The prevalence of malnutrition among critically ill children: a systematic review and meta-analysis
Eyob Girma Abera1,2, Habtamu Sime3
1Department of Public Health, Jimma University, P.O.Box 378, Jimma, Oromia, Ethiopia. eyob.girma@ju.edu.et.
Insights
Malnutrition affects over one-third of critically ill children, worsening their health outcomes. Early nutritional intervention is crucial for these vulnerable pediatric patients to prevent severe complications and mortality.
Area of Science:
- Pediatric critical care medicine
- Nutritional science
- Epidemiology
Background:
- Critically ill children possess diminished nutritional reserves, exacerbated by restricted intake in intensive care units (ICUs).
- Limited data exist on the prevalence of malnutrition in this vulnerable pediatric population.
- This review assesses the pooled prevalence of malnutrition among critically ill children.
Approach:
- A systematic review and meta-analysis was performed following JBI methodology.
- Comprehensive literature searches were conducted across multiple databases (PubMed/MEDLINE, CINAHL/EBSCO, HINARI, Google Scholar) and gray literature.
- Eligible studies were critically appraised, and data were analyzed using STATA 17, including publication bias assessment via funnel plots and Egger's test.
Key Points:
- The pooled prevalence of malnutrition among 4331 critically ill children across 15 studies was 37.19%.
- Significant statistical heterogeneity (I² = 98.6%) was observed.
- Higher-income countries reported a lower pooled prevalence (30.14%).
Conclusions:
- Over one-third of critically ill children are malnourished, posing a significant risk for adverse outcomes, including mortality.
- Malnutrition can complicate critical illness and may lead to death if not addressed concurrently with critical care.
- Integrating specific malnutrition prevention strategies into healthcare systems and nutritional programs is essential for this patient group.
Background:
Critically ill children have a lower nutritional reserve, compounding the restricted food intake during intensive care unit (ICU) and hospital stays, and scarce data are available to point out the problem. Therefore, this review aimed to assess the pooled prevalence of malnutrition among critically ill children.
Methodology:
This systematic review was conducted in accordance with the JBI methodology for systematic reviews of prevalence and incidence. Databases including, PubMed/MEDLINE, CINAHL/EBSCO, HINARI, Google Scholar, and gray literatures were used to find relevant articles. Eligible studies were critically appraised by two independent reviewers. Systematic review and meta-analysis was conducted using STATA 17 software. Funnel plot and at the 5% significance level, Egger's test were used to check for publication bias.
Result:
From a total of 15 studies with 4331 study participants, the pooled prevalence of malnutrition in critically ill children was 37.19% (95% CI; 35.89-38.49) with a significant statistical heterogeneity (I2 = 98.6, P = < 0.0001). High income countries reported the lower pooled prevalence of malnutrition among critically ill children (30.14%, 95% CI; 28.41, 31.88). No publication bias was reported and sensitivity analysis suggested that no significance difference was shown in the prevalence of malnutrition among critically ill children with the pooled prevalence.
Conclusion:
The current systematic review and meta-analysis showed that more than one in three critically ill children was malnourished. Serious medical conditions in children that deserve admission to the intensive care unit could be a complication of malnutrition that may end up in deaths unless the undernutrition is addressed together with critical care intervention. Hence, specific strategies to prevent malnutrition among this neglected segment should be integrated with the existing healthcare systems and nutritional programs.
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