The relationship between nutritional management and prognosis in children on prolonged mechanical ventilation

Nutritional management is crucial for improving outcomes in children on prolonged mechanical ventilation (PMV); but detailed data are lacking. This study aimed to investigate the nutritional management of children on PMV in China and to explore their association with clinical outcomes.

This multicenter prospective observational cohort study enrolled children (aged 28 days to 18 years) who received mechanical ventilation for ≥ 21 consecutive days (PMV) from 11 tertiary hospitals across China between April 2021 and September 2022. Data on demographics and nutritional indicators (including calorie intake, protein intake, and laboratory test) were collected at enrollment (Day 1), Day 14, and Day 28. Nutritional status was assessed using Screening Tool for the Assessment of Malnutrition in Pediatrics (STAMP) screening tool and World Health Organization (WHO) age-specific Z-scores. The primary outcome was in-hospital mortality.

Among 296 children, in-hospital mortality rate was 31.8%. All were at high nutritional risk at the time of enrollment, and 51.4% were malnourished. Non-survivors received full enteral nutrition significantly less frequently than survivors at all time points (e.g., 58.5% vs. 82.2% at Day 1, p < 0.001). Linear mixed models showed non-survivors had persistently lower median caloric and protein intake (calories: 42.9 vs. 53.3 kcal/kg/day; protein: 1.2 vs. 1.6 g/kg/day; both p < 0.05). Hemoglobin levels were persistently lower in non-survivors, with no significant difference in serum albumin.

Children on prolonged mechanical ventilation are at high nutritional risk, with total parenteral nutrition, low caloric intake and protein intake, and low hemoglobin being more pronounced in non-survivors.