Nutritional Status as a Severity Predictor in Critical Pediatric Patients With COVID-19.

INTRODUCTION

Nutritional status plays an important part in the health of children and teenagers. It also has an impact on the clinical outcomes of disease situations. This paper's objective is to evaluate the impact of nutritional status in the clinical outcomes of critically ill children diagnosed with COVID-19.

METHODS

This is an observational, longitudinal, and multicentric study, developed between March 2020 and December 2021, in 36 Pediatric Intensive Care Units in Brazil. The patients included were between the ages of 1 month old and 18 years old, with the diagnosis of COVID-19, confirmed by RT-PCR, from nasopharyngeal and oropharyngeal swabs, tracheal aspirates, or blood serology for the detection of IgA/IgM/IgG antibodies. Nutritional status was evaluated based on the z-score of the body mass index for age (BMI/A), weight for age (W/A), and stature for age (S/A). The outcomes evaluated included final clinical diagnosis of respiratory syndromes, need for ventilatory support, prolonged length of hospital stay, and mortality. A model of regression linear analysis was used to evaluate the independent association with the nutritional status.

RESULTS

Four hundred and thirty-two patients were included in the study. The average age was 30 months (IQR, 11-85); 200 (46.3%) were under 24 months old, and 29 (6.7%) had comorbidities. There were 302 (69.9%) patients with average weight, 54 (12.5%) were underweight, 76 (17.6%) were overweight, and 44 (23%) had short stature. The underweight category presented independent association with the outcomes of Acute Respiratory Distress Syndrome (ARDS) (RR 2.12; 95% CI 1.01-4.46; p = 0.04), need for invasive mechanical ventilation (IMV) (RR 1.8; 95% CI 1.1-3.1; p = 0.02), prolonged length of stay (LOS) (RR 1.5; 95% CI 1.01-2.1, p = 0.03), and mortality (RR 8; 95% CI 1.9-36; p = 0.005).

CONCLUSION

Independent association was identified between low weight in children with COVID-19 in Pediatric Intensive Care Units and longer length of hospital stay, need for IMV, ARDS and higher risk of mortality.