title: Nutritional Status Based on Body Mass Index Is Associated With Morbidity and Mortality in Mechanically Ventilated Critically Ill Children in the PICU.
abstract: OBJECTIVE
  To determine the influence of admission anthropometry on clinical outcomes in mechanically ventilated children in the PICU.
  
  
  METHODS
  Data from two multicenter cohort studies were compiled to examine the unique contribution of nutritional status, defined by body mass index z score, to 60-day mortality, hospital-acquired infections, length of hospital stay, and ventilator-free days, using multivariate analysis.
  
  
  METHODS
  Ninety PICUs from 16 countries with eight or more beds.
  
  
  METHODS
  Children aged 1 month to 18 years, admitted to each participating PICU and requiring mechanical ventilation for more than 48 hours.
  
  
  RESULTS
  Data from 1,622 eligible patients, 54.8% men and mean (SD) age 4.5 years (5.1), were analyzed. Subjects were classified as underweight (17.9%), normal weight (54.2%), overweight (14.5%), and obese (13.4%) based on body mass index z score at admission. After adjusting for severity of illness and site, the odds of 60-day mortality were higher in underweight (odds ratio, 1.53; p < 0.001) children. The odds of hospital-acquired infections were higher in underweight (odds ratio, 1.88; p = 0.008) and obese (odds ratio, 1.64; p < 0.001) children. Hazard ratios for hospital discharge were lower among underweight (hazard ratio, 0.71; p < 0.001) and obese (hazard ratio, 0.82; p = 0.04) children. Underweight was associated with 1.3 (p = 0.001) and 1.6 (p < 0.001) fewer ventilator-free days than normal weight and overweight, respectively.
  
  
  CONCLUSIONS
  Malnutrition is prevalent in mechanically ventilated children on admission to PICUs worldwide. Classification as underweight or obese was associated with higher risk of hospital-acquired infections and lower likelihood of hospital discharge. Underweight children had a higher risk of mortality and fewer ventilator-free days.
authors.affiliation: 1Center for Nutrition, Boston Children's Hospital, Harvard Medical School, Boston, MA. 2Department of Nutritional Sciences, Rutgers University School of Health Related Professions, Newark, NJ. 3Department of Interdisciplinary Studies, Rutgers University School of Health Related Professions, Newark, NJ. 4Clinical Evaluation Research Unit, Kingston General Hospital and Queen's University, Kingston, ON, Canada. 5Critical Care Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Boston, MA.
authors.forename: Lori J
authors.initials: LJ
authors.lastname: Bechard
authors.forename: Christopher
authors.initials: C
authors.lastname: Duggan
authors.forename: Riva
authors.initials: R
authors.lastname: Touger-Decker
authors.forename: J Scott
authors.initials: JS
authors.lastname: Parrott
authors.forename: Pamela
authors.initials: P
authors.lastname: Rothpletz-Puglia
authors.forename: Laura
authors.initials: L
authors.lastname: Byham-Gray
authors.forename: Daren
authors.initials: D
authors.lastname: Heyland
authors.forename: Nilesh M
authors.initials: NM
authors.lastname: Mehta
mesh_terms: D000293:Adolescent; D015992:Body Mass Index; D002648:Child; D002675:Child, Preschool; D016638:Critical Illness / Q000453:epidemiology* / Q000401:mortality; D003428:Cross Infection / Q000453:epidemiology; D005260:Female; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric / Q000706:statistics & numerical data*; D007902:Length of Stay; D008297:Male; D009752:Nutritional Status; D009765:Obesity / Q000453:epidemiology; D050177:Overweight / Q000453:epidemiology; D012121:Respiration, Artificial / Q000401:mortality / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013851:Thinness / Q000453:epidemiology