12 Effective Treatment of Malnourished Pediatric Burn Patients

Abstract

Abstract Introduction Pediatric burn patients are at high nutritional risk given disease burden and its impact on body reserves. As part of our global mission, we care for children who arrive late after their injury, often with malnutrition. In our experience, these patients have greater susceptibility to infection, poor wound healing, and longer lengths of stay. In accordance, we implemented strategies to improve outcomes in this population including a sustained period of nutritional optimization prior to surgery. The purpose of this study was to describe the frequency of malnutrition in our hospital and to compare clinical outcomes between malnourished (MN) and well-nourished patients (WN) using this approach. Methods An IRB approved retrospective review of pediatric burn patients at our institution from 2010–2018 who received nutritional support (enteral and/or parenteral nutrition) for at least five days was conducted. Data collection included general demographics, anthropometrics, nutritional intake, nutrition related labs, and clinical outcome variables such as length of stay (LOS), and days to wound closure. Using a case-control design, malnourished patients were matched (by age and burn size) to their well-nourished counterparts. Differences in nutritional status and clinical outcome were compared by student’s t test. Results A total of 174 patients, 7.02 ± 5.19 years of age with 39.18 ± 18.31% total body surface area (TBSA) burns were included in the study. Thirty percent of all patients classified as malnourished based upon body mass index (BMI) or weight/length z-scores, visual assessment and/or reported weight loss. On admission, malnourished patients had significantly lower BMI z scores (MN -2.5 vs. WN 0.8, p< 0.0001). Despite significant differences in days post burn admission (MN 97.9 days, WN 17.7 days, p=0.028); there was no statistical difference in days to 95% wound closure (MN 39.4, WN 38.2 days, p=0.85) or LOS (MN 56.5, WN 52.5 days p=0.63) between the two groups. Average intake of malnourished patients over the first four weeks of admission ranged between 92–116% of calorie goal and 96–109% protein goal.Nutrition related lab value averages for MN patients improved over the four week time frame, Prealbumin (mg/dl) (week one 9.6, week four 17.75), C-reactive protein (mg/L) (week one 92.3, week four 71.91), and Albumin (g/dl) (week one 2.64, week four 3.32). Conclusions Despite arriving significantly malnourished, our pediatric burn patients had similar outcomes to their well-nourished counterparts in terms of LOS and 95% wound closure. This can be attributed to prompt identification of those patients at risk, and use of refeeding and nutritional rehabilitation protocols prior to surgical intervention. Applicability of Research to Practice Effective protocols for the management of malnourished pediatric burn patients can negate the impact of malnutrition on clinical outcomes.