked to increased mortality risk.
Main Methods:
- A cohort of 126 children (2 months to 13 years) with acute respiratory failure was studied.
- Nutritional status was assessed using Z-scores (BMI, height-for-age, weight-for-age, weight-for-height) on admission.
- Sixty-day mortality was the primary outcome, analyzed using Cox regression.
Main Results:
- 41-50% of patients were undernourished based on various Z-scores.
- The overall 60-day mortality rate was 27.8%.
- Undernutrition, particularly based on weight-for-age, BMI-for-age, and weight-for-height Z-scores, was significantly associated with increased 60-day mortality.
Conclusions:
- Undernutrition is prevalent in mechanically ventilated children in the pediatric intensive care unit.
- Undernutrition is a significant risk factor for 60-day mortality in pediatric acute respiratory failure.
- Early nutritional assessment and intervention are crucial for improving outcomes.
Background:
To determine whether undernutrition affects 60-day mortality in pediatric acute respiratory failure.
Methods:
Subjects with acute respiratory failure aged between two months and 13 years were included in the study. The Z-scores were calculated on admission and children were categorized into two groups of undernutrition and normal nutrition. The nutritional intake of the children was measured daily. The outcome was 60-day mortality.
Results:
A total of 126 patients met the inclusion criteria; 41% were undernourished based on the Z-score of BMI and weight for height, 50% based on the Z-score of height and length for age and 45% based on the Z-score of weight for age. Overall, the 60-day mortality rate was 27.8%. The Cox regression analysis adjusted with PIM2, age and gender, showed that undernutrition has a significant relationship with 60-day mortality based on the weight for age Z-score (HR = 2.33; CI: 1.175-4.638). In addition, undernutrition has a significant relationship with 60-day mortality based on the BMI for age (HR = 3.04; CI:1.070-8.639) and weight for height (HR = 2.62; CI: 1.605-6.658) Z-scores. The mean calorie and protein intake of 72% of the children was less than 80% of their calorie needs. The time to start feeding in 63% of the children was more than 48 h. There was no relationship between the time of starting nutrition and nutritional intake during PICU admission and mortality.
Conclusion:
Undernutrition is prevalent in mechanically ventilated children in the PICU and may be associated with 60-day mortality.
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