Malnutrition and Nutrition Support in Latin American PICUs: The Nutrition in PICU (NutriPIC) Study
Santiago Campos-Miño1, Artur Figueiredo-Delgado2, Patricia Zárate3
1Pediatric Intensive Care Unit, Hospital Metropolitano, Quito, Ecuador.
Insights
Malnutrition is common in pediatric intensive care units (PICUs) in Latin America, particularly in children under 24 months. However, nutritional support generally meets energy and protein needs.
Area of Science:
- Pediatric critical care medicine
- Nutritional science
- Public health in Latin America
Background:
- Pediatric malnutrition is a significant concern in intensive care settings.
- International guidelines exist for optimal nutrition support in critically ill children.
- Data on nutritional status and support adequacy in Latin American PICUs are limited.
Purpose of the Study:
- To assess the prevalence of malnutrition in children admitted to Latin American PICUs.
- To evaluate the adequacy of nutrition support compared to international recommendations.
Main Methods:
- The Nutrition in PICU (NutriPIC) study employed a point-prevalence design on a single day in 2021.
- A retrospective cohort analysis examined nutritional support adequacy over the preceding week.
- Data were collected from 41 PICUs across 13 Latin American countries.
Main Results:
- Malnutrition (underweight, low length-for-age) was prevalent in 47.7% and 46.6% of children under 24 months, respectively.
- Obesity was observed in 5.7% of children under 24 months and 12.6% of older children.
- Median 7-day enteral energy and protein delivery adequacy was 114% and 99% of recommended values, respectively.
Conclusions:
- Malnutrition is highly prevalent in Latin American PICU admissions, especially in those under 24 months.
- Nutritional support in these PICUs generally meets energy and protein requirements.
- Further research may be needed to address specific nutritional challenges in pediatric critical care across Latin America.
Objectives:
To characterize the nutritional status of children admitted to Latin American (LA) PICUs and to describe the adequacy of nutrition support in reference to contemporary international recommendations.
Design:
The Nutrition in PICU (NutriPIC) study was a combined point-prevalence study of malnutrition carried out on 1 day in 2021 (Monday 8 November) and a retrospective cohort study of adequacy of nutritional support in the week preceding.
Setting:
Four-one PICUs in 13 LA countries.
Patients:
Patients already admitted to the PICU of 1 month to 18 years old on the study day were included in the point-prevalence study. For the retrospective arm, we included patients receiving nutritional support on the study day and with a PICU length of stay (LOS) greater than or equal to 72 hours. Exclusion criteria were being a neonate, conditions that precluded accurate anthropometric measurements, and PICU LOS greater than 14 days.
Interventions:
None.
Measurements And Main Results:
Of 316 patients screened, 5 did not meet age criteria. There were 191 of 311 patients who were included in the point-prevalence study and underwent anthropometric evaluation. Underweight and length for age less than -2 z scores were present in 42 of 88 children (47.7%) and 41 of 88 children (46.6%) less than 24 months old, and 14 of 103 (13.6%) and (23/103) 22.3% of 103 children greater than or equal to 24 months, respectively. Evidence of obesity (body mass index > 2 z score) was present in 7 of 88 children (5.7%) less than 24 months old and 13 of 103 children (12.6%) greater than or equal to 24 months. In the 115 of 311 patients meeting criteria for the retrospective arm, a total of 98 patients reported complete nutritional data. The 7-day median (interquartile range) adequacy for delivered versus recommended enteral energy and protein requirement was 114% (75, 154) and 99% (60, 133), respectively.
Conclusions:
The NutriPIC study found that in 2021 malnutrition was highly prevalent especially in PICU admissions of less than 24 months old. Retrospectively, the 7-day median nutritional support appears to meet both energy and protein requirements.
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