Admission factors associated with nutritional status deterioration and prolonged pediatric intensive care unit stay in critically ill children: PICU-ScREEN multicenter study
Child; Child Preschool; chronic disease; Critical Illness; Humans; Infant; Intensive Care Units Pediatric; length of stay; Length of Stay; malnutrition; Malnutrition; nutritional status; Nutritional Status; outcomes; pediatric intensive care unit; Prospective Studies; Retrospective Studies
BACKGROUND: Early identification of patients in the pediatric intensive care unit (PICU) at risk of nutritional status (NS) deterioration and poor outcomes is desirable. We aimed to identify factors associated with NS deterioration and prolonged PICU stay. METHODS: Prospective cohort study in eight Brazilian PICUs with children <18 years with a PICU stay >72h. We used multivariable logistic regression to identify the clinical, laboratory, and nutrition variables at admission that were associated with outcomes. NS deterioration was defined as the reduction in weight-for-age, body mass index-for-age or mid-upper arm circumference-for-age z-score ≥1 during PICU stay. Prolonged PICU stay was defined as ≥13 days. RESULTS: We enrolled 363 eligible patients, median age 11.3 months (interquartile range:3.1-45.6) and 46% had at least one complex chronic condition (CCC). NS deterioration was observed in 23% of participants and was associated with CCC (odds ratio [OR]:2.71; 95% confidence interval [CI]:1.44-5.09), after adjusting for severity risk score, leukocyte count, obesity, and PICU site. Prolonged PICU stay was associated with age <2 years (OR:1.95; 95%CI:1.03-3.66), fluid overload (>10%) over the first 72h (OR:2.66; 95%CI:1.50-4.73), and hypoalbuminemia (<3.0 g/dL) (OR:2.05; 95%CI:1.12-3.76), after adjusting for CCC, severity risk score, undernutrition, early nutrition therapy, and PICU site. CONCLUSIONS: CCC at admission was associated with NS deterioration. Age <2 years, fluid overload, and hypoalbuminemia at PICU admission were associated with prolonged PICU stay. These factors must be further evaluated as part of an admission nutrition screening tool for critically ill children.
Ventura JC; Oliveira LDA; Silveira TT; Hauschild DB; Mehta NM; Moreno YMF; PICU-ScREEN Study Group
Journal of Parenteral and Enteral Nutrition
2022
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1002/jpen.2116" target="_blank" rel="noreferrer noopener">10.1002/jpen.2116</a>
Priorities for Nutrition Research in Pediatric Critical Care
child; Child; Child Nutrition Disorders/prevention & control/*therapy; Child Nutritional Physiological Phenomena; Children; Consensus; Critical Care/*methods; Critical Illness; Delphi Technique; enteral nutrition; Humans; Intensive Care; Intensive care units (paediatric); Internationality; Nutritional Support/*methods; parenteral nutrition; Pediatric; research
BACKGROUND: Widespread variation exists in pediatric critical care nutrition practices, largely because of the scarcity of evidence to guide best practice recommendations. OBJECTIVE: The objective of this paper was to develop a list of topics to be prioritized for nutrition research in pediatric critical care in the next 10 years. METHODS: A modified 3-round Delphi process was undertaken by a newly established multidisciplinary group comprising 11 international researchers in the field of pediatric critical care nutrition. Items were ranked on a 5-point Likert scale. RESULTS: Forty-five research topics (with a mean priority score >3(0-5) were identified within the following 10 domains: the pathophysiology and impact of malnutrition in critical illness; nutrition assessment: nutrition risk assessment and biomarkers; accurate assessment of energy requirements in all phases of critical illness; the role of protein intake; the role of pharmaco-nutrition; effective and safe delivery of enteral nutrition; enteral feeding intolerance: assessment and management; the role of parenteral nutrition; the impact of nutrition status and nutrition therapies on long-term patient outcomes; and nutrition therapies for specific populations. Ten top research topics (that received a mean score >4(0-5) were identified as the highest priority for research. CONCLUSIONS: This paper has identified important consensus-derived priorities for clinical research in pediatric critical care nutrition. Future studies should determine topics that are a priority for patients and parents. Research funding should target these priority areas and promote an international collaborative approach to research in this field, with a focus on improving relevant patient outcomes.
Tume L N; Valla F V; Floh A A; Goday P; Jotterand Chaparro C; Larsen B; Lee J H; Moreno Y M F; Pathan N; Verbruggen S; Mehta N M
Journal of Parenteral and Enteral Nutrition
2019
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1002/jpen.1498" target="_blank" rel="noreferrer noopener">10.1002/jpen.1498</a>
Efficacy and tolerance of gastrostomy feeding in pediatric forms of neuromuscular diseases
Male; Treatment Outcome; Infant Newborn; Follow-Up Studies; Child; Humans; Adult; Adolescent; Female; Child Preschool; Infant; Nutritional Status; Weight Gain; Gastrostomy; Gastroesophageal Reflux/complications; Enteral Nutrition; Neuromuscular Diseases/complications/therapy; feeding difficulties; SMA type I; surgical intervention; percutaneous endoscopic gastrostomy; gastroesophageal reflux; GERD
BACKGROUND: Percutaneous endoscopic gastrostomy (PEG) is a simple and reliable method, but there are few data about its use in pediatric forms of neuromuscular diseases (NMD). The aim of this study was to evaluate the nutritional effects and tolerance of gastrostomy feeding in NMD patients. METHODS: Twelve patients with NMD, ranging in age from 1 month to 25.5 years, underwent a gastrostomy placement (PEG, n = 11; surgical gastrostomy, n = 1) between January 1990 and December 2000. Diseases were muscular dystrophies (n = 5), infantile spinal muscular atrophies (n = 3), congenital myopathies (n = 3), and polyradiculoneuritis (n = 1). Height-for-age (Z(H/A)), weight-for-age (Z(W/A)), and weight-for-height (Z(W/H)) z scores were assessed at birth, at the time of gastrostomy placement, after a 6-month and 1-year follow-up, and at the end of follow-up. Complications that occurred during the gastrostomy feeding period were recorded. Comparisons of z scores at the different times were performed with repeated-measures analyses of variance. RESULTS: Z(W/A) (p < .05) and Z(W/H) (p < .001) improved in the whole group after gastrostomy. For the 10 patients for whom follow-up was more than 1 year, Z(W/A) (p < .03) and Z(W/H) (p < .001) increased from the time of gastrostomy to the end of follow-up. Among 5 patients who had a gastroesophageal reflux diagnosed before gastrostomy placement, 3 had at least 1 episode of pneumonia and 2 died of respiratory distress caused by the worsening of NMD. No other major complication was encountered. CONCLUSIONS: Gastrostomy feeding is well tolerated and results in an improvement of nutritional indices in NMD patients. Special care should be taken in patients with preexisting gastroesophageal reflux.
Seguy D; Michaud L; Guimber D; Cuisset J; Devos P; Turck D; Gottrand F
Journal of Parenteral and Enteral Nutrition
2002
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1177/0148607102026005298" target="_blank" rel="noreferrer noopener">10.1177/0148607102026005298</a>
Functional duodenal obstruction (superior mesenteric artery or cast syndrome) in cerebral palsy
Child; Female; Humans; Enteral Nutrition/methods; Cerebral Palsy/complications; Duodenal Obstruction/complications/physiopathology; Nutrition Disorders/diet therapy/etiology
An 8-yr-old girl with cerebral palsy who was chronically malnourished presented with functional duodenal obstruction (superior mesenteric artery or cast syndrome) proven by barium meal. Six months of feeding through a fluoroscopically positioned gastrojejunal tube generated sufficient weight gain and increase in body bulk to cure the functional obstruction.
1989
Vaisman N; Stringer DA; Pencharz P
Journal Of Parenteral And Enteral Nutrition
1989
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1177/0148607189013003326" target="_blank" rel="noreferrer">10.1177/0148607189013003326</a>