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Calf circumference may complement the nutritional assessment of children under 10 in the paediatric intensive care
Rafaela Rodrigues Vieira1, Patrícia Zamberlan2
1ITACI - Hematology-Oncology Department, Instituto do Câncer do Estado de São Paulo, School of Medicine, University of São Paulo, São Paulo, Brazil.
Insights
Calf circumference (CC) shows potential for monitoring critically ill children
Area of Science:
- Pediatric Intensive Care
- Nutritional Assessment
- Anthropometry
Background:
- Nutritional status is critical for pediatric intensive care patients.
- Mid-upper arm circumference (MUAC) is used for nutritional assessment but has limitations.
- Calf circumference (CC) is a simple, inexpensive anthropometric measure with no existing reference values for pediatric patients.
Purpose of the Study:
- To evaluate calf circumference (CC) as a method for nutritional monitoring in critically ill children and adolescents.
- To compare the changes in CC with mid-upper arm circumference (MUAC) over the first week of pediatric intensive care unit (PICU) admission.
Main Methods:
- Anthropometric measurements (MUAC and CC) were taken within 48 hours of admission and after 7 days in 103 pediatric patients (6 months to 18 years).
- Percentage changes in MUAC and CC were analyzed and compared between age groups (<10 years and ≥10 years).
- Demographic and outcome data were also evaluated.
Main Results:
- Both MUAC and CC significantly decreased within the first week of hospitalization.
- A weak positive correlation between percentage changes in MUAC and CC was observed in the total sample and in children under 10 years, but not in adolescents.
- Children under 10 years showed a greater reduction in CC compared to MUAC, unlike adolescents.
Conclusions:
- Calf circumference (CC) may serve as a valuable tool for early nutritional depletion detection in critically ill children.
- CC appears more sensitive than MUAC in reflecting nutritional changes in younger children within the PICU setting.
- Further research is needed to establish reference values for CC in pediatric intensive care.
Background:
Nutritional intervention during hospitalisation is vital in managing of children and adolescents in intensive care. In this context, body composition measurements, such as mid-upper arm circumference (MUAC), can help improve the accuracy of nutritional assessments. However, using MUAC has some limitations. Calf circumference (CC) is a straightforward, inexpensive, and easily obtainable measurement. However, no reference values currently exist for CC in paediatric patients.
Aims:
To describe the nutritional monitoring of critically ill children and adolescents in the Paediatric Intensive Care Unit (PICU) using CC.
Methods:
Patients aged 6 months to 18 years old who were admitted to the PICUs participated in the study. Two MUAC and CC measurements were performed: one in the first 48 h of admission to the PICU and another after 7 days. The percentage change between the two measurements was compared. Information was also evaluated about demographic and outcome data. Analyses were conducted with all patients included in the sample collectively and subdivided by age (<10 years and ≥10 years).
Results:
Two hundred and eleven patients underwent anthropometric assessment on admission, and the sample for comparative analyses consisted of 103 patients (after discharges and deaths). MUAC and CC significantly decreased in the first week of hospitalisation. A positive weak correlation was found between the percentage change in the MUAC and CC only for individuals under 10 years old and for the total sample, but not for adolescents. The all age group and children under 10 years old showed a greater reduction in CC than in MUAC. The same did not occur for adolescents.
Conclusions:
Calf circumference may be a promising method for nutritional monitoring of critically ill children in Paediatric Intensive Care Units because it can indicate signs of depletion earlier than mid-upper arm circumference. These results are more meaningful for children than for adolescents.
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