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Factors associated with constipation in critically ill children: A retrospective study
Luise V Marino1,2, Brittany Rothman3, Graeme O'Connor3
1Southwest Yorkshire Partnership NHS Foundation Trust, Wakefield, UK.
Insights
Nearly half of critically ill children in pediatric intensive care units (PICUs) experience constipation. Opioids, muscle relaxants, cardiac conditions, and male sex increase risk, while bowel protocols and laxatives help prevent it.
Area of Science:
- Pediatric critical care medicine
- Gastroenterology
- Clinical nutrition
Background:
- Constipation is a common issue affecting critically ill children in pediatric intensive care units (PICUs).
- Understanding the factors contributing to constipation is crucial for improving patient care and outcomes.
Purpose of the Study:
- To identify factors associated with the development of constipation in critically ill children.
- To analyze the impact of nutrition, medication, and specific diagnoses on constipation incidence.
Main Methods:
- A multicenter retrospective review was conducted involving 250 critically ill children across five PICUs.
- Data collected included nutrition support, medication use, and time to first bowel movement (defined as >3 days post-admission).
- Multivariate analysis was used to determine risk factors and protective elements for constipation.
Main Results:
- The incidence of constipation was 47% among the studied pediatric intensive care unit population.
- Opioid and muscle relaxant use, cardiac diagnosis, and male sex were identified as significant risk factors for constipation.
- Children with constipation had substantially lower energy and protein intake compared to those without constipation.
Conclusions:
- Constipation is prevalent in critically ill children, with specific risk factors identified.
- Implementing bowel-management protocols and using laxatives can reduce the incidence of constipation.
- Addressing constipation is essential for optimizing nutritional intake and overall well-being in the PICU setting.
Background And Aim:
Constipation affects half of critically ill children in pediatric intensive care units (PICUs). The primary aim was to identify factors associated with constipation.
Methods:
A multicenter retrospective review of nutrition support, medication, and defecation in critically ill children in five PICUs with an expected length of stay greater than 48 h. Constipation: defined as ≥3 days from admission without a bowel movement.
Results:
A total of 250 children, mean age 38.1 ± 56.2 months, of which 155 (62%) were male. Among the 47% (117/250) of children who were constipated, compared to no constipation group, the mean time to passage of first stool was 6.0 ± 3.7 days vs.1.0 ± 1.1 days, respectively (P < 0.001). Children with and without constipation achieved 43% of energy and 36% of protein recommendations, compared with 67% and 56%, respectively. In a multivariate analysis, factors that increased the risk of constipation included children prescribed opioids and muscle relaxants, a cardiac diagnosis (P < 0.0001), and sex (males) (P = 0.04). Conversely, children had a reduced risk of constipation if they were following a bowel-management protocol (30% reduced risk) or prescribed laxatives (P = 0.001).
Conclusion:
In this retrospective study, the incidence of constipation among children admitted to the PICU was 47%. Risk factors for constipation included the use of opioid and muscle relaxants, a cardiac diagnosis, and sex (males). Children with constipation had significantly lower energy and protein intake during their PICU admission. Implementation of a bowel-management protocol and prescription of laxatives was associated with a reduced risk of constipation.
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