الفهرس 
Nutritional assessmentOnly 14 pages are availabe for public view
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Abstract
Nutritional support is important in critically ill patients, with variable energy and nitrogen
requirements according to their underlying diseases, as the metabolism of critically ill
infants and children is significantly influenced by the original illness .
Deli very of appropriate metabolic support begins with appropriate n utri ti onal assessment.
Assessment tools can also be used to monitor maintenance and improvemeat. So, the ideal
nutritional tool must be sensittve, specific, reproducible and relevant in illness and health .
So the aim of the present study was to assess the nutritional state of critically ill infants
and children in pediatric ICU of A in Shams University Hospital to find out the predictive n u tri
ti on al parameters for morbidity and mortality and to eva!uate our n utri ti onal supportive
measures aiming to provide better nutritional management o f those patients.
This study was conducted on 3 0 pati ents admitted in PICU of Ain Shams University Hospital in the
period from January 2000 to April 2000. Their age ranged from 1.5 months to 16 years with a mean
age of 34+30.7 month .
All patients were subjected to fu ll history
taking laying stress on the type of nutritional support
during ICU admission , therapy during ICU admission and fate of the patients .
The history followed by thorough clinical examination including measurement of different
anthropometric parameters (weight, weight % of predicted, mid arm circumference (MAC) , triceps
skin fold thickness (TSF) and using the Subjective Global Nutritional Assessment (SGNA) to assess
the nutritional status of the patients.
Indirect calorimetric assay for Vo 2 , VC0 2 , REE, RQ and REE% of predicted were performed using
Med Graphic Critical care system (CCM) .
Laboratory investigations were performed for CBC analysis, complete biochemical markers analysis
including total protein and album in level , then serum level of prealbumin was estimated using RID
plates . All these parameters were elicited at the time of ICU admission and one week later .
Ten of our 30 studied patients died with mortality rate 3 3 .3o/o. Eight patients were mechanically
ventilated out of the 30 studied patients.
All our patients received nutritional support. EN in 16 cases and PN in 14 cases . The
mortality rate within the group of PN was 71% , while within the group of EN was Zero.
A comparison between survivors and non survivors revealed that RQ, REE % of predict ed , V02 and
prealbumin are important nutritional markers that
can discriminate between the 2 groups. The age of the patients is another risk factor as the
younger the age, the more the liability to malnutrition and the worse the outcome.
When we compare between the group of mechanically ventilated patients and non mechanically
ventilated group we found out that indirect calorimetry is the only tool that can detect the
significant metabolic differences between the two groups. The group of mechanically ventilated
patients had significantly decreased RQ and increased REE% of predicted.
EN was proved to be better route than the PN , as the current study could elicit better
nutritional response in the group of EN than the group of PN. There was a statistically
significant difference in the
%change in most of the nutritional parameters towards the nutritional improvement in the EN group.
There was a significant correlation between the
% change of the prealbumin level and the duration of ICU admission which indicates that patients
with decrease of prealbumin level who developed acute malnutrition are more liable to complications
and therapy resistance .
There wa s also a significant correlation between the RQ and prealbumin level which indicates
that protein and calorie malnutrition usually accompany each other as PCM is one entity.
So we can conclude that bad nutritional status has bad impact on the outcome of the critically ill
patient , which makes nutritional assessment and nutritional support are obligations .
Also we have to consider infants, malnourished patients and mechanically ventilated patients as
high risk groups .