Document Type : original article

Authors

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

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

3 Clinical Research Development Unit, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran.

10.22038/jpp.2024.82331.5487

Abstract

Background: Sepsis is a potentially fatal condition resulting from an infection and is recognized as a critical global health concern. Among children, sepsis causes many deaths and affects one-third of those in Pediatric Intensive Care Units (PICUs). Malnutrition in children, especially those in PICUs, increases susceptibility to sepsis. Critically ill children, especially those with sepsis, are at increased risk of malnutrition. Knowing the nutritional status at the start of hospitalization and patient management, planning and decision-making is particularly important.
Methods: A Cross-sectional study conducted at Akbar Children's Hospital in Mashhad involved 54 children aged one month to 10 years with sepsis. Anthropometric measurements, including weight, height/length, BMI, and Z-scores were evaluated/calculated. Malnutrition was diagnosed using the weight-for-height Z score; a Z-score of -2 or lower was used to indicate moderate or severe malnutrition. Statistical analyses were done using SPSS version 22.0, with a significance level considered at P-values less than 0.05.
Results: The study included 54 septic patients in PICU, including 53.7% girls and 46.3% boys. The mean age was 37 months, and mean body weight and height were 13.62 kg, and 88.85 cm, respectively. Malnutrition was found in 18.5% of the studied patients as moderate and 13% as severe grades, while 68.5% had a normal nutritional status.
Conclusion: Malnutrition is prevalent among critically ill septic patients, indicating a crucial need for prompt intervention. Regular nutritional assessments and early, intensified nutritional support considering evidence-based local protocols, are essential for ensuring adequate energy and nutrients, potentially leading to improved outcomes for these vulnerable patients.

Keywords

Fleischmann-Struzek C, Mellhammar L, Rose N, Cassini A, Rudd KE, Schlattmann P, et al. Incidence and mortality of hospital-and ICU-treated sepsis: results from an updated and expanded systematic review and meta-analysis. Intensive care medicine. 2020 Aug;46:1552-62. O’Brien Jr JM, Ali NA, Aberegg SK. Abraham E. Sepsis. Am. J. Med. 2007;120(12):1012-22. Hartman ME, Linde-Zwirble WT, Angus DC, Watson RS. Trends in the epidemiology of pediatric severe sepsis. Pediatric Critical Care Medicine. 2013 Sep 1;14(7):686-93. de Souza DC, Barreira ER, Faria LS. The epidemiology of sepsis in childhood. Shock. 2017 Jan 1;47(1S):2-5. Weiss SL, Fitzgerald JC, Pappachan J, Wheeler D, Jaramillo-Bustamante JC, Salloo A, et al. Global epidemiology of pediatric severe sepsis: the sepsis prevalence, outcomes, and therapies study. American journal of respiratory and critical care medicine. 2015 May 15;191(10):1147-57. Carlton EF, Barbaro RP, Prescott HC. Cost of pediatric severe sepsis hospitalizations. JAMA pediatrics. 2019 Oct 1;173(10):986-7. Imanzadeh F, Olang B, Khatami K, Hosseini A, Dara N, Rohani P, et al. Assessing the Prevalence and Treatment of Malnutrition in Hospitalized Children in Mofid Children’s Hospital During 2015–2016. Archives of Iranian medicine. 2018 Jun 1;21(7):302-9. Adejumo AC, Akanbi O, Pani L. Protein energy malnutrition is associated with worse outcomes in sepsis—a nationwide analysis. Journal of the Academy of Nutrition and Dietetics. 2019 Dec 1;119(12):2069-84. Stelmasiak M, Bałan B, Mikaszewska-Sokolewicz M, Niewiński G, Kosałka K, Szczepanowska E, et al. The relationship between the degree of malnutrition and changes in selected parameters of the immune response in critically ill patients. Central European Journal of Immunology. 2021 Jan 1;46(1):82-91. Prieto MB, Cid JL. Malnutrition in the critically ill child: the importance of enteral nutrition. International journal of environmental research and public health. 2011 Nov;8(11):4353-66. Arı HF, Ağın H, Ceylan G, Atakul G, Sandal ÖS, Sarı F, et al. Nutritional Status and Malnutrition Assessment of Patients Followed in Pediatric Intensive Care Unit. Harran Üniversitesi Tıp Fakültesi Dergisi. 2022;19(1):56-60.. Corish CA, Kennedy NP. Protein–energy undernutrition in hospital in-patients. British Journal of Nutrition. 2000 Jun;83(6):575-91. Correia MI, Waitzberg DL. The impact of malnutrition on morbidity, mortality, length of hospital stay and costs evaluated through a multivariate model analysis. Clinical nutrition. 2003 Jun 1;22(3):235-9. Norman K, Pichard C, Lochs H, Pirlich M. Prognostic impact of disease-related malnutrition. Clinical nutrition. 2008 Feb 1;27(1):5-15. McLaughlin J, Chowdhury N, Djurkovic S, Shahab O, Sayiner M, Fang Y, et al. Clinical outcomes and financial impacts of malnutrition in sepsis. Nutrition and Health. 2020 Sep;26(3):175-8. Beser OF, Cokugras FC, Erkan T, Kutlu T, Yagci RV, Ertem D, et al. Evaluation of malnutrition development risk in hospitalized children. Nutrition. 2018 Apr 1;48:40-7. McCarthy A, Delvin E, Marcil V, Belanger V, Marchand V, Boctor D, et al. Prevalence of malnutrition in pediatric hospitals in developed and in-transition countries: the impact of hospital practices. Nutrients. 2019 Jan 22;11(2):236. Srzić I, Adam VN, Pejak DT. Sepsis definition: What’s new in the treatment guidelines. Acta clinica croatica. 2022 Jun;61(Suppl 1):67. Burgos R, Sarto B, Elío I, Planas M, Forga M, Cantón A, et al. Prevalence of malnutrition and its etiological factors in hospitals. Nutricion hospitalaria. 2012 Mar 1;27(2). Ge KY, Chang SY. Definition and measurement of child malnutrition. Biomedical and environmental sciences: BES. 2001 Dec 1;14(4):283-91. Delgado AF, Okay TS, Leone C, Nichols B, Del Negro GM, Vaz FA. Hospital malnutrition and inflammatory response in critically ill children and adolescents admitted to a tertiary intensive care unit. Clinics. 2008 Jun 1;63(3):357-62. Teka SG, Kebede RA, Sherman C. The prevalence of malnutrition during admission to the pediatric intensive care unit, a retrospective cross-sectional study at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia. Pan African Medical Journal. 2022 Jan 27;41(1). Abera EG, Sime H. The prevalence of malnutrition among critically ill children: a systematic review and meta-analysis. BMC pediatrics. 2023 Nov 21;23(1):583. Bagri NK, Jose B, Shah SK, Bhutia TD, Kabra SK, Lodha R. Impact of malnutrition on the outcome of critically ill children. The Indian Journal of Pediatrics. 2015 Jul;82:601-5. Dipasquale V, Cucinotta U, Romano C. Acute malnutrition in children: pathophysiology, clinical effects and treatment. Nutrients. 2020 Aug 12;12(8):2413. Agarwal E, Ferguson M, Banks M, Batterham M, Bauer J, Capra S, Isenring E. Malnutrition and poor food intake are associated with prolonged hospital stay, frequent readmissions, and greater in-hospital mortality: results from the Nutrition Care Day Survey 2010. Clinical nutrition. 2013 Oct 1;32(5):737-45. Englert JA, Rogers AJ. Metabolism, metabolomics, and nutritional support of patients with sepsis. Clinics in chest medicine. 2016 Jun 1;37(2):321-31. Scrimshaw NS. Historical concepts of interactions, synergism and antagonism between nutrition and infection. The Journal of nutrition. 2003 Jan 1;133(1):316S-21S. de Souza Menezes F, Leite HP, Nogueira PC. Malnutrition as an independent predictor of clinical outcome in critically ill children. Nutrition. 2012 Mar 1;28(3):267-70. Irving SY, Daly B, Verger J, Typpo KV, Brown AM, Hanlon A, et al. The association of nutrition status expressed as body mass index z score with outcomes in children with severe sepsis: a secondary analysis from the sepsis prevalence, outcomes, and therapies (SPROUT) study. Critical care medicine. 2018 Nov 1;46(11):e1029-39. Krawinkel MB. Interaction of nutrition and infections globally: an overview. Annals of Nutrition and Metabolism. 2013 Jan 1;61(Suppl. 1):39-45. Patterson GT, Manthi D, Osuna F, Muia A, Olack B, Mbuchi M, et al. Environmental, metabolic, and inflammatory factors converge in the pathogenesis of moderate acute malnutrition in children: an observational cohort study. The American Journal of Tropical Medicine and Hygiene. 2021 May;104(5):1877. Alaaraj N, Soliman A, Rogol AD. Growth of malnourished infants and children: how is inflammation involved?. Expert Review of Endocrinology & Metabolism. 2021 Sep 3;16(5):213-6. Wen B, Njunge JM, Bourdon C, Gonzales GB, Gichuki BM, Lee D, et al. Systemic inflammation and metabolic disturbances underlie inpatient mortality among ill children with severe malnutrition. Science advances. 2022 Feb 16;8(7):eabj6779.