Background: Underweight children admitted to the pediatric intensive care unit (PICU) have a higher risk of mortality than normal-weight children. The authors hypothesized that subjective global nutrition assessment (SGNA) could identify malnutrition in the PICU and predict nutrition-associated morbidities. Methods: The authors prospectively evaluated the nutrition status of 150 children (aged 31 days to 5 years) admitted to the PICU with the use of SGNA and commonly used objective anthropometric and laboratory measurements. Each child was administered the SGNA by a dietitian while anthropometric measurements were performed by an independent assessor. To test interrater reproducibility, 76 children had SGNA performed by another dietitian. Occurrence of nutrition-associated complications was documented for 30 days after admission. Results: SGNA ratings of well nourished, moderately malnourished, or severely malnourished demonstrated moderate to strong correlation with several standard anthropometric measurements (P < .05). The laboratory markers did not demonstrate any correlation with SGNA. Interrater agreement showed moderate reliability (κ = 0.671). Length of stay, pediatric logistic organ dysfunction, and Pediatric Risk of Mortality III were not significantly different across the groups and did not correlate with SGNA.
GodayPSVermilyeaSKuhnEMOttoMMMikhailovTA. Admission anthropometric measures and outcomes in the pediatric intensive care unit (PICU). JPEN J Parenter Enteral Nutr. 2009;33:237-238.
2.
MehtaNMDugganCP. Nutritional deficiencies during critical illness. Pediatr Clin North Am. 2009;56(5):1143-1160.
3.
PawellekIDokoupilKKoletzkoB. Prevalence of malnutrition in paediatric hospital patients. Clin Nutr. 2008;27(1):72-76.
4.
RojratsirikulCSangkhathatSPatrapinyokulS. Application of subjective global assessment as a screening tool for malnutrition in pediatric surgical patients. J Med Assoc Thai. 2004;87(8):939-946.
5.
HulstJMvan GoudoeverJBZimmermannLJ. The effect of cumulative energy and protein deficiency on anthropometric parameters in a pediatric ICU population. Clin Nutr. 2004;23(6):1381-1389.
6.
Sermet-GaudelusIPoisson-SalomonASColombV. Simple pediatric nutritional risk score to identify children at risk of malnutrition. Am J Clin Nutr. 2000;72(1):64-70.
7.
VeselLBahlRMartinesJPennyMBhandariNKirkwoodB. Use of new World Health Organization child growth standards to assess how infant malnutrition relates to breastfeeding and mortality. Bull World Health Organ. 2010;88(1):39-48.
8.
GodayPKuhnESachdevaRMikhailovT. Does admission weight influence mortality and morbidity in the pediatric intensive care unit (PICU)?JPEN J Parenter Enteral Nutr. 2008;32:316-317.
9.
WhiteJGuenterPMaloneAJensenGSchofieldM. Consensus statement from the Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition: characteristics recommended for the identification and documentation of adult malnutrition (undernutrition). JPEN J Parenter Enteral Nutr. 2012;36(3):275-283.
10.
RogolADClarkPARoemmichJN. Growth and pubertal development in children and adolescents: effects of diet and physical activity. Am J Clin Nutr. 2000;72(2)(suppl):521S-528S.
11.
CorralesKUtterS. Growth failure. In: SamourPKingK, eds. Handbook of Pediatric Nutrition. 3rd ed.Sudbury, MA: Jones and Bartlett; 2005:391-406.
12.
American Academy of Pediatrics. Failure to thrive. In: Pediatric Nutrition Handbook. 6th ed.Elk Grove Village, IL: American Academy of Pediatrics; 2009:601-628.
13.
SentongoT. Growth assessment and monitoring. In: CorkinsM, ed. The A.S.P.E.N. Pediatric Nutrition Support Core Curriculum. Silver Spring, MD: American Society for Parenteral and Enteral Nutrition; 2010:143-161.
14.
LipmanTHenchKBenyiT. A multicenter randomised controlled trial of an intervention to improve the accuracy of linear growth measurement. Arch Dis Child. 2004;89:342-346.
15.
VossLBaileyBCummingKWilkinTBettsP. The reliability of height measurement (the Wessex Growth Study). Arch Dis Child. 1990;65:1340-1344.
16.
CresciG. Nutrition assessment and monitoring. In: ShikoraSMartindaleRSchwaitzbergS, eds. Nutritional Considerations in the Intensive Care Unit. Silver Spring, MD: American Society for Parenteral and Enteral Nutrition; 2002:21-30.
17.
O’ConnorJYoudeLSAllenJRHansonRMBaurLA. Outcomes of a nutrition audit in a tertiary paediatric hospital: implications for service improvement. J Paediatr Child Health. 2004;40(5-6):295-298.
18.
RogersEJGilbertsonHRHeineRGHenningR. Barriers to adequate nutrition in critically ill children. Nutrition. 2003;19(10):865-868.
19.
SleeperEJArizaAJBinnsHJ. Do hospitalized pediatric patients have weight and blood pressure concerns identified?J Pediatr. 2009;154(2):213-217.
20.
SeckerDJeejeebhoyK. Subjective global nutritional assessment for children. Am J Clin Nutr. 2007;85(4):1083-1089.
21.
Centers for Disease Control and Prevention. Using the CDC Growth Charts: accurately weighing and measuring: technique [electronic training module]. 2001. http://www.cdc.gov/growthcharts/. Accessed August 15, 2006.
FrisanchoA. Anthropometric Standards for the Assessment of Growth and Nutritional Status. Ann Arbor: University of Michigan Press; 1990.
24.
WHO Anthro [computer program]. Version 3.2.2. Geneva, Switzerland: World Health Organization; 2011.
25.
Centers for Disease Control and Prevention. Hematological and nutritional reference data for persons 6 months to 74 years of age: United States, 1976-80. Vital Health Stat11. 1982;232:1-173.
26.
HollowellJAssendelftOVGunterE. Hematological and iron-related analytes—reference data for persons aged 1 year and over: United States, 1988-94. Vital Health Stat11. 2005;(247):1-156.
27.
SeckerDJeejeebhoyK. How to perform subjective global nutritional assessment in children. J Acad Nutr Diet. 2012;112(3):424-431.
28.
GohVWakehamMBrazauskasRMikhailovTGodayP. Obesity is not associated with increased mortality and morbidity in critically ill children [published online ahead of print March28, 2012]. JPEN J Parenter Enteral Nutr. doi:10.1177/0148607112441801.
29.
HoranTCAndrusMDudeckMA. CDC/NHSN surveillance definition of health care–associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control. 2008;36(5):309-332.
30.
LandisJKochG. The measurement of observer agreement for categorical data. Biometrics. 1977;33(1):159-174.
31.
FeferbaumRDelgadoAFZamberlanPLeoneC. Challenges of nutritional assessment in pediatric ICU. Curr Opin Clin Nutr Metab Care. 2009;12(3):245-250.
32.
SeresDS. Surrogate nutrition markers, malnutrition, and adequacy of nutrition support. Nutr Clin Pract. 2005;20(3):308-313.
33.
LarkRKWilliamsCLStadlerD. Serum prealbumin and albumin concentrations do not reflect nutritional state in children with cerebral palsy. J Pediatr. 2005;147(5):695-697.
34.
RagusoCADupertuisYMPichardC. The role of visceral proteins in the nutritional assessment of intensive care unit patients. Curr Opin Clin Nutr Metab Care. 2003;6(2):211-216.
35.
FuhrmanMPCharneyPMuellerCM. Hepatic proteins and nutrition assessment. J Am Diet Assoc. 2004;104(8):1258-1264.
36.
PaganaKPaganaT. Blood studies. In: Mosby’s Manual of Diagnostic and Laboratory Tests. 2nd ed.St. Louis, MO: Mosby; 2002.
37.
MehtaNMCompherC. A.S.P.E.N. Clinical Guidelines: nutrition support of the critically ill child. JPEN J Parenter Enteral Nutr. 2009;33(3):260-276.
38.
ShizgalHMVasilevskyCAGardinerPFWangWZTuittDABrabantGV. Nutritional assessment and skeletal muscle function. Am J Clin Nutr. 1986;44(6):761-771.
39.
SrinivasanRAsselinJGildengorinGWiener-KronishJFloriHR. A prospective study of ventilator-associated pneumonia in children. Pediatrics. 2009;123(4):1108-1115.
40.
JeffriesHEMasonWBrewerM. Prevention of central venous catheter–associated bloodstream infections in pediatric intensive care units: a performance improvement collaborative. Infect Control Hosp Epidemiol. 2009;30(7):645-651.
41.
FieldstonESHallMSillsMR. Children’s hospitals do not acutely respond to high occupancy. Pediatrics. 2010;125(5):974-981.
42.
RotterTKinsmanLJamesE. Clinical pathways: effects on professional practice, patient outcomes, length of stay and hospital costs. Cochrane Database Syst Rev. 2010;(3):CD006632.
43.
HigginsTLMcGeeWTSteingrubJSRapoportJLemeshowSTeresD. Early indicators of prolonged intensive care unit stay: impact of illness severity, physician staffing, and pre-intensive care unit length of stay. Crit Care Med. 2003;31(1):45-51.
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
