Malnutrition Diagnoses and Burden Among Pediatric Critically Ill Patients: Results from an Academic Medical Center

Background: The contribution of nutrition to the health and economic outcomes of critically ill pediatric patients in developed countries is increasingly recognized, although the lack of standardized screening and diagnosis protocols across institutions remains an issue. Malnutrition in pediatric intensive care units (PICUs) when left unrecognized and untreated can lead to prolonged and costly hospitalizations. We examined malnutrition diagnosis rates and its burden by assessing clinical patient outcomes among a large cohort of critically ill pediatric patients at an academic medical center.

Methods: A retrospective analysis of 8,725 admissions of patients (mean age 6.2 ± 6.3) admitted to a PICU for acute, acute on chronic, or chronic illnesses from 2011 to 2019 was conducted. Patients were identified as malnourished if they had International Classification of Disease (ICD)-9 or ICD-10 diagnosis codes indicating malnutrition. Age, admitting diagnoses, number of comorbid diagnoses and clinical outcomes such as length of stay and readmissions of malnourished and not malnourished patients were assessed.

Results: 1,331 of 8,725 patient admissions (15.3%) had a malnutrition diagnosis during the sample period. Patients diagnosed with malnutrition had a lower mean age (5.8 vs 6.2 years, p =0.03) and had a greater number of comorbid diagnoses (14.0 vs 7.6, p<0.01) than patients with no malnutrition diagnosis. Diseases of the respiratory system were the most common primary admitting diagnoses for all patients regardless of nutrition status. Malnourished patients had significantly longer hospital stays (26.2 vs 11.5 days, p<0.01), and higher 30-day readmission rates (8.7% vs 5.5%, p<0.01).

Conclusion: A substantial number of PICU patients at a major academic medical center were diagnosed with malnutrition. However, additional efforts are needed to inform higher diagnosis rates since malnutrition risk prevalence among hospitalized pediatric patients in the United States is reported to be as high as 46% for patients with cardiac disease and even higher in patients with other chronic conditions. Malnourished patients were younger, had more secondary diagnoses, and poorer health outcomes including prolonged hospitalizations and higher 30-day readmission rates, which would result in turn in higher healthcare costs. These findings highlight the importance of optimizing malnutrition screening, diagnosis, and treatment protocols. Future research is also needed to examine the impact of malnutrition-focused quality improvement initiatives and nutrition interventions on improving the health and economic outcomes of critically ill pediatric patient populations.