ESICM LIVES 2016: part three

Abstract

Introduction: Critically ill children in the pediatric intensive care unit (PICU) are at high risk for developing nutritional deficiencies and un-dernutrition is known to be a risk factor for morbidity and mortality. Malnutrition represents a continuous spectrum ranging from marginal nutrient status to severe metabolic and functional alterations and this in turn, affects clinical outcome. Objectives: The aim of the study was to assess nutritional status of critically ill children admitted to the PICU and its association to clinical outcomes. Methods: Critically ill children age 6 months to 18 years were prospectively enrolled on PICU admission. Nutritional status was assessed by weight for age (WFA: underweight), weight for height (WFH: wasting), height for age (HFA: stunting) z-scores and mid upper arm circumference (MUAC: wasting) according to the WHO. (1,2) Malnutrition was defined as mild, moderate, and severe if z-scores were > −1, > − 2, and > −3, respectively. Hospital and PICU length of stay (LOS), duration of mechanical ventilation (MV), and risk of mortality (ROM) by the Pediatric Index of Mortality 2 (PIM2) were obtained. Sensitivity and specificity of the MUAC to identify children with wasting (WFH) were calculated. Results: Two hundred and fifty children (136 males), aged 81 months (23-167; median (25-75 th IQR)), were prospectively included in the study. The hospital LOS was 8 (4-16) days; PICU LOS: 2 (1-4) days; duration of MV, 0 (0-1.5) days; PIM2 ROM 2.61 ± 0.25 %. WFA, WFH, and HFA z-scores of −0.48 ± 0.14; 0.19 ± 0.13; and −0.95 ± 0.13 respectively; MUAC, 16.3 ± 0.18 cm (6 to 59 months, n = 108); 24.2 ± 0.46 cm (5 to 18 years, n = 142). The prevalence of underweight, wasting and stunting was 26.4 %, 19.6 %, and 44.4 % respectively. The sensitivity and specificity for MUAC vs. WFH to identify wasting was: 34.5 % (20.3-50.6; 95 % CI) and 95.5 % (91.8-97.9), respectively. Values are mean ± SE. Conclusions: Malnutrition in critically ill children is prevalent with half of the patients being stunted, reflecting the chronic nature of the disease process and its effects on the nutritional status. The performance of MUAC as a screening tool in this population was poor, but identified correctly almost all children with wasting. There was an association between nutritional status and length of stay and risk of mortality.