Undernutrition in critically ill children

Abstract

Malnutrition remains a serious issue in the pediatric intensive care unit (PICU) and it is associated with poor clinical outcomes. However, it is commonly unrecognized. There is still no consensus on the best definition of pediatric malnutrition. The scope of this review is to describe and critically discuss the undernutrition identification at admission and during PICU stay and the prevalence of undernutrition in critically ill children reported in the literature. We provide some discussion regarding the implications of undernutrition on the short- and long-term outcomes in critically ill children. In critical illness, negative protein balance with muscle protein loss is higher in comparison to other diseases. This review identified that previous studies have used diverse nutritional indicators and cut-offs to recognize undernutrition in critically ill children, as well as anthropometric measurements and laboratory markers. Besides the undernutrition at admission, critically ill children are also at risk of worsening nutritional status (NS) during PICU stay. Nevertheless, few studies have evaluated the NS deterioration during PICU stay. The prevalence of acute undernutrition in critically ill children may range from 7.2% to 64.9%, according to age, severity of illness, and the nutritional parameter used. NS changes and loss of muscle mass leads to worse prognosis at short and long term, with impairment of function and quality of life. Future data to properly define undernutrition and NS deterioration during PICU stay are needed.