الفهرس 
Malnutrition in Critically Ill ChildrenOnly 14 pages are availabe for public view
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Abstract
Pediatric malnutrition is defined by the American Society of Parenteral and Enteral Nutrition (ASPEN) as an imbalance between nutrient requirements and intake, resulting in cumulative deficits of energy, protein, or micronutrients that may negatively affect growth, development, and other relevant outcomes. Hospital-acquired malnutrition (HAM) is described as a worsening of a patient’s nutrition status in comparison to their nutrition level at the time of admission.
Malnutrition is widespread in hospitalized children, yet it is underreported. Poor nutritional status (NS) at admission or deteriorating NS during hospitalization is known to have a negative impact on clinical outcomes and raise healthcare expenses.
Among developed countries, undernutrition is common in severely ill children admitted to pediatric intensive care units (PICUs). The reported prevalence of undernutrition at pediatric PICU admission ranges from 8.1 % to 71.7 %, although variances in nutritional indices, presence of chronic illness, age, and severity of critical illness should all considered.
Critically unwell children are also at risk of nutritional deterioration because of the disease and insufficient nutrient delivery. Weight, height, mid-upper arm circumference (MUAC), are currently employed as nutritional status markers in critically unwell children. Historically, serum proteins such as albumin and prealbumin (i.e. transthyretin) were widely applied by medics to assess patients’ nutritional status. Other markers explored include retinol-binding protein (RBP), transferrin, total cholesterol, and inflammatory markers such as C-reactive protein (CRP) and total lymphocyte count (TLC).
Prealbumin is a thyroid hormone transport protein that is produced by the liver and partially catabolized by the kidneys. Malnutrition is associated with serum prealbumin values less than 10 mg/dl. The use of prealbumin as a nutritional marker has been promoted, particularly during Refeeding.
A study by Quadros et al., had highlighted the diagnostic utility of serum prealbumin use in predicting weight loss among hospitalized children. They found that it may have some use in identifying and monitoring nutritional status, with moderately sensitive in predicting weight loss among hospitalized children.
The key advantage of prealbumin over albumin is that it has a shorter half-life (two to three days), making it a better monitor of acute nutritional alterations. Furthermore, in patients with protein-losing enteropathy, prealbumin was unaffected by intestinal protein losses.
There was a correlation between TLC <1200 cells/ mm3 and nutritional status in children. The low TLC as a component of routine complete blood counts is related to malnutrition so that the number of lymphocytes can be used as a parameter of nutritional status and to predict prognosis. TLC can be used as a predictor of the risk of hospital malnutrition in children hospitalized. it can be suggested to check the TLC in each sick child who was admitted to the hospital on the first day of treatment. The results of these tests can be applied to early identification of the possibility of malnutrition in the hospital in treated patients.
Malnutrition has been linked to an increased risk of death, a longer hospital length of stay (LOS), and an increase in hospital costs. However, the link between malnutrition and poor clinical outcomes in the PICU is less obvious. Nonetheless, because critically ill patients are frequently in an inflammatory state (which can greatly worsen nutrition status), the effects of malnutrition are likely to be amplified in the ICU. As a result, it is critical to investigate the relationship between malnutrition and ICU clinical outcomes.
Hospital malnutrition is an important risk factor to increase morbidity, length of stay, medical costs, and mortality in critically unwell children and adolescents. Malnutrition can cause severe immune dysfunction and predispose to infections. Disabilities can appear as a consequence of severe sarcopenia, and this is one of the most important sequels during admission at de pediatric intensive care unit (PICU). Furthermore, early detection of pediatric malnutrition and observation of NS worsening can lead to early and proper nutritional therapy, which may improve clinical outcomes.
The main purpose of this study is to identify role of serum pre-albumin in early detection of malnutrition in critically unwell children and its relation to prognosis and PICU outcomes.