• Lori J Bechard, Christopher Duggan, Riva Touger-Decker, J Scott Parrott, Pamela Rothpletz-Puglia, Laura Byham-Gray, Daren Heyland, and Nilesh M Mehta.
• 1Center for Nutrition, Boston Children's Hospital, Harvard Medical School, Boston, MA. 2Department of Nutritional Sciences, Rutgers University School of Health Related Professions, Newark, NJ. 3Department of Interdisciplinary Studies, Rutgers University School of Health Related Professions, Newark, NJ. 4Clinical Evaluation Research Unit, Kingston General Hospital and Queen's University, Kingston, ON, Canada. 5Critical Care Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Boston, MA.
• Crit. Care Med. 2016 Aug 1; 44 (8): 1530-7.

ObjectiveTo determine the influence of admission anthropometry on clinical outcomes in mechanically ventilated children in the PICU.DesignData from two multicenter cohort studies were compiled to examine the unique contribution of nutritional status, defined by body mass index z score, to 60-day mortality, hospital-acquired infections, length of hospital stay, and ventilator-free days, using multivariate analysis.SettingNinety PICUs from 16 countries with eight or more beds.PatientsChildren aged 1 month to 18 years, admitted to each participating PICU and requiring mechanical ventilation for more than 48 hours.Measurements And Main ResultsData from 1,622 eligible patients, 54.8% men and mean (SD) age 4.5 years (5.1), were analyzed. Subjects were classified as underweight (17.9%), normal weight (54.2%), overweight (14.5%), and obese (13.4%) based on body mass index z score at admission. After adjusting for severity of illness and site, the odds of 60-day mortality were higher in underweight (odds ratio, 1.53; p < 0.001) children. The odds of hospital-acquired infections were higher in underweight (odds ratio, 1.88; p = 0.008) and obese (odds ratio, 1.64; p < 0.001) children. Hazard ratios for hospital discharge were lower among underweight (hazard ratio, 0.71; p < 0.001) and obese (hazard ratio, 0.82; p = 0.04) children. Underweight was associated with 1.3 (p = 0.001) and 1.6 (p < 0.001) fewer ventilator-free days than normal weight and overweight, respectively.ConclusionsMalnutrition is prevalent in mechanically ventilated children on admission to PICUs worldwide. Classification as underweight or obese was associated with higher risk of hospital-acquired infections and lower likelihood of hospital discharge. Underweight children had a higher risk of mortality and fewer ventilator-free days.

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