Factors associated with constipation in critically ill children: A retrospective study

BACKGROUND AND AIM: Constipation affects half of critically ill children in pediatric intensive care units (PICUs). The primary aim was to identify factors associated with constipation. METHODS: A multicenter retrospective review of nutrition support, medication, and defecation in critically ill children in five PICUs with an expected length of stay greater than 48 h. Constipation: defined as ≥3 days from admission without a bowel movement. RESULTS: A total of 250 children, mean age 38.1 ± 56.2 months, of which 155 (62%) were male. Among the 47% (117/250) of children who were constipated, compared to no constipation group, the mean time to passage of first stool was 6.0 ± 3.7 days vs.1.0 ± 1.1 days, respectively (P < 0.001). Children with and without constipation achieved 43% of energy and 36% of protein recommendations, compared with 67% and 56%, respectively. In a multivariate analysis, factors that increased the risk of constipation included children prescribed opioids and muscle relaxants, a cardiac diagnosis (P < 0.0001), and sex (males) (P = 0.04). Conversely, children had a reduced risk of constipation if they were following a bowel-management protocol (30% reduced risk) or prescribed laxatives (P = 0.001). CONCLUSION: In this retrospective study, the incidence of constipation among children admitted to the PICU was 47%. Risk factors for constipation included the use of opioid and muscle relaxants, a cardiac diagnosis, and sex (males). Children with constipation had significantly lower energy and protein intake during their PICU admission. Implementation of a bowel-management protocol and prescription of laxatives was associated with a reduced risk of constipation.