Overweight or obese children may be up to 57 percent more likely to die in a pediatric intensive care unit (ICU), a new study indicates.
“With increasing weight, there was an increasing risk of death,” said study author Dr. Patrick Ross, a critical care specialist with Children’s Hospital Los Angeles.
However, all children in the ICU had an overall low death rate with only 2.5 percent dying during treatment. And, the study did not prove that excess weight caused death risk to rise, it only found an association, the researchers added.
The pattern of higher death risk appeared in children as young as 1 year old and in kids who were overweight but not obese, two findings that were “a bit surprising,” said Amanda Staiano. She is director of the Pediatric Obesity and Health Behavior Laboratory at Louisiana State University’s Pennington Biomedical Research Center, in Baton Rouge.
“Even before children reached obesity, we saw a relationship between weight and mortality,” said Staiano, who serves as a spokeswoman for the Obesity Society.
Procedures and equipment in pediatric ICUs could be contributing to this increased risk of death, Ross and Staiano said, or it could be that excess weight is much more detrimental to a child’s health than previously thought.
Nearly 17 percent of children aged 2 to 19 are obese in the United States, the study authors said in background information. But until now, no one had looked into how obesity might affect a child’s chances when fighting for life in an intensive care unit.
For this study, Ross and his colleagues gathered information on more than 127,000 pediatric ICU patients from an international database, with cases running from January 2009 to March 2013.
They found that children carrying excess weight were 18 percent to 57 percent more likely to die while receiving critical care.
Underweight children also appeared to have an increased risk of death. But, that finding lost its statistical significance after researchers adjusted for factors such as the severity of their illness or other additional health problems they had.
The findings were published online Feb. 16 in the journal Pediatrics.
Heavy children might have an increased risk of death because a pediatric ICU isn’t set up to care for children their size, Ross said.
“On the extremes of weight, very overweight, it’s harder to care for those children,” he said. “The equipment is designed for size X and they [overweight children] are 3X.”
“The next step really would be to see if there’s something systematically we can do better,” Ross continued. “Is there a way we give them fluids or breathe for them that is compounding this?”
Doctors also might be providing too much medicine or too little medicine to children in the ICU based on their weight, Ross and Staiano said.
Adult intensive care units base medication dosing on a person’s “ideal weight” rather than their actual weight. This practice stems from the understanding that the size of people’s organs more closely correlates to their height than their weight, Ross said. Therefore, the person’s “ideal” BMI (body mass index, a ratio of weight to height) based on their height is a better tool for safe dosing.
But since children are still growing, pediatric ICUs continue to use their total weight, “and we’re not sure whether that’s right or wrong,” Ross said.
Staiano said: “Physicians may not be appropriately adjusting the medication to the weight of the child. Some of these children are physically older than what their chronological age is. When you’re a considering a child who’s 5, their body, due to their obesity status, might be presenting as an 8- or 9-year-old. Because of that, the medication might need to be adjusted.”
Ross said another study is looking into whether a child’s weight affects the size of their lungs. These future results could help doctors better prescribe appropriate doses of medication.
Finally, heavy kids might be more likely to die in the ICU because their excess weight exposes them to health problems, Ross and Staiano said.
“Whatever brought you into the ICU, you are compounding it with potentially other organs that have damage or have issues,” Ross said of this theory.
Evidence is mounting that even young children can develop chronic illness from obesity, Staiano said.
“We’ve accepted that teenagers now are presenting with advanced heart disease and diabetes,” Staiano said. “We’re starting to see cases as young as 8 or 9 years old with diabetes or heart disease. It could be children even younger than that are developing these risk factors.”
Doctors need to use these findings to figure out ways to better care for these kids, she said.
“From here, we need to start performing the trials to actually start improving these children’s survivorship and quality of life,” Staiano said.
For more information on pediatric critical care, visit the American Academy of Pediatrics.
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