Pediatric ICU and Nutritional Assessments

  • Rubens Feferbaum
  • Patrícia Zamberlan
Living reference work entry


The nutritional assessment of children in the pediatric intensive care unit (PICU) is unique in view of the metabolic changes of the underlying disease. The presence of inflammatory activity leads to body composition changes (lean mass reduction) and undernutrition. Nutritional assessment is one of the main aspects of the pediatric intensive care patient and is the most important tool to avoid hospital undernutrition. It must prioritize anthropometric and laboratory markers that can differentiate body composition to detect specific macronutrient and micronutrient deficiencies and assessment of the inflammatory activity. There is currently no gold standard for nutritional assessment in the PICU. The results of anthropometric and laboratory markers must be jointly analyzed but individually interpreted according to disease and metabolic changes, in order to reach a correct diagnosis of the nutritional status and to plan and monitor the nutritional treatment.


Body Composition Nutritional Status Pediatric Intensive Care Unit Nutritional Assessment Anthropometric Index 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

List of Abbreviations


American Academy of Pediatrics


Arm circumference


Arm fat area


Appropriate for gestational age


Arm muscle area


Arachidonic acid


Body mass index for age


Docosahexaenoic acid


Dietary Reference Intakes


Extremely low birth weight


European Society of Parenteral and Enteral Nutrition


European Society for Paediatric Gastroenterology, Hepatology and Nutrition


Food and Agriculture Organization


Gestational age




Height for age


Head circumference


Intensive care unit




Low birth weight


Mid-upper arm circumference


Pediatric intensive care unit


Small for gestational age


Triceps skinfold thickness


Very low birth weight




Weight for age


Weight for height


Weight birth


World Health Organization


Score Z


  1. Agostoni C, Axelsson I, Colomb V, et al. The need of nutritional support teams in pediatric units. A commentary by the ESPGHAN Committee on Nutrition. J Pediatr Gastroenterol Nutr. 2005;41:8–11.PubMedCrossRefGoogle Scholar
  2. Agostoni C, Buonocore G, Carnielli VP, et al. Enteral nutrient supply for preterm infants: commentary from the European Society for Paediatric Gastroenterology, Hepatology, and Nutrition Committee on Nutrition. J Pediatr Gastroenterol Nutr. 2010;50:85–91.PubMedCrossRefGoogle Scholar
  3. Alexander GR, Himes JH, Kaufman RB, et al. A United States national reference for fetal growth. Obstet Gynecol. 1996;87:163–8.PubMedCrossRefGoogle Scholar
  4. Azevedo ZMA, Silva DR, Dutra MVP, et al. Bioimpedance analysis, reactance and resistance in nutritional support and intensive care. Rev Bras Ter Intensiva. 2007;19:297–303.PubMedCrossRefGoogle Scholar
  5. Battaglia FC, Lubchenco LO. A practical classification of newborn infants by weight and gestational age. J Pediatr. 1967;71:159–63.PubMedCrossRefGoogle Scholar
  6. Bettler J, Roberts KE. Nutrition assessment of the critically ill child. AACN Clin Issues. 2000;11:498–506.PubMedCrossRefGoogle Scholar
  7. Bott L, Beghin L, Gondon E, et al. Body composition in children with bronchopulmonary dysplasia predicted from bioelectric impedance and anthropometric variables: comparison with a reference dual X-ray absorptiometry. Clin Nutr. 2006;25:810–5.PubMedCrossRefGoogle Scholar
  8. Carney LN, Blair J. Assessment of nutrition status by age and determining nutrient needs. In: Corkins MR, editor. The ASPEN pediatric nutrition support core curriculum. Silver Spring: American Society for Parenteral and Enteral Nutrition; 2010. p. 433–47.Google Scholar
  9. Chioléro R, Revelly JP, Tappy L. Energy metabolism in sepsis and injury. Nutrition. 1997;13:45S–51.PubMedCrossRefGoogle Scholar
  10. Chumlea WC, Guo SS, Steinbaugh ML. Prediction of stature from knee height for black and white adults and children with application to mobility-impaired or handicapped persons. J Am Diet Assoc. 1994;94:1385–91.PubMedCrossRefGoogle Scholar
  11. Coss-Bu JA, Klish WJ, Walding D, et al. Energy metabolism, nitrogen balance, and substrate utilization in critically ill children. Am J Clin Nutr. 2001;74:664–9.PubMedGoogle Scholar
  12. Delgado AF, Okay TS, Leone C, et al. Hospital malnutrition and inflammatory response in critically ill children and adolescents admitted to a tertiary intensive care unit. Clinics. 2008;63:357–62.PubMedCentralPubMedCrossRefGoogle Scholar
  13. Desport JC, Marin B, Funalot B, et al. Phase angle is a prognostic factor for survival in amyotrophic lateral sclerosis. Amyotroph Lateral Scler. 2008;9:273–8.PubMedCrossRefGoogle Scholar
  14. Dietary Reference Intakes (DRI). In: Food and nutrition information center. Institute of Medicine’s Food and Nutrition Board. 2010. Accessed 25 Jul 2013.
  15. Faulhaber D. Nutrition assessment of infants and children. In: Nevin-Folino N, editor. Pediatric manual of clinical dietetics. 2nd ed. Chicago: Pediatric Nutrition Practice Group; 2003. p. 145–62.Google Scholar
  16. Feferbaum R, Delgado AF, Zamberlan P, et al. Challenges of nutritional assessment in pediatric ICU. Curr Opin Clin Nutr Metab Care. 2009;12:245–50.PubMedCrossRefGoogle Scholar
  17. Feferbaum R, Leone C, Siqueira AA, et al. Rest energy expenditure is decreased during the acute as compared to the recovery phase of sepsis in newborns. Nutr Metab (Lond). 2010;7:63.CrossRefGoogle Scholar
  18. Fomon SJ, Haschke F, Ziegler EE, et al. Body composition of reference children from birth to age 10 years. Am J Clin Nutr. 1982;35:1169–75.PubMedGoogle Scholar
  19. Frisancho AR. Anthropometric standards for the assessment of growth and nutritional status. Ann Arbor: University Michigan Press; 1999.Google Scholar
  20. Holliday MA, Segar WE. The maintenance need for water in parenteral fluid therapy. Pediatrics. 1957;19:823–32.PubMedGoogle Scholar
  21. Huang YC, Yen CE, Cheng CH, et al. Nutritional status of mechanically ventilated critically ill patients: comparison of different types of nutritional support. Clin Nutr. 2000;19:101–7.PubMedCrossRefGoogle Scholar
  22. Hulst J, Joosten K, Zimmermann L, et al. Malnutrition in critically ill children: from admission to 6 months after discharge. Clin Nutr. 2004;23:223–32.PubMedCrossRefGoogle Scholar
  23. Kleinman RE, editor. Pediatric nutrition handbook. 6th ed. Elk Grove Village: American Academy of Pediatrics; 2009. p. 79–112. Nutritional needs of the preterm infant.Google Scholar
  24. Lavery GG, Glover P. The metabolic and nutritional response to critical illness. Curr Opin Crit Care. 2000;6:233–8.PubMedCrossRefGoogle Scholar
  25. Lee SY, Gallagher D. Assessment methods in human body composition. Curr Opin Clin Nutr Metab Care. 2008;11:566–72.PubMedCentralPubMedCrossRefGoogle Scholar
  26. Lochs H, Allison SP, Meier R, et al. Introductory to the ESPEN guidelines on enteral nutrition: terminology, definitions and general topics. Clin Nutr. 2006;25:180–6.PubMedCrossRefGoogle Scholar
  27. Lyoumi S, Tamion F, Petit J, et al. Induction and modulation of acute-phase response by protein malnutrition in rats: comparative effect of systemic and localized inflammation on interleukin-6 and acute-phase protein synthesis. J Nutr. 1998;128:166–74.PubMedGoogle Scholar
  28. Máttar JA. Association between phase angle, PRISM I and sepsis severity. Rev Metab Nutr. 1995;2:58–62.Google Scholar
  29. Melchior JC, Niyngabo T, Henzel D, et al. Malnutrition and wasting, immunodepression, and chronic inflammation as independent predictors of survival in HIV-infected patients. Nutrition. 1999;15:865–9.PubMedCrossRefGoogle Scholar
  30. Messer J, Eyer D, Donato L, et al. Evaluation of interleukin-6 and soluble receptors of tumor necrosis factor for early diagnosis of neonatal infection. J Pediatr. 1996;129:574–80.PubMedCrossRefGoogle Scholar
  31. Metha NM, Compher C. ASPEN Board of Directors. Clinical guidelines: nutrition support of the critically ill child. JPEN J Parenter Enteral Nutr. 2009;33:260–76.CrossRefGoogle Scholar
  32. Michaelsen KF. Child growth. In: Koletzko B, editor. Pediatric nutrition in practice. Basel: Karger; 2008. p. 1–5.CrossRefGoogle Scholar
  33. Onis M, Yip R, Mei Z. The development of PMB-for-age reference data recommended by a WHO Expert Committee. Bull WHO. 1997;75:11–8.PubMedCentralPubMedGoogle Scholar
  34. Pawellek I, Dokoupil K, Koletzko B. Prevalence of malnutrition in paediatric hospital patients. Clin Nutr. 2008;27:72–6.PubMedCrossRefGoogle Scholar
  35. Pietrobelli A, Andreoli A, Cervelli V, et al. Predicting fat-free mass (FFM) in children using bioimpedance analysis. Acta Diabetol. 2003;40 Suppl 1:212–5.CrossRefGoogle Scholar
  36. Puntis JWL. Nutritional assessment clinical evaluation and anthropometry. In: Koletzko B, editor. Pediatric nutrition in practice. Basel: Karger; 2008. p. 6–12.CrossRefGoogle Scholar
  37. Ravasco P, Camilo ME, Gouveia-Oliveira A, et al. A critical approach to nutritional assessment in critically ill patients. Clin Nutr. 2002;21:73–7.PubMedCrossRefGoogle Scholar
  38. Sauerwein RW, Mulder JA, Mulder L, et al. Inflammatory mediators in children with protein-energy malnutrition. Am J Clin Nutr. 1997;65:1534–9.PubMedGoogle Scholar
  39. Schofield WN. Predicting basal metabolism rate, new standards and review of previous work. Hum Nutr Clin Nutr. 1985;39(Supl1):5–41.PubMedGoogle Scholar
  40. Slone DS. Nutritional support of the critically ill and injured patient. Crit Care Clin. 2004;20:135–57.PubMedCrossRefGoogle Scholar
  41. Soeters PB, Reijven PLM, van der Schueren MAEB, et al. A rational approach to nutritional assessment. Clin Nutr. 2008;27:706–16.PubMedCrossRefGoogle Scholar
  42. Sungurtekin H, Sungurtekin U, Oner O, et al. Nutrition assessment in critically ill patients. Nutr Clin Pract. 2008;23:635–41.PubMedCrossRefGoogle Scholar
  43. Wells JCK, Fewtrell MS. Measuring body composition. Arch Dis Child. 2006;91:612–7.PubMedCentralPubMedCrossRefGoogle Scholar
  44. WHO growth charts. In: The WHO child growth standards. World Health Organization. 2006. Accessed 27 Jul 2013.
  45. WHO growth charts. In: The WHO child growth standards. World Health Organization. 2007. Accessed 27 Jul 2013.
  46. WHO. Energy and protein requirements. Report of a joint FAO/WHO/UNU expert consultation. Geneva: World Health Organization; 1985. Technical Report Series 724.Google Scholar
  47. WHO. Physical status: the use and interpretation of anthropometry. Report of a WHO Expert Committee. Geneva: World Health Organization; 1995. WHO Technical Report Series 854.Google Scholar
  48. Wright CM, Sherriff A, Ward SC, et al. Development of bioelectrical impedance-derived indices of fat and fat-free mass for assessment of nutritional status in childhood. Eur J Clin Nutr. 2008;62:210–7.PubMedCrossRefGoogle Scholar
  49. Zamberlan P, Delgado AF, Leone C, et al. Nutrition therapy in a pediatric intensive care unit: indications, monitoring, and complications. JPEN J Parenter Enteral Nutr. 2011;35:523–9.PubMedCrossRefGoogle Scholar
  50. Zemel BS, Riley EM, Stallings VA. Evaluation of methodology for nutritional assessment in children: anthropometry, body composition, and energy expenditure. Annu Rev Nutr. 1997;17:211–35.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  1. 1.Division of Neonatology, Department of PediatricsUniversidade de Sao PauloSao PauloBrazil
  2. 2.Division of NutritionNutritional Team of Instituto da Criança do Hospital das Clínicas da Faculdade de Medicina da Universidade de São PauloSao PauloBrazil

Personalised recommendations