Nutritional Assessment Of Pediatric Sepeie/Severe Sepsis And Investigation Of Microelement Cu Fe Zn

BackgroundSepsis refers to the systemic inflammatory response syndrome (SIRS) induced by infection and it is one of the common diseases in the pediatric intensive care unit (PICU) with a high mortality rate. Severe sepsis refers in particular to the sepsis with concomitant organ dysfunction and tissue hypoperfusion. As for the high mortality rate, the cause of death in most children is not the primary disease resulting in sepsis but the multiple-organ dysfunction syndrome (MODS) resulted from sepsis. Sepsis causes high treatment expenditure and affects the prognosis and life quality of children seriously. Even though the techniques of anti-infection treatment and organ function improvement have achieved great progress in recent years, the mortality rate of sepsis/severe sepsis remains high.ObjectiveMalnutrition is constantly induced since the children with sepsis/severe sepsis in PICU cannot intake or cannot intake sufficient nutrition. Currently, the amount of domestic and foreign multi-center studies on the nutritional risk evaluation in children with sepsis/severe sepsis in PICU is limited. Deficiency of trace elements and decreased immune function may lead to growth retardation, hypophrenia, digestive function disorder, anemia and other functions in children. Excessive, insufficient or deficient intake of trace elements can induce physiological disorder or disease to varying degrees. Since that trace elements cannot be synthesized independently in human body and the exclusive sources are diet, air and other exogenous agents, trace elements deficiency or excess can be easily caused and thereby diseases of varying degrees can be induced. Currently, national survey research on trace elements is seldom implemented in China. In addition that the amount of ad hoc survey of trace element level in children is even more limited, the health risk assessment on the trace element nutrition in Chinese children has been severely impacted. This project is participated collectively by Beijing Children’s Hospital, Shanghai Children’s Medical Center Affiliated to Shanghai Jiaotong University School of Medicine, Children’s Hospital of Fudan University, and Children’s Hospital of Zhengzhou. As a subproject of a multi-center project of study on the nutritional evaluation and nutritional support for children with sepsis/severe sepsis, this project is intended to conduct nutritional risk assessment for children with sepsis/severe sepsis, research the trace element level in children with sepsis/severe sepsis, and provide objective evidences for the nutrition status investigation, nutrition support therapy and other studies in children with sepsis/severe sepsis. This object is of great significance for establishing normalized strategy of nutrition support and improving prognosis.Methods1. A total of 80 sepsis (35 cases)/severe sepsis (45 cases) children hospitalized in the PICU of Children’s Hospital of Zhengzhou from Apr.2013 to Dec.2013 were selected as subjects of the case group. A total of 80 children receiving physical examination in Children’s Hospital of Zhengzhou were selected as subjects of the control group.2. Nutritional assessment tools:in accordance with the criteria recommended by WHO in 2006, WHO Anthro, WHO AnthroPls and CDC/WHO Anthro software was applied and standard statistic detection (Z value method) was adopted to evaluate the nutritional statuses of the children admitted to PICU and enrolled to the project (sepsis/severe sepsis).3. Statistical analysis:SPSS 19.0 software was applied for statistical analysis and the materials and data received chi-square test; the measurement data was expressed with X±S to indicate the comparison of means between the two groups and the difference was statistically significant (P<0.05)..ResultsNutrition severe sepsis in the low-risk group was significantly lower than in sepsis group and there was a statistically significant difference (P<0.05); nutrition high risk of severe sepsis group was significantly higher than the sepsis group and was statistically significant Differences (P<0.05). Overall nutritional status among the three groups have significant difference (P<0.05); and further to do pairwise comparisons between groups, the normal number of nutrients between sepsis and severe sepsis group was not statistically difference (P> 0.05); the number of undernourished sepsis group was significantly lower than the severe sepsis group and there is a statistically significant difference (P<0.05); normal number of nutrition sepsis group was significantly lower than the control group and there statistically significant difference (P<0.05); the number of undernourished between sepsis group and the control group had no significant difference (P> 0.05); normal number of nutritional severe sepsis group was significantly lower than the control group and significantly statistically significant difference (P<0.05); the number of undernourished severe sepsis group was significantly higher and there was a statistically significant difference (P<0.05). No significant difference (P> 0.05) nutrition and nutrition in a high risk group Cu values between low-risk group; nutrition high risk group Fe, Zn values below the low nutritional risk group and there was a statistically significant difference (P< 0.01).ConclusionsSepsis/severe sepsis in children with a high incidence of malnutrition risk of PICU in sepsis/severe sepsis in children to assess nutritional status has important clinical significance, severely malnourished children with sepsis the incidence of sepsis was significantly higher than in children, suggesting that the clinical treatment should be given nutritional support; sepsis/severe sepsis in children with high nutritional risk group of Fe, Zn nutritional value is lower than the low risk group, suggesting clinical treatment should be given iron, zinc treatment.