Assessment of nutritional status of critically Ill pediatric patients and its impact on outcome in a low-and middle-income settings.

Abstract

Malnutrition among children is a crucial public health issue. Children in critical care units may suffer from nutritional vulnerability due to their underlying disease or barriers to nutrient delivery. Early detection and management of malnutrition may improve clinical outcomes. To evaluate the nutritional status of critically ill children admitted to the pediatric intensive care unit (PICU) and its prognostic outcome. This observational prospective cohort research entailed 250 children admitted to the PICU. All participants were assessed at admission and weekly thereafter for 28 days. Nutritional status was evaluated using anthropometric measurements and the PYMS and STRONGkids scores. The PRISM score was used to assess illness severity on the day of admission. 59.2% of patients were underweight and/or stunted at admission and 59% at day 28 of follow-up. PYMS, and STRONGkids scores were significantly higher among underweight and/or stunted on day 1 and during follow-up (p < 0.05). Multivariable regression analysis demonstrated that admission PRISM score was an independent predictor of mortality (aOR 1.50, 95% CI 1.19-1.88, p = 0.001), mechanical ventilation requirement (aOR 1.18, 95% CI 1.07-1.31, p = 0.001), and feeding interruptions (aOR 1.29, 95% CI 1.16-1.45, p < 0.001). Socioeconomic status was independently associated with feeding interruptions and length of stay.

Conclusion:  Underweight and/or stunting was common among PICU patients. PYMS and STRONGkids were effective in identifying nutritional risk. After adjustment for confounding variables, clinical severity rather than baseline malnutrition independently predicted adverse clinical outcomes.

What is known: • Underweight and/or stunting were prevalent among children admitted to the PICU and this represent a crucial public health problem. • Both PYMS and STRONGkids were useful screening tools for identifying children at risk of malnutrition.

What is new: • This study demonstrated that clinical severity and the need for inotropic support were the primary independent predictors of adverse outcomes. • The baseline malnutrition was not independently associated with mortality, mechanical ventilation, feeding interruptions, or length of PICU stay.