The objective of nutritional support (NS) in critically ill pediatric patients is not only to maintain an adequate nutritional status, but also to modulate said metabolic and inflammatory response, optimize the benefits of the adaptive response to stress and, in the medium-long term, reduce the negative consequences that could arise from this response. (1)
The nutritional management of the child undergoing surgery is not a glamorous subject and rarely receives the attention it deserves, despite the growing evidence of a better postoperative evolution, with a favorable prognosis, associated with better and more specific nutritional support. (2)
The ASPEN 2009 guideline (1) recommended that when a critically ill child is admitted to the PICU, a nutritional risk screening be carried out that allows the early identification of those children who are at risk of malnutrition during the hospital stay and who would benefit from early nutritional interventions. The nutritional risk assessment tools in children include 6 scales:
• Nutritional Risk Score (NRS)
• Pediatric Nutritional Risk Score (PNR)
• Screening tool for the evaluation of malnutrition in Pediatrics (STAMP)
• Subjective Global Nutritional Assessment (SGNA)
• Pediatric Yorkhill Malnutrition Score (PYMS)
• Screening tool for risk of deterioration of nutritional status (STRONGkids). (1.3-8)
Of these tools, PYMS and STRONGKids were the most used in PICUs and were evaluated in multiple centers in Europe. The latest ASPEN guideline from 2017 concludes that none of these nutritional screening tools could be recommended in clinical practice. Currently, there is no consensus on the screening tool upon admission. (9)
The Yorkhill Pediatric Malnutrition Score (PYMS) was developed and used by the Royal Hospital for Sick Children at Yorkhill in Glasgow, Scotland. This screening tool was developed according to the nutritional screening guidelines of the European Society for Clinical Nutrition and Metabolism. The PYMS score measures four parameters that can assess and predict symptoms of malnutrition: (1) body mass index (BMI), (2) history of unintentional weight loss in a short period of time, (3) changes in food intake, and (4) the predictive effect of disease diagnosis on nutritional status. Each parameter is scored separately and the total score shows the level of risk for pediatric malnutrition. (10)
Multiple recent studies have reported a prevalence between 20 and 47% of malnutrition in critically ill children, an incidence of malnutrition in critically ill children that varies between 40 and 70%. (11) To calculate energy requirements, energy expenditure at rest (GER) is used. The GER is defined as the amount of calories required by the body at rest during a 24-hour period and represents 70% of the total energy expenditure; constitutes the sum of basal metabolic rate (BMR) plus endogenous thermogenesis produced by food. (6.12)
Adequate caloric-protein intake is decisive in the morbidity and mortality of critically ill pediatric patients; The caloric-protein debt is very often underestimated, that is, the objective difference between the necessary and real contribution in a day of nutrition. It has been shown in several studies that daily caloric-protein delivery is inadequate by 60–85%, respectively, by day 8 of nutrition in the PICU. (13–14)
The calculation of energy requirements must be carried out individually, according to age, nutritional status and underlying disease. In patients with diseases that carry a high risk of malnutrition, the best method is the calculation of the (GER) corrected by a factor that includes the activity and the degree of stress. The ideal way to know the GER is through indirect calorimetry. However, most clinicians do not have this technique and, therefore, need to estimate energy needs with guide calculations using prediction equations, the most widely accepted being the Schofield formula. (15)
Mortality in pediatric surgical patients is variable; there are no studies in Cuba that relate mortality to the new PYMS, an important tool in nutritional risk stratification extrapolated to the PICU (pediatric intensive care unit). In our country, the survival of patients with these characteristics is highly variable, and the need for a tool in the PICU for early identification and change in therapy is imperative. Due to its demonstrated ability to show nutritional risk, we wonder if it will be possible to determine the survival of critical surgical pediatric patients with high PYMS score and nutritional deficiency.
Objective: To determine survival in pediatric surgical patients with high PYMS and caloric deficit.