Factors associated with constipation in critically ill children: A retrospective study

Area of Science:

• Pediatric critical care medicine
• Gastroenterology
• Clinical nutrition

Background:

• Constipation is a common issue affecting up to 50% of children in pediatric intensive care units (PICUs).
• Identifying factors contributing to constipation is crucial for improving patient outcomes in critically ill children.

Purpose of the Study:

• To determine the incidence of constipation in critically ill children.
• To identify risk factors and protective elements associated with constipation in this population.

Main Methods:

• A multicenter retrospective review was conducted across five PICUs.
• Data collected included nutrition support, medication use, and time to first bowel movement for critically ill children with expected stays over 48 hours.
• Constipation was defined as no bowel movement within 3 days of admission.

Main Results:

• The study included 250 children, with 47% experiencing constipation.
• Constipated children had significantly delayed first stool passage (6.0 vs. 1.0 days) and lower energy and protein intake (43% and 36% of recommendations) compared to non-constipated children.
• Multivariate analysis revealed increased constipation risk with opioid/muscle relaxant use, cardiac diagnosis, and male sex. Bowel management protocols and laxative use reduced constipation risk.

Conclusions:

• Constipation affects nearly half of critically ill children in PICUs.
• Key risk factors include opioid/muscle relaxant use, cardiac diagnosis, and male sex.
• Implementing bowel management protocols and using laxatives can mitigate constipation risk and improve nutritional intake.