Indian Journal of Critical Care Medicine

Register      Login

SEARCH WITHIN CONTENT

FIND ARTICLE

Volume / Issue

Online First

Archive
Related articles

VOLUME 20 , ISSUE 7 ( 2016 ) > List of Articles

RESEARCH ARTICLE

Impact of malnutrition on pediatric risk of mortality score and outcome in Pediatric Intensive Care Unit

Romi Nangalu, Puneet Aulakh Pooni, Siddharth Bhargav, Harmesh Singh Bains

Keywords : Anthropometric data, malnutrition, outcome in malnourished children, pediatric risk of mortality

Citation Information : 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 (7):385-390.

DOI: 10.4103/0972-5229.186218

License: CC BY-ND 3.0

Published Online: 01-01-2014

Copyright Statement:  Copyright © 2016; The Author(s).


Abstract

Objectives: This study was done to determine the effect of malnutrition on mortality in Pediatric Intensive Care Unit (PICU) and on the pediatric risk of mortality (PRISM) scoring. Subjects and Methods: This was a prospective study done over 1 year. There were total 400 patients (1 month 14 years), who were divided into cases with weight for age <3 rd centile and controls with ≥3 rd centile of WHO charts. Cases were subdivided into mild/moderate (61-80% of expected weight for age) and severe malnutrition (<60%). Results: Out of total, 38.5% patients were underweight, and malnutrition was more in infancy, 61/104, i.e. 58.5% (P - 0.003). There was no significant difference in vitals at admission. Cases needed prolonged mechanical ventilation (P - 0.0063) and hospital stay (P - 0.0332) compared to controls. Mean and median PRISM scores were comparable in both the groups, but mortality was significantly higher in severely malnourished (P value 0.027). Conclusion: Severe malnutrition is independently associated with higher mortality even with similar PRISM score. There is need to give an additional score to children with weight for age <60% of expected.


PDF Share
  1. Grover Z, Ee LC. Protein energy malnutrition. Pediatr Clin North Am 2009;56:1055-68.
  2. Young H, Jaspars S. Review of Nutrition and Mortality Indicators for the Integrated Food Security Phase Classification (IPC) Reference Levels and Decision-Making by Helen; September, 2009A.
  3. Pelletier DL, Frongillo EA Jr., Schroeder DG, Habicht JP. A methodology for estimating the contribution of malnutrition to child mortality in developing countries. J Nutr 1994;124 10 Suppl: 2106S-22S.
  4. Hartman C, Shamir R, Hecht C, Koletzko B. Malnutrition screening tools for hospitalized children. Curr Opin Clin Nutr Metab Care 2012;15:303-9.
  5. Alam N, Wojtyniak B, Rahaman MM. Anthropometric indicators and risk of death. Am J Clin Nutr 1989;49:884-8.
  6. Briend A, Bari A. Critical assessment of the use of growth monitoring for identifying high risk children in primary health care programmes. BMJ 1989;298:1607-11.
  7. El Halal MG, Barbieri E, Filho RM, Trotta Ede A, Carvalho PR. Admission source and mortality in a pediatric intensive care unit. Indian J Crit Care Med 2012;16:81-6.
  8. Thukral A, Lodha R, Irshad M, Arora NK. Performance of pediatric risk of mortality (PRISM), pediatric index of mortality (PIM), and PIM2 in a pediatric intensive care unit in a developing country. Pediatr Crit Care Med 2006;7:356-61.
  9. Singhal D, Kumar N, Puliyel JM, Singh SK, Srinivas V. Prediction of mortality by application of PRISM score in intensive care unit. Indian Pediatr 2001;38:714-9.
  10. Bellad R, Rao S, Patil VD, Mahantshetti NS. Outcome of intensive care unit patients using Pediatric risk of mortality (PRISM) score. Indian Pediatr 2009;46:1091-2.
  11. World Health Organization. WHO child growth standards and the identification of severe acute malnutrition in infants and children 2009. World Health Organization; 2009.
  12. Pollack MM, Ruttimann UE, Getson PR. Pediatric risk of mortality (PRISM) score. Crit Care Med 1988;16:1110-6.
  13. Kumar N, Shekhar C, Kumar P, Kundu AS. Kuppuswamy′s socioeconomic status scale-updating for 2007. Indian J Pediatr 2007;74:1131-2.
  14. Gemke RJ, Bonsel GJ, Bught AJ. Outcome assessment and quality assurance in pediatric intensive care. In: Tibboel D, van der Voort E, editors. Intensive Care in Childhood. A Challenge to Future. 2 nd ed. Berlin: Springer; 1996. p. 117-32.
  15. 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.
  16. El-Nawawy A. Evaluation of the outcome of patients admitted to the pediatric intensive care unit in Alexandria using the pediatric risk of mortality (PRISM) score. J Trop Pediatr 2003;49:109-14.
  17. Castello FV, Cassano A, Gregory P, Hammond J. The pediatric risk of mortality (PRISM) score and injury severity score (ISS) for predicting resource utilization and outcome of intensive care in pediatric trauma. Crit Care Med 1999;27:985-8.
  18. 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;8:1174-1205.
  19. Lindskog U, Lindskog P, Carstensen J, Larsson Y, Gebre-Medhin M. Childhood mortality in relation to nutritional status and water supply - A prospective study from rural Malawi. Acta Paediatr Scand 1988;77:260-8.
  20. Staebel O. Malnutrition in Belgian children with congenital heart disease on admission to hospital. J Clin Nurs 2000;9:784-91.
  21. da Silva VM, de Oliveira Lopes MV, de Araujo TL. Growth and nutritional status of children with congenital heart disease. J Cardiovasc Nurs 2007;22:390-6.
  22. Singhi S, Marudkar A. Hypokalemia in a pediatric intensive care unit. Indian Pediatr 1996;33:9-14.
  23. Ashworth A. Treatment of severe malnutrition. J Pediatr Gastroenterol Nutr 2001;32:516-8.
  24. Mishra SK, Bastola SP, Jha B. Biochemical nutritional indicators in children with protein energy malnutrition attending Kanti Children Hospital, Kathmandu, Nepal. Kathmandu Univ Med J 2009;7:129-34.
  25. Pasricha SR, Black J, Muthayya S, Shet A, Bhat V, Nagaraj S, et al. Determinants of anemia among young children in rural India. Pediatrics 2010;126:e140-9.
  26. Tyagi A, Chandra J, Narayan S, Sharma D. Platelet function tests in protein energy malnutrition. Indian Pediatr 1992;29:228-31.
  27. 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) 2002;78:146-52.
  28. Arora NS, Rochester DF. Respiratory muscle strength and maximal voluntary ventilation in undernourished patients. Am Rev Respir Dis 1982;126:5-8.
  29. Keens TG, Bryan AC, Levison H, Ianuzzo CD. Developmental pattern of muscle fiber types in human ventilatory muscles. J Appl Physiol Respir Environ Exerc Physiol 1978;44:909-13.
  30. Rochester DF. Respiratory muscles and ventilatory failure: 1993 perspective. Am J Med Sci 1993;305:394-402.
  31. Schroeder DG, Brown KH. Nutritional status as a predictor of child survival: Summarizing the association and quantifying its global impact. Bull World Health Organ 1994;72:569-79.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.