The role of initial monitoring of routine biochemical nutritional markers in critically ill children.
OBJECTIVE
The objectives of this study were to determine whether abnormal values of routine laboratory parameters at admission predict outcome and changes in anthropometric parameters in critically ill children during intensive care unit (ICU) stay and to discuss the clinical implications of abnormalities.


METHODS
This is a prospective descriptive study in a tertiary multidisciplinary pediatric ICU. Serum urea, albumin, triglycerides and magnesium were measured in samples obtained from 105 children (age, 7 days-16 years) within the first 24 h after their admission. The prevalences of abnormalities in these parameters as well as their possible association with outcome (length of stay, days on mechanical ventilation) and changes in nutritional status (changes in S.D. scores for weight, mid upper arm circumference and calf circumference) between admission and discharge were assessed.


RESULTS
Prevalences of hypomagnesemia, hypertriglyceridemia, uremia and hypoalbuminemia were 20%, 25%, 30% and 52%, respectively, with no significant associations between the different disorders. Except for uremia, no significant association was found between abnormalities in biochemical parameters and changes in S.D. scores of anthropometric measurements. Children with uremia showed larger declines in S.D. scores for weight and arm circumference between admission and discharge than children without uremia did. Children with hypertriglyceridemia had longer ventilator dependence (P<.01) and length of stay (P<.001) than children with normal triglyceride levels upon admission had.


CONCLUSIONS
Abnormalities in routine nutritional laboratory parameters were frequently noted in critically ill children at admission. Detection of abnormalities was not predictive of changes in anthropometric parameters during ICU admission but can be important in individualizing nutritional support.
Hulst
Jessie M
JM
Department of Pediatric Surgery, Erasmus MC, Sophia Children's Hospital, 3000 CB, Rotterdam, The Netherlands.
van Goudoever
Johannes B
JB
Zimmermann
Luc J I
LJ
Tibboel
Dick
D
Joosten
Koen F M
KF
D000293:Adolescent; D015415:Biomarkers / Q000032:analysis / Q000097:blood; D001774:Blood Chemical Analysis; D001835:Body Weight; D002648:Child; D002675:Child, Preschool; D003422:Critical Care; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric; D007902:Length of Stay; D008297:Male; D015596:Nutrition Assessment; D009752:Nutritional Status; D011379:Prognosis; D012720:Severity of Illness Index; D016896:Treatment Outcome
D015415:Biomarkers