Protein/Energy Debt in Critically Ill Children in the Pediatric Intensive Care Unit: Acute Kidney Injury As a Major Risk Factor

Background: Acute kidney injury is a common problem highly associated with hospitalization. Acute Kidney Injury (AKI) is associated with severe morbidity and mortality especially in children. Lack of consensus definition has been major limitation in improving outcomes. This study tries to address the need of limited data on pediatric AKI. Detection of the incidence, etiological profile and outcome of AKI is important for the initiation of preventive and therapeutic strategies, identifying patients early to avoid renal replacement therapy.Methods: This prospective observational study was conducted in the pediatric intensive care unit (PICU) of tertiary hospital (GMC Srinagar) between January 2015 to December 2016.This is the only prospective study conducted in this hospital, all other studies conducted here and other higher centers were retrospective. Serum creatinine level was estimated on all patients on admission and alternate days till discharge from Pediatric Intensive Care Unit (PICU). Urine output was recorded. Estimated Creatinine- Clearance (eCrCL) was calculated using Schwartz formula. AKI diagnosis and staging was based on pRIFLE (pediatric RIFLE) criteria. eCrCl criteria was used to diagnose and stage AKI. Maximal stage that the patient progressed during the stay in PICU was assigned the stage for that case.Results: Of total 500 cases, 480 cases met inclusion criteria. Of them, the incidence of AKI was 154 (32.1%). Stage ‘Risk (R)’, ‘Injury (I)’ and ‘Failure (F)’ constituted 93(60.38%), 46 (29.8%) and15 (9.74%) respectively. Maximum AKI occurred in <1 year (30.5%). Infections were commonest etiology. Amongst infections sepsis (30.5%) was most common, followed by acute gastroenteritis (20.7%) and pneumonia (16.9%). Hypotension, nephrotoxic drugs, sepsis, need for mechanical ventilation were significant (p<0.001) risk factors for AKI. Pre-renal causes constituted 68% and intrinsic renal 32%.Conclusions: The incidence of AKI is high among critically ill children. AKI continues to be associated with adverse outcomes. pRIFLE staging system provides early identification and stratification of AKI. Infections are leading etiology of AKI in children.

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A Study of Acute Kidney Injury in a Tertiary Care Pediatric Intensive Care Unit

Journal of Pediatric Intensive Care ◽

10.1055/s-0040-1716577 ◽

2020 ◽

Author(s):

Akanksha C. Parikh ◽

Milind S. Tullu

Keyword(s):

Risk Factors ◽

Intensive Care Unit ◽

Acute Kidney Injury ◽

Intensive Care ◽

Hospital Stay ◽

Pediatric Intensive Care Unit ◽

Tertiary Care ◽

Kidney Injury ◽

Pediatric Intensive Care ◽

Critically Ill Children

AbstractThe objective of this study was to calculate the incidence, severity, and risk factors for acute kidney injury (AKI) in a tertiary care pediatric intensive care unit (PICU). Also, to assess the impact of AKI and its varying severity on mortality and length of hospital and PICU stays. A prospective observational study was performed in children between 1 month and 12 years of age admitted to the PICU between July 1, 2013, and July 31, 2014 (13 months). The change in creatinine clearance was considered to diagnose and stage AKI according to pediatric risk, injury, failure, loss, and end-stage renal disease criteria. The risk factors for AKI and its impact on PICU stay, hospital stay, and mortality were evaluated. Of the total 220 patients enrolled in the study, 161 (73.2%) developed AKI, and 59 cases without AKI served as the “no AKI” (control) group. Majority (57.1%) of children with AKI had Failure grade of AKI, whereas 26.1% had Risk grade and 16.8% had Injury grade of AKI. Infancy (p = 0.000), hypovolemia (p = 0.005), shock (p = 0.008), and sepsis (p = 0.022) were found to be significant risk factors for AKI. Mortality, PICU stay, and hospital stay were comparable in children with and without AKI as well as between the various grades of renal injury (i.e., Failure, Risk, and Injury). An exceedingly high incidence of AKI, especially of the severe Failure grade was observed in critically ill children. Infancy and frequent PICU occurrences such as sepsis, hypovolemia, and shock predisposed to AKI.

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Profile and outcome of acute kidney injury in critically ill children admitted to pediatric intensive care unit

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20184262 ◽

2018 ◽

Vol 5 (6) ◽

pp. 2148

Author(s):

Urmila Chauhan ◽

Yogesh Phirke ◽

Sandeep Golhar ◽

Abhishek Madhura

Keyword(s):

Intensive Care Unit ◽

Mechanical Ventilation ◽

Acute Kidney Injury ◽

Intensive Care ◽

Serum Creatinine ◽

Critically Ill ◽

Kidney Injury ◽

Pediatric Intensive Care ◽

Critically Ill Children ◽

Nephrotoxic Drugs

Background: Acute kidney injury (AKI) is defined as an abrupt onset of renal dysfunction resulting from injurious endogenous or exogenous processes characterized by a decrease in glomerular filtration rate (GFR) and an increase in serum creatinine. AKI is common in critically ill children and early diagnosis is important for better outcome in these children.Methods: This was a prospective observational study. Critically ill infants and children of either sex and in age group between >28 days to 12 years admitted to pediatric intensive care unit (PICU) were included. Serum creatinine and estimated creatinine clearance (eCC) were used to and patients classified as AKI on pRIFLE criteria either at admission or subsequently during the hospital stay. AKI cases were further classified into risk, injury or failure category on the day of development of AKI and the maximum pRIFLE stage reached during PICU stay was noted. Detailed data regarding the treatment received and use of nephrotoxic drugs, inotropic support, mechanical ventilation, dialysis and total length of stay in PICU in all was noted. Outcome of the subjects were observed for survival or mortality.Results: Total 343 subjects were enrolled in the study. During the study 27.1% patients developed AKI according to pRIFLE staging. In AKI category 60.21% reached maximum risk category, 21.5% reached maximum injury category, 18.28% reached maximum failure category. Amongst AKI subjects 64.52% had infectious etiology. Multiorgan dysfunction, encephalopathy, shock, metabolic acidosis, hypertension, mechanical ventilation and nephrotoxic drugs administration were more associated with AKI and was statistically significant.Conclusions: Pediatric modification of RIFLE criteria is sensitive index to detect AKI at earliest in critically ill children for early intervention leading to better outcome.

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Use of body composition and phase angle analysis for the assessment of nutritional status and clinical outcomes in critically ill children

10.21203/rs.3.rs-923773/v1 ◽

2021 ◽

Author(s):

Zi-Hong Xiong ◽

Xue-Mei Zheng ◽

Guo-Ying Zhang ◽

Meng-Jun Wu ◽

Yi Qu

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Nutritional Status ◽

Clinical Outcomes ◽

Critically Ill ◽

Pediatric Intensive Care Unit ◽

Phase Angle ◽

Pediatric Intensive Care ◽

Critically Ill Children ◽

Duration Time

Abstract BackgroundMalnutrition is highly prevalent in critically ill children in the pediatric intensive care unit .We aimed to investigate the efficiency of bioelectrical impedance analysis (BIA) measurements and phase angle (PhA) analysis for the assessment of nutritional risk and clinical outcomes in critically ill children.MethodsThis single-center observational study included patients admitted to the Pediatric Intensive Care Unit (PICU) of Chengdu Women’s and Children’s Central Hospital. All patients underwent anthropometric measurement in the first 24 h of admission and underwent BIA measurements within 3 days after the admission. The patients were classified into different groups based on body mass index (BMI) for age. Electronic hospital medical records were reviewed to collect clinical data for each patient. All the obtained data were analyzed by the statistics method.ResultsThere were 204 patients enrolled in our study, of which 32.4% were diagnosed with malnutrition. We found that BMI, arm muscle circumference, fat mass, and %body fat were lower in the group with poorer nutritional status (P < 0.05). Evident differences in the score of the Pediatric Risk of Mortality and the duration of mechanical ventilation (MV) among the three groups with different nutritional statuses were observed (P < 0.05). Patients in the severely malnourished group had the longest duration of MV. In the MV groups, there were significant differences (P < 0.05) in albumin level, PhA, and extracellular water/total body water (ECW/TBW ratio). The ECW/TBW ratio and the time for PICU stay had a weak degree of correlation (Pearson correlation coefficient = 0.375). PhA showed a weak degree of correlation with the duration time of medical ventilation (coefficient of correlation = 0.398).ConclusionBIA can be considered an alternative way to assess nutritional status in critically ill children. ECW/TBW ratio and PhA were correlated with PICU stay and duration time of medical ventilation, respectively.

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