Nutritional Outcome measure of Critically Ill Children after Schofield formula intervention in Pediatric Intensive Care Unit, Tikur Anbessa Specialized Hospital: Prospective observational Cohort study
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Date
2024-02
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Addis Ababa University
Abstract
Background: In critically ill pediatric patients, under nutrition plays a major role in high
mortality rates, longer hospital stays, higher risk of hospital-acquired infections, and higher
medical expenses.
Objective: To assess the nutritional outcome measure of critically ill children in pediatric
intensive care unit after Schofield formula intervention in Tikur Anbesa Specialized Hospital,
Addis Ababa, Ethiopia, 2024
Methods: Prospective cohort observational study was employed to investigate anthropometric
effect after Schofield formula intervention. The categorical variables in the study were presented
with using frequency, percentage, and compared between groups using the chi-square test. Since
our sample size was less than 50 and with the normal distribution of continuous variables, we
have used Shapiro-Wilk test. The mean and standard deviation calculated for normality
distributed data while median and interquartile range calculated for skewed data. Paired sample
T test was used to compare the mean difference for parametric variables while Wilcoxon Singed
Rank test was employed for nonparametric data. Pearson correlation analysis was conducted to
assess the strength and nature of the linear relationship between the independent and
postintervention BMI. In this study, a multivariate linear regression model was utilized to predict
the value of the dependent variable Y (post BMI) based on several independent variables
Results: The study was done in 25 participants, the median age of the participants in this study
was 9(±IQR=5.5) years. Female accounted 16/25(64%) and urban 15/25 (60%).
. The most underlying cause of critical illness was brain tumor 9/25 (36%) and sever infection
6/25(24%). The majority of patients (68%) initiated feeding within 48 hours, and 96% began
feeding within 72 hours of admission to PICU. The median length of ICU stay was 5 days
(±IQR=6.5). Analyzing the anthropometric changes post-intervention, we observed a statistically
significant difference in mean post-treatment BMI (16.5 ± 2.1) compared to preadmission BMI
(16.04 ± 2.2) with a p-value of 0.007. It was observed that for each additional year in age,
postinterventional BMI decreased by a factor of 1.14 (p=0.000). Interestingly, the timing of
feeding initiation within 48 hours of admission to PICU emerged as a particularly influential
factor, showing a substantial 2.2 times increase in postinterventional BMI (p=0.001).
Conclusion: The use of the Schofield formula intervention has shown statistically significant
improvements in post-intervention BMI and weight outcomes. Moreover, this study has gone a
step further by developing a prediction model for post-intervention BMI, demonstrating an
impressive predictive accuracy of approximately 84%. These findings not only underscore the
effectiveness of the Schofield formula intervention but also highlight the potential of predictive
modeling in optimizing outcomes in BMI management.
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Keywords
Pediatric Patients, Under Nutrition, Nutritional Outcome