TY - CHAP M1 - Book, Section TI - Nutritional Support of Critically ill Children in Resource-Limited Settings A1 - Singhi, Sunit A2 - Goday, Praveen S. A2 - Mehta, Nilesh M. PY - 2015 T2 - Pediatric Critical Care Nutrition AB - The provision of optimal nutrition may be challenging in developing countries due to a higher prevalence of malnutrition and scarcity of resources in the pediatric intensive care unit (PICU). Malnutrition affects nearly 50% of hospitalized children and 20% to 70% of critically ill children, more so in resource-limited countries.1 In a recent international multicenter cohort, over 30% of patients admitted to 31 PICUs had severe malnutrition on admission, with body mass index (BMI) Z-score >2 (13.2%) or <−2 (17.1%) on admission.2 Malnutrition was associated with greater length of ventilation, higher rate of complications, longer length of hospital stay and increased costs, and increased mortality.3,4 Furthermore, it is easy to underfeed critically ill children because of poor gut function, fasting for various surgical and nonsurgical procedures, and fluid constraints.5 Therefore, nutrition may deteriorate further in the hospital, and specifically in the PICU, with resultant poor outcomes, unless specific attention is paid to management of nutritional losses from drains, wound and skin losses, renal dysfunction, dialysis, etc. In the presence of preexisting malnutrition, children are much more susceptible to the deleterious effects of the protracted catabolic stress caused by critical illness. Compared to adults, children have significantly lower nutritional reserves and higher resting energy expenditure (REE) per unit body weight; the quantity of protein as a percentage of body weight, lipid stores, and carbohydrate reserves are reduced. The caloric and protein deficits accumulate quickly in critically ill children. While public health programs have focused on infant and child malnutrition in the general community, the deterioration of nutritional status in the hospital during critical illness is often neglected. SN - PB - McGraw-Hill Education CY - New York, NY Y2 - 2024/03/28 UR - accesspediatrics.mhmedical.com/content.aspx?aid=1105180019 ER -