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Theses

Évaluation nutritionnelle systémique de l’enfant en réanimation pédiatrique

Abstract : Malnutrition at pediatric Intensive care unit (PICU) admission is frequent and associated with impaired outcomes. However, most studies have focused solely on a static definition. A holistic approach would improve the description of malnutrition: this would include both a static and dynamic assessment of nutritional status, together with body composition assessment and with malnutrition classified based on its patho-physiology and etiology. This holistic assessment of malnutrition has been applied and examined in four observational studies which included critically ill children older than 36 gestational weeks (corrected age). These found that malnutrition was frequent at PICU admission (27.3%) and faltering growth prior to PICU admission was associated with an increased length of PICU stay (+3 days). Critically ill children present at admission with decreased plasma levels of 6 micro-nutrients (Selenium, Copper, Zinc, Vitamin C, E and beta-carotene) involved in anti-oxidative stress pathways. Nutritional status deterioration during PICU stay, and associated muscle mass loss occurred frequently and were intense. This early phenomenon was associated with extended length of PICU stay. A profound critical illness related metabolic shift leads to malnutrition as an adaptive process. However, malnutrition may also negatively impact on outcomes in this setting. These studies have led to a clearer understanding of the underlying patho-physiology. This, combined with a more systematic and holistic nutritional assessment, will enable implementation and assessment of nutritional strategies aiming to improve the functional outcome of critically ill children
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Frédéric Valla. Évaluation nutritionnelle systémique de l’enfant en réanimation pédiatrique. Santé. Université de Lyon, 2019. Français. ⟨NNT : 2019LYSE1281⟩. ⟨tel-02461367⟩

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