Malnutrition as an independent predictor of clinical outcome in critically ill children

• Published in: Nutrition (Burbank, Los Angeles County, Calif.) Los Angeles County, Calif.), 2012-03, Vol.28 (3), p.267-270
• Main Authors: de Souza Menezes, Fernanda, R.D., M.Sc, Leite, Heitor Pons, M.D., Ph.D, Koch Nogueira, Paulo Cesar, M.D., Ph.D
• Format: Article
• Language: English
• Subjects: artificial; Biological and medical sciences; body mass index; child growth; Child, Preschool; children; Children & youth; Chronic Disease; Clinical outcomes; Critical Illness - mortality; Feeding. Feeding behavior; Female; Fundamental and applied biological sciences. Psychology; Gastroenterology and Hepatology; Hospitalization; Humans; Infant; Intensive care unit; Intensive Care Units, Pediatric; Length of Stay; Logistic Models; logit analysis; Male; Malnutrition; Malnutrition - epidemiology; Mortality; Nutrition Assessment; Nutritional assessment; Nutritional Status; patients; Pediatric; Prognosis; Prospective Studies; Respiration; Respiration, Artificial; Risk Factors; septic shock; Shock, Septic - epidemiology; Studies; Ventilation; Vertebrates: anatomy and physiology, studies on body, several organs or systems; World Health Organization; Wound healing
• ISSN: 0899-9007; 1873-1244
• DOI: 10.1016/j.nut.2011.05.015

Abstract Objective To determine the nutritional status of a cohort of children admitted to a pediatric intensive care unit (ICU) and to assess the effect of malnutrition as an independent risk factor affecting outcome in this patient group. Methods In a prospective cohort study, 385 children admitted to the ICU of a teaching hospital over a 2-y period were assessed for nutritional status at admission and clinical outcome. The outcome variables were 30-d mortality, length of ICU stay, and length of mechanical ventilation. Potential exposure variables were gender, age, diagnosis (clinical versus surgical), septic shock, malnutrition, and scores on the Pediatric Index of Mortality and Pediatric Logistic Organ Dysfunction. Nutritional status was determined using z scores of weight for age, height for age, and body mass index, based on the World Health Organization child growth standards. Patients with z score < −2 of anthropometric indexes were considered malnourished. Results 175 patients (45.5%) were malnourished on admission. Sixteen patients of the malnourished group (9.14%) and 25 patients (11.9%) of the non-malnourished group died. Malnutrition was associated with greater length of mechanical ventilation and length of ICU stay, but not with mortality on univariate analysis. Malnutrition was associated with greater length of ventilation on the multiple logistic regression model (OR 1.76, 95%; CI 1.08-2.88; P = 0.024). Conclusion Malnutrition is common among children admitted to an ICU. This factor was not a predictor of mortality but showed independent association with length of mechanical ventilation.