Influence of nutritional status on clinical outcomes in critically ill children

Chaitra K. M., Bhavya G., Harish S., Shruthi Patel, Syeda Kausar Anjum


Background: Critically-ill children have a state of metabolic stress. The nutritional needs of these patients can be increased. Their nutritional status at admission and its possible deterioration during hospitalization can be a predictor of worse outcome. The objective of this study was to study the influence of nutritional status on outcomes like mortality, duration of mechanical ventilation and duration PICU stay and hospital stay, in critically ill children.

Methods: This was a prospective comparative study conducted on 60 critically ill children aged 1 month to 18 years admitted to PICU of tertiary care, teaching hospital, Bangalore, Karnataka over a study period of 12 months. Patients were divided into 4 categories based on Body mass index (BMI) as per WHO growth charts into: underweight, normal, overweight and obese and outcomes was analysed.

Results: In the present study 60 children were studied. Subjects were classified as underweight (23.33%), normal weight (45%), overweight/obese (31.67%) based on BMI Z-score at admission. The odds of prolonged hospital stay were higher in underweight and overweight/obese children (OR-2.85, p-0.12 and OR-3.92, p-0.03 respectively). Underweight and overweight/ obese children had higher odds for prolonged PICU stay. (OR-6, p-0.02 and OR-2.13, p-0.36 respectively). Underweight children required prolonged ventilator support (OR-2, p-0.03). There was no significant difference among the group.

Conclusions: There is a high prevalence of malnourishment in critically ill children compared to general population and they are prone for poor outcome. Malnourished children must be identified at admission and optimal therapies, nutritional strategies aimed at preventing further nutritional deterioration should be made.


BMI, Critically ill children, Malnourishment

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Cannon, Walter. Wisdom of the body. United States: W. W. Norton and Company; 1932

Brinker M. Acute stress response in critically ill children. [S.l.]: [s.n.]; 2005. P

Numa A, McAweeney J, Williams G, Awad J, Ravindranathan H. Extremes of weight centile are associated with increased risk of mortality in pediatric intensive care. Crit Care. 2011;15(2):R106.

Mello MJG, Albuquerque MFPM, Ximenes ARA, Lacerda HR, Ferraz EJS, Byington R, Barbosa MTS. Factors associated with time to acquisition of bloodstream infection in a pediatric intensive care unit. Infect Control Hospital Epidemiol. 2010;31(3):249-55.

World Health Organization. WHO Child Growth Standards: Methods and development: length/height-for-age, weight-for-age, weight-for length, weight-for-height and body mass index-for-age. World Health Organization. Geneva, Switzerland; 2016.

WHO. Training course on child growth assessment. World Health Organization. Geneva: WHO; 2008..

Pollack MM, Cuerdon TT, Patel KM, Ruttimann UE, Getson PR, Levetown M. Impact of quality of care factors on pediatric intensive care unit mortality. JAMA. 1994;272:941-6.

Rodríguez L, Cervantes E, Ortiz R. Malnutrition and gastrointestinal and respiratory infections in children: a public health problem. Int J Environ Res Public Health. 2011;8:1174 205.

UNICEF-WHO. Joint child malnutrition estimates 2017 (UNICEF-WHO-WB). Available at Accessed 14th December 2017.

UNICEF. UNICEF Data: Monitoring the situation of children and women. Available at Accessed 14th December 2017.

Bechard L, Duggan C, Touger-Decker R, Parrott J, Rothpletz-Puglia P, Byham-Gray L, et al. Nutritional status based on body mass index is associated with morbidity and mortality in mechanically ventilated critically ill children in the PICU. Critical Care Med. 2016;44(8):1530-7.

Nangalu R, Pooni PA, Bhargav S, Bains HS. Impact of malnutrition on pediatric risk of mortality score and outcome in Pediatric Intensive Care Unit. Indian J Crit Care Med. 2016;20:385-90.

Tait AR, Voepel-Lewis T, Burke C, Kostrzewa A, Lewis I. Incidence and risk factors for perioperative adverse respiratory events in children who are obese. Anesthesiol. 2008;108(3):375-80.

Joosten KFM, Hulst JM. Malnutrition in pediatric hospital patients: Current issues. Nutr. 2011;27(2):133-7.

Reid M, Badaloo A, Forrester T, Morlese JF, Heird WC, Jahoor F. The acute-phase protein response to infection in edematous and nonedematous protein-energy malnutrition. Am J Clin Nutr. 2002;76(6):1409-15.

de Souza Menezes F, Leite HP, Koch Nogueira PC. Malnutrition as an independent predictor of clinical outcome in critically ill children. Nutr. 2012;28(3):267-70.

Mota EM, Garcia PC, Piva JP, Fritscher CC. The influence of poor nutrition on the necessity of mechanical ventilation among children admitted to the Pediatric Intensive Care Unit. J Pediatr (Rio J).

;78:146 52.

Rochester DF. Respiratory muscles and ventilatory failure: 1993 perspective. Am J Med Sci 1993;305:394 402

Goh VL, Wakeham MK, Brazauskas R, Mikhailov TA, Goday PS. Obesity is not associated with increased mortality and morbidity in critically ill children. J Parenteral Enteral Nutr. 2013;37:102-8.

Becker PJ, Carney NL, Corkins MR, Monczka J, Smith E, Smith SE, et al. Consensus statement of the Academy of Nutrition and Dietetics/American Society for parenteral and enteral nutrition: indicators recommended for the identification and documentation of pediatric malnutrition (undernutrition). J Acad Nutr Dietetics. 2014;114(12):1988-2000.

Martin L, Birdsell L, Macdonald N, Reiman T, Clandinin MT, McCargar LJ, et al. Cancer cachexia in the age of obesity: skeletal muscle depletion is a powerful prognostic factor, independent of body mass index. J Clin Oncol. 2013;31(12):1539-47.

Briassoulis G, Zavras N, Hatzis T. Malnutrition, nutritional indices, and early enteral feeding in critically ill children. Nutr. 2001;17(7-8):548-57.

Dietz WH, Bellizzi MC. Introduction: the use of body mass index to assess obesity in children. Am J Clin Nutr. 1999;70(1):123S-5.