Sharma Kamal, Raszynski Andre, Totapally Balagangadhar R
Department of Pediatric Critical Care Medicine and Children's and Women's Hospital, University of South Alabama, Mobile, AL, USA.
Division of Critical Care Medicine, Nicklaus Children's Hospital, Miami, FL, USA.
SAGE Open Med. 2019 Jan 22;7:2050312119825509. doi: 10.1177/2050312119825509. eCollection 2019.
Obesity is associated with poor health outcomes but may be protective in intensive care unit patients. The objective of this study is to describe the characteristics of underweight, normal weight, and obese children, and to compare their length of stay, resource utilization, and mortality.
The charts of 1447 patients who were admitted to a tertiary-level pediatric intensive care unit during 1 calendar year were reviewed. Patients were divided into three groups: underweight (<5th percentile), normal (5th-95th percentiles), and obese (>95th percentile). Body mass index for age percentile was used for children older than age 2 years, and weight-for-height percentile was used for children younger than age 2 years. Demographic data, Pediatric Index of Mortality 2 score, Pediatric Index of Mortality 2 risk of mortality, hospital mortality, hospital length of stay, the use and duration of ventilator support, hemodynamic support, and dialysis were determined.
Fifteen percent of children were underweight, while 61.5% were normal weight and 23.5% were obese; 54.9% of the patients were male. The overall mortality was 1.87%, with no significant difference between the three weight groups. The racial distribution, prevalence, and duration of invasive and noninvasive ventilation, and the use of vasopressors, central venous lines, and dialysis were similar between three groups. Tube feeding and parenteral nutrition were used more often in the underweight group. Pediatric intensive care unit and hospital lengths of stays were higher in underweight children. Underweight children were younger when compared to normal or obese children. Pediatric Index of Mortality 2 scores and Pediatric Index of Mortality 2 risk of mortality scores were higher in underweight children.
There were no significant differences between the three weight groups in mortality. Underweight children were younger and sicker, and received tube feeding and parenteral nutrition more frequently.
肥胖与不良健康结局相关，但在重症监护病房患者中可能具有保护作用。本研究的目的是描述体重过轻、体重正常和肥胖儿童的特征，并比较他们的住院时间、资源利用情况和死亡率。
回顾了在一个日历年内入住三级儿科重症监护病房的1447例患者的病历。患者分为三组：体重过轻（低于第5百分位数）、正常（第5 - 95百分位数）和肥胖（高于第95百分位数）。2岁以上儿童使用年龄别体重指数百分位数，2岁以下儿童使用身高别体重百分位数。确定人口统计学数据、儿童死亡率指数2评分、儿童死亡率指数2死亡风险、医院死亡率、住院时间、呼吸机支持的使用和持续时间、血流动力学支持以及透析情况。
15%的儿童体重过轻，61.5%体重正常，23.5%肥胖；54.9%的患者为男性。总体死亡率为1.87%，三组体重组之间无显著差异。三组之间的种族分布、有创和无创通气的发生率及持续时间、血管升压药、中心静脉导管和透析的使用情况相似。体重过轻组更常使用管饲和肠外营养。体重过轻儿童的儿科重症监护病房和医院住院时间更长。与正常或肥胖儿童相比，体重过轻儿童年龄更小。体重过轻儿童的儿童死亡率指数2评分和儿童死亡率指数2死亡风险评分更高。
三组体重组在死亡率方面无显著差异。体重过轻的儿童年龄更小且病情更重，更频繁地接受管饲和肠外营养。
