title: Constipation in the Critically Ill Child: Frequency and Related Factors.
abstract: OBJECTIVE
  To analyze the incidence and factors associated with constipation in critically ill children.
  
  
  METHODS
  We performed a prospective observational study that included children admitted to the pediatric intensive care unit for more than 3 days. Constipation was defined as more than 3 days without a bowel movement. Relationships between constipation and demographic data; clinical severity score; use of mechanical ventilation, use of vasoconstrictors, sedatives, and muscle relaxants; nutritional data; electrolyte disturbances; and clinical course were analyzed.
  
  
  RESULTS
  Constipation developed in 46.7% of the 150 patients studied (mean age, 34.3 ± 7.1 months). It was most common in postoperative, older, and higher-body-weight patients, and in those with fecal continence (P < .01). Compared with patients without constipation, patients with constipation had higher severity scores and more frequently received midazolam, fentanyl, muscle relaxants, and inotropic support (P < .05). Patients with constipation also started nutrition later and with a lower volume of nutrition (P < .01). There were no between-group differences in mortality or length of pediatric intensive care unit stay. In multivariate analysis, independent factors associated with constipation were body weight (OR, 1.08; 95% CI, 1.03-1.13), Pediatric Index of Mortality 2 score (OR, 1.05; 95% CI, 1.02-1.09), admission after surgery (OR, 7.64; 95% CI, 2.56-22.81), and treatment with vasoconstrictors (OR, 10.28; 95% CI, 3.53-29.93).
  
  
  CONCLUSIONS
  Constipation is common in critically ill children. Body weight, Pediatric Index of Mortality 2 clinical severity score, admission after surgery, and the need for vasoconstrictor therapy are major independent risk factors associated with constipation.
authors.affiliation: Pediatric Intensive Care Department, Gregorio Marañón General University Hospital, Gregorio Marañón Health Research Institute, Mother-Child Health and Development Network of Carlos III Health Institute, Complutense University of Madrid, Madrid, Spain. Electronic address: dr_pyta@yahoo.es.
authors.forename: Jorge
authors.initials: J
authors.lastname: López
authors.affiliation: Pediatric Department, Nuevo Belén Madrid Hospital, Madrid, Spain.
authors.forename: Marta
authors.initials: M
authors.lastname: Botrán
authors.affiliation: Pediatric Department, Hospital Sur Alcorcón, Madrid, Spain.
authors.forename: Ana
authors.initials: A
authors.lastname: García
authors.affiliation: Pediatric Intensive Care Department, Gregorio Marañón General University Hospital, Gregorio Marañón Health Research Institute, Mother-Child Health and Development Network of Carlos III Health Institute, Complutense University of Madrid, Madrid, Spain.
authors.forename: Rafael
authors.initials: R
authors.lastname: González
authors.affiliation: Pediatric Intensive Care Department, Gregorio Marañón General University Hospital, Gregorio Marañón Health Research Institute, Mother-Child Health and Development Network of Carlos III Health Institute, Complutense University of Madrid, Madrid, Spain.
authors.forename: María J
authors.initials: MJ
authors.lastname: Solana
authors.affiliation: Pediatric Intensive Care Department, Gregorio Marañón General University Hospital, Gregorio Marañón Health Research Institute, Mother-Child Health and Development Network of Carlos III Health Institute, Complutense University of Madrid, Madrid, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Urbano
authors.affiliation: Pediatric Intensive Care Department, Gregorio Marañón General University Hospital, Gregorio Marañón Health Research Institute, Mother-Child Health and Development Network of Carlos III Health Institute, Complutense University of Madrid, Madrid, Spain.
authors.forename: Sarah N
authors.initials: SN
authors.lastname: Fernández
authors.affiliation: Pediatric Intensive Care Department, Gregorio Marañón General University Hospital, Gregorio Marañón Health Research Institute, Mother-Child Health and Development Network of Carlos III Health Institute, Complutense University of Madrid, Madrid, Spain.
authors.forename: César
authors.initials: C
authors.lastname: Sánchez
authors.affiliation: Pediatric Intensive Care Department, Gregorio Marañón General University Hospital, Gregorio Marañón Health Research Institute, Mother-Child Health and Development Network of Carlos III Health Institute, Complutense University of Madrid, Madrid, Spain.
authors.forename: Jesús
authors.initials: J
authors.lastname: López-Herce
mesh_terms: D001835:Body Weight; D002648:Child; D002675:Child, Preschool; D003248:Constipation / Q000209:etiology*; D016638:Critical Illness; D004573:Electrolytes; D005260:Female; D006760:Hospitalization; D006801:Humans; D006993:Hypnotics and Sedatives / Q000009:adverse effects; D007223:Infant; D015278:Intensive Care Units, Pediatric; D008297:Male; D009125:Muscle Relaxants, Central / Q000009:adverse effects; D011446:Prospective Studies; D012044:Regression Analysis; D012121:Respiration, Artificial / Q000009:adverse effects; D012307:Risk Factors; D014662:Vasoconstrictor Agents / Q000009:adverse effects
chemical_list: D004573:Electrolytes; D006993:Hypnotics and Sedatives; D009125:Muscle Relaxants, Central; D014662:Vasoconstrictor Agents