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Nutritional Status as a Severity Predictor in Critical Pediatric Patients With COVID-19

Gabriela Rupp Hanzen Andrades1,2, Gustavo Rodrigues-Santos3, Jaqueline Rodrigues Robaina3

  • 1Post Graduate Program in Pediatrics and Child Health of PUCRS - Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil.

Pediatric Pulmonology
|May 14, 2026
PubMed

Insights

Critically ill children with COVID-19 who were underweight faced higher risks of Acute Respiratory Distress Syndrome (ARDS), invasive mechanical ventilation (IMV), longer hospital stays, and increased mortality.

Area of Science:

  • Pediatric critical care medicine
  • Infectious diseases
  • Nutritional science

Background:

  • Nutritional status significantly impacts children's health and disease outcomes.
  • COVID-19 presents unique challenges for critically ill pediatric patients.

Purpose of the Study:

  • To assess the influence of nutritional status on clinical outcomes in critically ill children with COVID-19.
  • To identify specific nutritional factors associated with severe COVID-19 in pediatrics.

Main Methods:

  • Observational, longitudinal, multicentric study in 36 Brazilian Pediatric Intensive Care Units (PICUs).
  • Included 432 children (1 month-18 years) with confirmed COVID-19.
  • Nutritional status assessed using z-scores (BMI/A, W/A, S/A); outcomes included ARDS, IMV, prolonged LOS, and mortality.

Main Results:

  • Underweight children (12.5%) showed an independent association with ARDS (RR 2.12), need for IMV (RR 1.8), prolonged LOS (RR 1.5), and mortality (RR 8).
  • Overweight children (17.6%) and short stature (23%) were also noted.
  • The study included a significant proportion of patients under 24 months (46.3%).

Conclusions:

  • Low weight in pediatric COVID-19 patients admitted to PICUs is independently associated with adverse outcomes.
  • Underweight status correlates with increased risk of ARDS, IMV, prolonged hospital stay, and mortality.
  • Highlights the critical role of nutritional assessment and intervention in pediatric COVID-19 critical care.
Abstract

Keywords:
COVID‐19Pediatric Intensive Care Unitschildrenmortalitynutritional status

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