Hospital Malnutrition and Inflammatory Response in Critically Ill Children and Adolescents Admitted to a Tertiary Intensive Care Unit

Abstract

Delgado AF, Okay TS, Leone C, Nichols B, Del-Negro GM, Costa-Vaz FA. Hospital malnutrition and inflammatory response in critically ill children and adolescents admitted to a tertiary intensive care unit. Clinics. 2008;63:357-62.Critical illness has a major impact on the nutritional status of both children and adults. A retrospective study was conducted to evaluate the incidence of hospital malnutrition at a pediatric tertiary intensive care unit (PICU). Serum concentrations of IL-6 in subgroups of well-nourished and malnourished patients were also evaluated in an attempt to identify those with a potential nutritional risk. MeTHODS: A total of 1077 patients were enrolled. Nutritional status was evaluated by Z-score (weight for age). We compared mortality, sepsis incidence, and length of hospital stay for nourished and malnourished patients. We had a subgroup of 15 patients with severe malnutrition (MN) and another with 14 well-nourished patients (WN). Cytokine IL-6 determinations were performed by enzyme-linked immunosorbent assay. ReSULTS: 53% of patients were classified with moderate or severe malnutrition. Similar amounts of C-reactive protein (CRP) were observed in WN and MN patients. Both groups were able to increase IL-6 concentrations in response to inflammatory systemic response and the levels followed a similar evolution during the study. However, the mean values of serum IL-6 were significantly different between WN and MN patients across time, throughout the study (p = 0.043). DISCUSSION: a considerable proportion of malnourished patients need specialized nutritional therapy during an intensive care unit (ICU) stay. Malnutrition in children remains largely unrecognized by healthcare workers on admission. CONCLUSIONS: The incidence of malnutrition was very high. Malnourished patients maintain the capacity to release inflammatory markers such as CRP and IL-6, which can be considered favorable for combating infections On the other hand, this capacity might also have a significant impact on nutritional status during hospitalization.

Nutrition Support among Critically Ill Children with AKI

“…Hospital undernutrition is a known risk factor for morbidity and mortality in children, adolescents, and adults (1,2). Malnutrition has been shown to affect patient outcome and represents a continuous spectrum ranging from marginal nutrient status to severe metabolic and functional alterations, with different degrees of relative alterations of body weight and body composition (3).…”

Diagnostic and Prognostic Value of Procalcitonin and C-Reactive Protein in Malnourished Children

“…Several authors have suggested that malnutrition does not affect CRP production in response to infections. 33,34 In a study in Malawi, although children with kwashiorkor had reduced rates of protein breakdown and synthesis, their CRP levels were similar to those without kwashiorkor. 35 To our knowledge, only 1 study found that CRP levels in response to infection are lower in malnourished than in wellnourished children.…”

Is undernutrition prognostic of infection complications in children undergoing surgery? A systematic review

“…These patient populations are known to be most vulnerable to postoperative morbidity, and are most vulnerable to further nutritional depletion during their inpatient stay. 6,9,10 There is a need for large, adequately powered prospective studies incorporating a gold-standard method for nutritional assessment, with robust and consistently applied definitions of undernutrition and infectious complications. If undernutrition is a risk factor for infection, aspects of pre-and postoperative feeding practices could be modified in order to reduce the physical, psychosocial and financial burdens associated with HCAIs in children.…”

“…5 There is evidence that nutritional status deteriorates in children following hospital admission, 6,7 often when associated with chronic or critical illness. 8,9 Poor nutritional status (measured by lower weight-for-age zscores) has been associated with increased duration of mechanical ventilatory support, increased length of stay and increased one-year mortality in neonates undergoing surgery within an intensive care setting. 10 A recent evidence-based review of the literature found weak evidence of preoperative nutritional assessment being predictive of adverse clinical outcomes in paediatric surgical patients.…”