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Late Nutrition and Negative Outcomes in a Brazilian Paediatric Intensive Care Unit: A Retrospective Cohort
Arnildo Linck Júnior1, Flávia Lopes Gabani2, Edmarlon Girotto3
1Department of Pediatrics and Pediatric Surgery, State University of Londrina (UEL), Paraná, Brazil.
Insights
Delayed nutrition in pediatric intensive care units (PICU) is linked to longer hospital stays and increased healthcare-associated infections (HAIs). Early nutritional support is crucial for better patient outcomes in critically ill children.
Area of Science:
- Pediatric critical care medicine
- Clinical nutrition
- Epidemiology
Background:
- Timely enteral nutrition is vital for critically ill children.
- Late initiation of nutrition may be associated with adverse outcomes in the Paediatric Intensive Care Unit (PICU).
Purpose of the Study:
- To analyze the association between late enteral nutrition initiation and negative outcomes in a Brazilian PICU.
Main Methods:
- Retrospective cohort study of 840 pediatric hospitalizations (2012-2017).
- Defined late enteral nutrition as initiation >24 hours post-admission.
- Used Poisson regression to assess associations with length of stay, healthcare-associated infections (HAIs), and mortality.
Main Results:
- 37% of patients experienced delayed nutrition.
- Late nutrition was associated with longer PICU stays (RR: 1.41), hospital stays (RR: 1.22), and higher HAI incidence (RR: 1.40).
- No significant association found with mortality after adjustments.
Conclusions:
- Late enteral nutrition initiation in the PICU is linked to prolonged hospitalizations and increased HAI risk.
- Emphasizes the importance of early nutritional support for pediatric intensive care patients.
Aim:
To analyse the association between late initiation of enteral nutrition and negative outcomes in the Paediatric Intensive Care Unit (PICU) in Brazil.
Method:
This was a retrospective cohort study with data from the medical records of children hospitalised between 2012 and 2017. The independent variable was late initiation of enteral nutrition (> 24 h after admission). The outcomes analysed included longer length of stay in the PICU and hospital, incidence of healthcare-related infections (HAIs), and death. Poisson regression models with robust variance were adjusted for potentially confounding variables by presenting relative risks (RR) and 95% confidence intervals (95% CI).
Results:
We analysed 840 hospitalizations: 311 (37.0%) with delayed initiation of nutrition, 252 (30.0%) with a diagnosis of HAIs, and 93 deaths (11.1%). After all adjustments, late initiation of enteral nutrition was associated with longer lengths of stay in the PICU (RR: 1.41; 95% CI: 1.01-1.30), hospital stay (RR: 1.22; 95% CI: 1.06-1.41), and higher HAI incidence (RR: 1.40; 95% CI: 1.14-1.73). The association with mortality was no longer significant after adjusting for the admission severity indicators.
Conclusion:
The results indicate that late initiation of nutrition can lead to longer PICU and hospital stays and a higher incidence of HAIs.
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