A Correlation between Nutritional Adequacy and Clinical Outcomes among Children Critically Hospitalized with COVID-19

Document Type : Research Paper

Authors

1 Department of Nutrition, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

2 Clinical Research Development Unit of Akbar Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

3 Department of Pediatrics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

Abstract

Introduction: Malnutrition is a prominent cause of mortality and morbidity in hospitalized children. Comorbidity of infection and malnutrition can exacerbate nutritional deficiencies and worsen healing. This study aimed to evaluate nutritional status, dietary intake adequacy, and their correlation with clinical outcomes among children diagnosed with coronavirus disease 2019 (COVID-19). Methods: This prospective observational study was conducted on 30 children admitted to the pediatric intensive care unit (PICU) ward of Akbar Hospital, Mashhad University of Medical Sciences, Mashhad, Iran, for eight weeks. Age, gender, and nutritional status (weight-for-lengths/heights z-scores, based on the World Health Organization child growth standards) of critically ill children with COVID-19 were recorded and evaluated upon admission. Dietary intake and its adequacy were also calculated during hospitalization. Then, the correlation between mentioned variables with clinical outcomes was examined. Results: Out of 30 patients, malnutrition was severe in 16.7%, moderate in 16.7%, while nutrition status was normal in 66.7% of patients. There was no significant correlation between z-scores and mortality or length of stay. However, significant differences were found between energy intake adequacy and length of hospitalization (p<0.001), as well as protein intake adequacy and mortality (p=0.008). Conclusion: The study showed a significant correlation between dietary intake adequacy and clinical outcomes, suggesting the role of optimizing nutrition therapy in ameliorating clinical consequences in critically ill children.

Keywords

References

  1. Organization WH. Coronavirus disease 2019 (COVID-19): situation report, 73. 2020.
  2. Wu Z, McGoogan JM. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72 314 cases from the Chinese Center for Disease Control and Prevention. Jama. 2020;323(13):1239-42.
  3. Covid C, Team R, Covid C, Team R, Bialek S, Gierke R, et al. Coronavirus disease 2019 in children—United States, february 12–april 2, 2020. Morbidity and Mortality Weekly Report. 2020;69(14):422.
  4. Lee P-I, Hu Y-L, Chen P-Y, Huang Y-C, Hsueh P-R. Are children less susceptible to COVID-19?. J Microbiol Immunol Infect. 2020;53(3):371.
  5. Jayawardena R, Sooriyaarachchi P, Chourdakis M, Jeewandara C, Ranasinghe P. Enhancing immunity in viral infections, with special emphasis on COVID-19: A review. Diabetes Metab Syndr. 2020;14(4):367-82.
  6. McMillan DC, Maguire D, Talwar D. Relationship between nutritional status and the systemic inflammatory response: micronutrients. Proc Nutr Soc. 2019;78(1):56-67.
  7. Bhaskaram P. Immunobiology of mild micronutrient deficiencies. Br J Nutr. 2001;85(S2):S75-S80.
  8. Bhaskaram P. Micronutrient malnutrition, infection, and immunity: an overview. Nutr Rev. 2002;60(suppl_5):S40-S5.
  9. Calder PC, Carr AC, Gombart AF, Eggersdorfer M. Optimal nutritional status for a well-functioning immune system is an important factor to protect against viral infections. Nutrients. 2020;12(4):1181.
  10. Walson JL, Berkley JA. The impact of malnutrition on childhood infections. Curr Opin Infect Dis. 2018;31(3):231.
  11. Pelletier DL, Frongillo Jr EA, Schroeder DG, Habicht J-P. The effects of malnutrition on child mortality in developing countries. Bulletin of the World Health Organization. 1995;73(4):443.
  12. Waterlow JC, Tomkins A, Grantham-McGregor SM. Protein-energy malnutrition: Edward Arnold, Hodder & Stoughton; 1992.
  13. Allard JP, Keller H, Jeejeebhoy KN, Laporte M, Duerksen DR, Gramlich L, et al. Decline in nutritional status is associated with prolonged length of stay in hospitalized patients admitted for 7 days or more: A prospective cohort study. Clin Nutr. 2016;35(1):144-52.
  14. Bagri NK, Jose B, Shah SK, Bhutia TD, Kabra SK, Lodha R. Impact of malnutrition on the outcome of critically ill children. Indian J Pediatr. 2015;82(7):601-5.
  15. Curtis LJ, Bernier P, Jeejeebhoy K, Allard J, Duerksen D, Gramlich L, et al. Costs of hospital malnutrition. Clin Nutr. 2017;36(5):1391-6.
  16. Organization WH. WHO child growth standards: training course on child growth assessment. 2008.
  17. Joosten K, Embleton N, Yan W, Senterre T, Braegger C, Bronsky J, et al. ESPGHAN/ESPEN/ESPR/CSPEN guidelines on pediatric parenteral nutrition: Energy. Clin Nutr. 2018;37(6):2309-14.
  18. Mehta NM, Compher C. ASPEN Clinical Guidelines: nutrition support of the critically ill child. Group. 2009;47:22.
  19. Mehta NM, Bechard LJ, Cahill N, Wang M, Day A, Duggan CP, et al. Nutritional practices and their relationship to clinical outcomes in critically ill children—an international multicenter cohort study. Crit Care Med. 2012;40(7):2204.
  20. Pollack MM, Wiley JS, Holbrook PR. Early nutritional depletion in critically ill children. Crit Care Med. 1981;9(8):580-3.
  21. Briassoulis G, Zavras N, Hatzis T. Malnutrition, nutritional indices, and early enteral feeding in critically ill children. Nutrition (Burbank, Los Angeles County, Calif). 2001;17(7-8):548-57.
  22. Wu J, Zha P. Treatment Strategies for Reducing Damages to Lungs in Patients with Coronavirus and Other Infections, 2020. Available at SSRN.
  23. Kyle UG, Jaimon N, Coss-Bu JA. Nutrition support in critically ill children: underdelivery of energy and protein compared with current recommendations. J Acad Nutr Diet. 2012;112(12):1987-92.
  24. Hulst JM, van Goudoever JB, Zimmermann LJ, Hop WC, Albers MJ, Tibboel D, et al. The effect of cumulative energy and protein deficiency on anthropometric parameters in a pediatric ICU population. Clin Nutr. 2004;23(6):1381-9.
  25. Rogers EJ, Gilbertson HR, Heine RG, Henning R. Barriers to adequate nutrition in critically ill children. Nutrition (Burbank, Los Angeles County, Calif). 2003;19(10):865-8.
  26. Petrillo-Albarano T, Pettignano R, Asfaw M, Easley K. Use of a feeding protocol to improve nutritional support through early, aggressive, enteral nutrition in the pediatric intensive care unit. Pediatric Crit Care Med. 2006;7(4):340-4.
  27. Meyer R, Harrison S, Sargent S, Ramnarayan P, Habibi P, Labadarios D. The impact of enteral feeding protocols on nutritional support in critically ill children. J Hum Nutr Diet. 2009;22(5):428-36.
  28. de Souza Menezes F, Leite HP, Nogueira PCK. Malnutrition as an independent predictor of clinical outcome in critically ill children. Nutrition (Burbank, Los Angeles County, Calif). 2012;28(3):267-70.
  29. Grippa RB, Silva PS, Barbosa E, Bresolin NL, Mehta NM, Moreno YM. Nutritional status as a predictor of duration of mechanical ventilation in critically ill children. Nutrition (Burbank, Los Angeles County, Calif). 2017;33:91-5.
  30. Sachdeva S, Dewan P, Shah D, Malhotra RK, Gupta P. Mid-upper arm circumference v. weight-for-height Z-score for predicting mortality in hospitalized children under 5 years of age. Public HealthNutr. 2016;19(14):2513-20.
  31. Bechard LJ, Staffa SJ, Zurakowski D, Mehta NM. Time to achieve delivery of nutrition targets is associated with clinical outcomes in critically ill children. Am J Clin Nutr. 2021;114(5):1859-67.
Journal of Nutrition,Fasting and Health
Volume 10, Issue 4
October 2022
Pages 290-294

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History

  • Receive Date: 25 October 2022
  • Revise Date: 03 December 2022
  • Accept Date: 04 December 2022

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