title: Challenges of nutritional assessment in pediatric ICU.
abstract: OBJECTIVE
  The nutritional assessment of children in the pediatric ICU is unique in view of the metabolic changes of the underlying disease. This review addresses the use and limitations of anthropometry and laboratorial and body composition markers in the diagnosis of the nutritional status of such patients.
  
  
  RESULTS
  The presence of inflammatory activity leads to body composition changes (lean mass reduction) and undernutrition. Nutritional assessment in pediatric ICU must prioritize anthropometric and laboratory markers that can differentiate body composition to detect specific macronutrient and micronutrient deficiencies and assessment of the inflammatory activity.
  
  
  CONCLUSIONS
  Nutritional assessment is one of the main aspects of the pediatric intensive care patient and is the most important tool to avoid hospital undernutrition. There is currently no gold standard for nutritional assessment in the pediatric ICU. The results of anthropometric and laboratory markers must be jointly analyzed, but individually interpreted according to disease and metabolic changes, in order to reach a correct diagnosis of the nutritional status and to plan and monitor the nutritional treatment.
authors.affiliation: Division of Neonatology, Department of Pediatrics, Instituto da Criança, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, Brazil. rfeferbaum@uol.com.br
authors.forename: Rubens
authors.initials: R
authors.lastname: Feferbaum
authors.forename: Artur F
authors.initials: AF
authors.lastname: Delgado
authors.forename: Patrícia
authors.initials: P
authors.lastname: Zamberlan
authors.forename: Claudio
authors.initials: C
authors.lastname: Leone