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Pediatr Crit Care Med. 2019 Aug;20(8):714-721. doi: 10.1097/PCC.0000000000001979.

Nutritional Status Deterioration Occurs Frequently During Children's ICU Stay.

Author information

1
Pediatric Intensive Care, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, 59 bd Pinel 69500 Lyon-Bron, France.
2
CarMEN INSERM UMR 1060 Equipe INFOLIP, 69100 Villeurbanne, France.
3
Univ Lyon, Université Claude Bernard Lyon1, Ifsttar, UMRESTTE, UMR T_9405, F- 69373, Lyon, France.
4
Pediatric Intensive Care, Hôpital Femme Mère Enfant, CHU de Nantes, 38 boulevard Jean Monnet 44000 Nantes, France.
5
Service diététique, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, 59 bd Pinel 69500 Lyon-Bron, France.
6
Université Claude Bernard Lyon 1 - Villeurbanne, France.
7
EPICIME-CIC 1407 de Lyon, Inserm, CHU-Lyon, F-69677, Bron, France.
8
EPICIME-CIC 1407 de Lyon, Inserm, Service de Pharmacologie Clinique, CHU-Lyon, F-69677, Bron, France.
9
Faculty of Health & Applied Sciences, University of the West of England, Bristol BS16 1DD, United Kingdom.
10
PICU Bristol Children's Hospital, Upper Maudlin Street, Bristol, United Kingdom.

Abstract

OBJECTIVES:

Malnutrition and faltering growth at PICU admission have been related to suboptimal outcomes. However, little is known about nutritional status deterioration during PICU stay, as critical illness is characterized by a profound and complex metabolism shift, which affects energy requirements and protein turnover. We aim to describe faltering growth occurrence during PICU stay.

DESIGN:

Single-center prospective observational study.

SETTING:

Twenty-three-bed general PICU, Lyon, France.

PATIENTS:

All critically ill children 0-18 years old with length of stay longer than 5 days were included (September 2013-December 2015).

INTERVENTIONS:

Weight and height/length were measured at admission, and weight was monitored during PICU stay, in order to calculate body mass index for age z score. Faltering growth was defined as body mass index z score decline over PICU stay. Children admitted during the first year of the study and who presented with faltering growth were followed after PICU discharge for 3 months.

MEASUREMENTS AND MAIN RESULTS:

We analyzed 579 admissions. Of them, 10.2% presented a body mass index z score decline greater than 1 SD and 27.8% greater than 0.5. Admission severity risk scores and prolonged PICU stay accounted for 4% of the variability in nutritional status deterioration. Follow-up of post-PICU discharge nutritional status showed recovery within 3 months in most patients.

CONCLUSIONS:

Nutritional deterioration is frequent and often intense in critically ill children with length of stay greater than 5 days. Future research should focus on how targeted nutritional therapies can minimize PICU faltering growth and improve post-PICU rehabilitation.

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