Nutritional Deficiencies During Critical Illness
Section snippets
Epidemiology and risk factors for malnutrition in the pediatric intensive care unit
One in every five children admitted to the PICU experiences acute or chronic malnutrition.3, 8, 9 Because of the lack of systematic nutritional assessment at many centers, the true extent of malnutrition in the PICU population may not be appreciated. Pediatric malnutrition, also commonly known as protein-energy malnutrition (PEM), remains a significant health care problem in the developing world and the industrial world. The correlation between nutritional status and outcomes is complex and
Causes of malnutrition in critically ill children
The etiology of malnutrition developing during critical illness is multifactorial, and common factors contributing to the protein and energy deficits during the PICU course include (1) increased demands secondary to the metabolic stress response, (2) failure to estimate energy expenditure accurately, and (3) inadequate substrate delivery at the bedside.
Nutritional assessment during critical illness
The nutritional assessment of critically ill children may be challenging from scientific and practical aspects. After admission, weights are infrequently obtained during the PICU course, and acute changes in nutritional status may be missed or detected late.47 Failure to weigh children in the PICU is attributable to the perceived dangers of moving critically ill patients and the low priority among health care workers for nutritional assessment. In a review of hospitalized adults outside the
Micronutrient deficiency in critically ill children
The antioxidant properties of certain micronutrients have renewed interest in their role during critical illness. Vitamins C and E have important antioxidant properties. Selenium has also been shown to be a critical micronutrient with antioxidant functions in patients with thermal injury and trauma.82 A complex system of special enzymes, their cofactors (selenium, zinc, iron, and manganese), sulfhydryl group donors (glutathione), and vitamins (E and C) form a defense system to counter the
Prevention of nutritional deterioration during critical illness
The first step in improving the nutritional status of critically ill children is to acknowledge the magnitude of the problem. Description of the epidemiology of malnutrition requires accurate and regular monitoring of nutritional parameters in hospitalized children. Despite the association between malnutrition in hospitalized patients and poorer outcomes, less than half of the patients actually have their nutritional assessment recorded in their notes and fewer are referred for specialized
Summary
Malnutrition is prevalent in children admitted to the PICU, and their nutritional status may further deteriorate during the course of critical illness. Assessment of nutritional status on admission to the PICU allows identification of those children at high risk for further nutritional deterioration. A basic understanding of the metabolic stress response and accurate assessment of energy expenditure are essential for designing individually tailored nutritional prescriptions for critically ill
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