Abstract

MESQUITA, M et al. Nutritional Status in the Pediatric Intensive Care Unit: Does It Influence Morbidity and Mortality?. Pediatr. (Asunción) [online]. 2008, vol.35, n.2, pp.88-94. ISSN 1683-9803.

Objectives:To determine the morbidity and mortality of patients ≤5 years of age entering the pediatric intensive care unit (PICU) in relation to their nutritional status. Methods: Prospective cohort study. Patients ≤5 of age admitted to the PICU from January to November 2003. Newborns and patients with history of prematurity, chronic disease, congenital malformations, or edema at admission were excluded. Nutritional status was assessed using the Epi-Nut system. The weight/age Z-score was used for children ≤2 years of age and weight/height for children ≥2 years. Nutritional status was classified as well-nourished (WN), generally malnourished (GMN), at risk of malnutrition (RMN), moderately malnourished (MMN), severely malnourished (SMN), overweight (OW) and obese (OB).  Morbidity criteria used included need for assisted ventilation (AV), nosocomial infection (NI), days hospitalized (DH), and death. Results: Of 116 patients ≤5 years of age admitted to the PICU, 73 met the inclusion criteria. WN patients made up 36% (26/73), RMN 23% (17/73), MMN 19% (14/73), SMN 12% (9/73), OW 7% (5/73), and OB 3% (2/73). No difference was found between WN and GMN patients needing AV (33% and 62%, respectively); RR = 0.62 (0.32- 1.03) p> 0.05.NI were similar between the GMN (30%) and WN (19%); RR = 1.6 (CI 95% 0.6 - 4) p> 0.05. The severely undernourished patients showed significantly more NI (56%) compared to WN patients or to the rest of the cohort studied. The average hospital stay was 6.7 ± 4 days for WN and 8.7 ± 5 days for GMN patients: p>0.05. However, it was significantly higher for SMN (11.8 ± 6 days) than for WN or other patients in the cohort. Mortality was similar between the WN (12%) and GMN (32%) patients; p>0.05. However, SMN patients had a mortality of 78% vs. 12% for WN patients; RR = 7 (IC 95% 2-20) p>0.001, and 78% vs. 17% for the rest of the cohort RR = 4.5 (CI 95% 2.4-8.8) p>0.001. Conclusions: SMN patients had more NI, more days hospitalized, and higher mortality than WN patients or other cohort groups (either WN or other malnourished groups). No differences in morbidity were found between the different nutritional groupings.

Keywords : Malnutrition; morbidity; mortality; pediatric intensive care unit.

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