title: Malnutrition as an independent predictor of clinical outcome in critically ill children.
abstract: OBJECTIVE
  To determine the nutritional status of a cohort of children admitted to a pediatric intensive care unit (ICU) and to assess the effect of malnutrition as an independent risk factor affecting outcome in this patient group.
  
  
  METHODS
  In a prospective cohort study, 385 children admitted to the ICU of a teaching hospital over a 2-y period were assessed for nutritional status at admission and clinical outcome. The outcome variables were 30-d mortality, length of ICU stay, and length of mechanical ventilation. Potential exposure variables were gender, age, diagnosis (clinical versus surgical), septic shock, malnutrition, and scores on the Pediatric Index of Mortality and Pediatric Logistic Organ Dysfunction. Nutritional status was determined using z scores of weight for age, height for age, and body mass index, based on the World Health Organization child growth standards. Patients with z score < -2 of anthropometric indexes were considered malnourished.
  
  
  RESULTS
  175 patients (45.5%) were malnourished on admission. Sixteen patients of the malnourished group (9.14%) and 25 patients (11.9%) of the non-malnourished group died. Malnutrition was associated with greater length of mechanical ventilation and length of ICU stay, but not with mortality on univariate analysis. Malnutrition was associated with greater length of ventilation on the multiple logistic regression model (OR 1.76, 95%; CI 1.08-2.88; P = 0.024).
  
  
  CONCLUSIONS
  Malnutrition is common among children admitted to an ICU. This factor was not a predictor of mortality but showed independent association with length of mechanical ventilation.
authors.affiliation: Discipline of Nutrition and Metabolism, Department of Pediatrics of the Federal University of São Paulo, Sao Paulo, Brazil.
authors.forename: Fernanda
authors.initials: F
authors.lastname: de Souza Menezes
authors.forename: Heitor Pons
authors.initials: HP
authors.lastname: Leite
authors.forename: Paulo Cesar
authors.initials: PC
authors.lastname: Koch Nogueira
mesh_terms: D002675:Child, Preschool; D002908:Chronic Disease; D016638:Critical Illness / Q000401:mortality*; D005260:Female; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D044342:Malnutrition / Q000453:epidemiology*; D015596:Nutrition Assessment; D009752:Nutritional Status; D011446:Prospective Studies; D012121:Respiration, Artificial; D012307:Risk Factors; D012772:Shock, Septic / Q000453:epidemiology