Nutritional Status of Critically Ill Children in Pediatric Intensive Care Units at Sohag University Hospitals

Nutrition is one of the important factors which affect morbidity and mortality in critically ill patients in pediatric intensive care units (PICU). Adequate and balanced nutrition is required not only to support physical growth and basic metabolic needs, but also to ensure proper organ function and sustain daily activities. Nutritional status reflects the dynamic balance between nutrient availability, dietary intake, and the body's ability to absorb and utilize those nutrients in relation to an individual's specific needs. Critical illness triggers significant metabolic and endocrine changes which are characterized by catabolism, insulin resistance, stress hyperglycemia and shifts in substrate utilization. These changes closely interact with disruptions in the autonomic and immune systems. Critically ill infants and children may have an increased metabolic need, which predisposes them to nutritional deterioration and malnutrition during illness. The World Health Organization (WHO) defines malnutrition as " an acute or chronic nutritional status due to deficiency or excess energy, protein and micronutrient resulting in imbalance between nutrient intake and requirement that can negatively affect growth and development". Malnutrition in critically ill patients is associated with decreased respiratory function, higher rate of nosocomial infections, secondary immunodeficiency, prolonged mechanical ventilation and prolonged hospitalization. It is also related to delayed wound healing process, impairment in gastrointestinal functions, thus increased morbidity and mortality. The American and European Society of Parenteral and Enteral Nutrition guidelines recommend that nutritional status should be evaluated on admission to the PICU to identify children at risk and to provide nutrition support in the PICU. Enteral feeding approach has been preferred to be started within the first 24-48 hours after admission to the PICU, if there are no contraindications for enteral nutrition. Early initiation of enteral feeding have been associated with improved clinical outcomes as regard morbidity and mortality. Metabolic demands must be determined by calculating energy consumption. Malnutrition at PICU admission is frequent (15-25% prevalence rates) in developing countries. A study published in 2022 on the nutritional status of critically ill children in one Egyptian PICU found that malnutrition rate can be around 30%. However, the data on nutritional status in Egyptian PICUs is scarce especially in Upper Egypt. Therefore, assessment of nutritional status in our PICU can help in improving the outcome of critically ill children in terms of both morbidity and mortality.