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

Abstract

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.

Feasibility of Achieving Nutritional Adequacy in Critically Ill Children with Critical Neurological Illnesses (CNIs)?—A Quaternary Hospital Experience

“…Our study on patients with CNI in our institution showed that 12% of the patients were diagnosed as underweight, 22.5% exhibited signs of chronic malnutrition, and 8% were classified as acute malnutrition ( Table 1 ). These results align with previously published reports of a ~20–30% prevalence of malnutrition in developed countries [ 21 , 22 , 23 , 24 ].…”

“…Existing malnutrition is not the only factor that influences clinical outcomes for these patients; the critical illness itself may increase metabolic demand in the early stages of the stress response, and nutrient intake may be limited. Thus, children admitted to a PICU are at a higher risk of worsening nutritional status and anthropometric changes, both of which could correlate with adverse clinical outcomes [ 21 , 22 , 23 , 25 , 26 ].…”

Editor’s Choice Articles for December

“…My fourth Editor's Choice article comes from the Latin American Society of Pediatric Intensive Care (SLACIP) and is a point prevalence study of malnutrition and nutritional support in 41 PICUs in 13 Latin American countries on one day in 2021 (14). SLACIP identified 311 children on the day of study who, in general, had adequate enteral nutritional support but half the children did not receive recommended levels of calories and protein.…”

“…Campos-Mino S, Figueiredo-Delgado A, Zarate P, et al; Nutrition Committee, Latin American Society of Pediatric Intensive Care (SLACIP): Malnutrition and Nutrition Support in Latin American PICUs: The Nutrition in PICU (NutriPIC) Study (14).…”

“…After reading my fourth Editor’s Choice article (14), by way of an educational review, move onto the 2019 world survey of 920 PICU practitioners in 57 countries that asked about barriers to delivery of enteral nutrition (15). Then read the 2019 survey of North American pediatric critical care fellowship programs, with 20 program directors and 60 fellows, which found that nutrition education was “highly underrepresented” in curricula (16).…”