Improving the Performance of Anthropometry Measurements in the Pediatric Intensive Care Unit

Srinivasan, Vijay; Seiple, Stephanie; Nagle, Monica; Falk, Shiela; Kubis, S.; Lee, Henry M; Sisko, Martha; Mascarenhas, Maria Inês; Irving, Sharon Y.

doi:10.1097/pq9.0000000000000022

Cited by 7 publications

(11 citation statements)

References 29 publications

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“…HC is used in children less than 24 months old as a marker of brain development and growth; we found a 36% prevalence of HC/A z score of less than –2. Unfortunately, the measurement of HC is often overlooked; in one PICU quality improvement study, 2012–2016, the authors were only able to achieve 19% compliance in admission measurements (18). Historically, several perceived barriers to obtaining anthropometry measurements in the PICU have been described (19).…”

Section: Discussionmentioning

confidence: 99%

Malnutrition and Nutrition Support in Latin American PICUs: The Nutrition in PICU (NutriPIC) Study

Campos-Miño,

Figueiredo-Delgado,

Zárate

et al. 2023

Pediatric Critical Care Medicine

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Objectives: To characterize the nutritional status of children admitted to Latin American (LA) PICUs and to describe the adequacy of nutrition support in reference to contemporary international recommendations. Design: The Nutrition in PICU (NutriPIC) study was a combined point-prevalence study of malnutrition carried out on 1 day in 2021 (Monday 8 November) and a retrospective cohort study of adequacy of nutritional support in the week preceding. Setting: Four-one PICUs in 13 LA countries. Patients: Patients already admitted to the PICU of 1 month to 18 years old on the study day were included in the point-prevalence study. For the retrospective arm, we included patients receiving nutritional support on the study day and with a PICU length of stay (LOS) greater than or equal to 72 hours. Exclusion criteria were being a neonate, conditions that precluded accurate anthropometric measurements, and PICU LOS greater than 14 days. Interventions: None. Measurements and Main Results: Of 316 patients screened, 5 did not meet age criteria. There were 191 of 311 patients who were included in the point-prevalence study and underwent anthropometric evaluation. Underweight and length for age less than –2 z scores were present in 42 of 88 children (47.7%) and 41 of 88 children (46.6%) less than 24 months old, and 14 of 103 (13.6%) and (23/103) 22.3% of 103 children greater than or equal to 24 months, respectively. Evidence of obesity (body mass index > 2 z score) was present in 7 of 88 children (5.7%) less than 24 months old and 13 of 103 children (12.6%) greater than or equal to 24 months. In the 115 of 311 patients meeting criteria for the retrospective arm, a total of 98 patients reported complete nutritional data. The 7-day median (interquartile range) adequacy for delivered versus recommended enteral energy and protein requirement was 114% (75, 154) and 99% (60, 133), respectively. Conclusions: The NutriPIC study found that in 2021 malnutrition was highly prevalent especially in PICU admissions of less than 24 months old. Retrospectively, the 7-day median nutritional support appears to meet both energy and protein requirements.

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Section: Discussionmentioning

confidence: 99%

Malnutrition and Nutrition Support in Latin American PICUs: The Nutrition in PICU (NutriPIC) Study

Campos-Miño,

Figueiredo-Delgado,

Zárate

et al. 2023

Pediatric Critical Care Medicine

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“…For example, nursing training programs in the pediatric ICU increased weight by 5% to 9%, height by 8% to 67%, and BMI by 9% to 59%. 19,23 Implementing a malnutrition-screening tool that utilizes anthropometric measurements increased weight measurement by 3% and height measurement by 58%. 21 EHR reminders increased BMI measurement rates by 9%.…”

Section: Discussionmentioning

confidence: 99%

Improving anthropometric measurements in hospitalized children: A quality‐improvement project

Persaud,

Hron,

Rudie

et al. 2023

Nut in Clin Prac

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BackgroundThe objective of this quality‐improvement project was to increase documentation rates of anthropometrics (measured weight, length/height, and body mass index [BMI], which are critical to identify patients at malnutrition (undernutrition) risk) from <50% to 80% within 24 hours of hospital admission for pediatric patients.MethodsMultidisciplinary champion teams on surgical, cardiac, and intensive care (ICU) pilot units were established to identify and iteratively test interventions addressing barriers to documentation from May 2016 to June 2018. Percentage of patients with documented anthropometrics <24 h of admission was assessed monthly by statistical process control methodology. Percentage of patients at malnutrition (undernutrition) risk by anthropometrics was compared by χ2 for 4 months before and after intervention.ResultsAnthropometric documentation rates significantly increased (P < 0.001 for all): BMI, from 11% to 89% (surgical), 33% to 57% (cardiac), and 16% to 51% (ICU); measured weight, from 24% to 88% (surgical), 69% to 83% (cardiac), and 51% to 67% (ICU); and length/height, from 12% to 89% (surgical), 38% to 57% (cardiac), and 26% to 63% (ICU). Improvement hospital‐wide was observed (BMI, 42% to 70%, P < 0.001) with formal dissemination tactics. For pilot units, moderate/severe malnutrition (undernutrition) rates tripled (1.2% [24 of 2081] to 3.4% [81 of 2374], P < 0.001).ConclusionDocumentation of anthropometrics on admission substantially improved after establishing multidisciplinary champion teams. Goal rate (80%) was achieved within 26 months for all anthropometrics in the surgical unit and for weight in the cardiac unit. Improved documentation rates led to significant increase in identification of patients at malnutrition (undernutrition) risk.

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“…Finally, the difficulty of using BMI to distinguish between fat and muscle mass, as well as the effect of fluid imbalances and linear development anomalies, restricts its use as a malnutrition indicator ( 31 , 51 , 52 ). Arm anthropometry, such as mid-upper arm circumference or calf circumference, has been demonstrated to be a rapid, effective measure that may be better at representing body composition than BMI ( 53 , 54 ), and is an alternative nutritional evaluation to investigate for future research.…”

Section: Discussionmentioning

confidence: 99%

Is Undernutrition Associated With Deterioration of Outcomes in the Pediatric Intensive Care Unit (PICU): Systematic and Meta-Analysis Review

Albadi

Bookari

2022

Front. Pediatr.

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Background and aimUndernutrition (UN) may negatively impact clinical outcomes for hospitalized patients. The relationship between UN status at pediatric intensive care unit (PICU) admission and clinical outcomes is still not well-reported. This systematic meta-analysis review evaluated the impact of UN at admission to PICU on clinical outcomes, including mortality incidence, length of stay (LOS), and the need for and length of time on mechanical ventilation (MV).MethodsA search was conducted using relevant and multi-medical databases from inception until January 2022. We considered studies that examined the link between UN at PICU admission and clinical outcomes in patients aged 18 years or younger. Pooled risk difference estimates for the PICU outcomes were calculated using a random-effects model.ResultThere were a total of 10,638 patients included in 17 observational studies; 8,044 (75.61%) and 2,594 (24.38%) patients, respectively, were normal-nourished (NN) and undernourished (UN). In comparison to NN patients, UN patients had a slightly higher risk of mortality (RD = 0.02, P = 0.05), MV usage (RD = 0.05, P = 0.02), and PICU LOS (RD = 0.07, P = 0.007). While the duration of MV was significantly longer in UN than in NN (RD = 0.13, P < 0.0001). Sensitivity analysis of UN classification cohorts with a z-score < -2 or in the 5%, patetints age up to 18 years, and mixed diagnose for PICU admission demonstrated a 6-fold increase in the probability of PICU LOS in UN patients compared to NN patients (RD = 0.06, 95% CI = 0.01, 0.12). UN patients have a higher risk of MV usage RD = 0.07, 95% CI = 0.00, 0.14) in studies involving cohorts with a mixed primary diagnosis for PICU admission.ConclusionIn PICU, UN is linked to mortality incidence, longer PICU stay, MV usage, and duration on MV. The primary diagnosis for PICU admission may also influence clinical outcomes. Determining the prevalence of UN in hospitalized patients, as well as the subgroups of patients diagnosed at the time of admission, requires more research. This may help explain the relationship between nutritional status and clinical outcomes in PICU patients.

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Improving the Performance of Anthropometry Measurements in the Pediatric Intensive Care Unit

Abstract: Supplemental Digital Content is available in the text.

Cited by 7 publications

References 29 publications

Malnutrition and Nutrition Support in Latin American PICUs: The Nutrition in PICU (NutriPIC) Study

Malnutrition and Nutrition Support in Latin American PICUs: The Nutrition in PICU (NutriPIC) Study

Improving anthropometric measurements in hospitalized children: A quality‐improvement project

Is Undernutrition Associated With Deterioration of Outcomes in the Pediatric Intensive Care Unit (PICU): Systematic and Meta-Analysis Review

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