Nutritional Status and Clinical Outcomes of Children with Medical Complexity in the United Arab Emirates: A Retrospective Cross-Sectional Study

Abstract

Background: Children with medical complexity (CMC) represent a unique pediatric population. Their prevalence is increasing and they are suggested to be at a higher risk of undernutrition. However, limited data exist regarding their nutritional status, predictors of undernutrition, and its association with clinical outcomes, particularly in the Middle East. Objective: This study explored the nutritional status of CMC aged 0–24 months, admitted to a dedicated pediatric tertiary hospital in the United Arab Emirates (UAE), and examined the predictors of undernutrition, and its association with clinical outcomes: hospital length of stay, early readmission, recurrent admission, and mortality. Methods: This retrospective cross-sectional study included 446 hospitalized CMC at Al Jalila Children’s Specialty Hospital, Dubai, from 2016 to 2023. Nutritional status was assessed using CDC growth z-scores (weight-for-age: WAZ, length-for-age LAZ, weight-for-length: WLZ) and the Composite Index of Anthropometric Failure (CIAF), with diagnoses grouped by medical condition. Descriptive statistics summarized nutritional status. Exploratory bivariate analyses (Chi-square, Pearson correlation, t-tests, ANOVA) identified factors associated with the CMC’s nutritional status, and variables with p < 0.2 were entered into multivariable linear regression models to identify predictors, adjusting for confounders. Results: Undernutrition was highly prevalent, with 60.8% of children classified as underweight, 49.1% as wasted, and 41.7% as stunted. According to the CIAF, 75.1% exhibited at least one form of anthropometric failure, while 54.9% presented with multiple concurrent forms. No significant differences in WAZ, LAZ, or WLZ scores were observed based on sex or nationality. Preterm birth was significantly associated with lower WAZ (β = -0.849, p < 0.001) and LAZ (β = -1.464, p < 0.001) scores. Children diagnosed with respiratory and gastrointestinal-related conditions had significantly lower WAZ (β = -0.884, p = 0.024) and WLZ (β = -2.108, p = 0.005) scores compared with those with congenital anomalies. Mixed feeding was linked to decreased WAZ (β= -0.465, p = 0.027) and WLZ (β = -1.329, p = 0.001) scores in comparison with exclusive breastfeeding, while formula feeding was associated with lower WLZ scores (β = -0.874, p = 0.025). Older age at admission was associated with lower WAZ scores (β = -0.053, p < 0.001). Longer hospital length of stay was associated with reduced LAZ scores (β = -0.005, p = 0.006) and increased WLZ scores (β = 0.006, p = 0.035). Although undernourished children exhibited higher rates of early readmission, recurrent admission, and in-hospital mortality, these associations were not statistically significant. Conclusion: Undernutrition is alarmingly high among hospitalized CMCs, with a significant association with adverse clinical outcomes, including prolonged hospitalization. Routine nutritional screening, early involvement of dietitians, and targeted, individualized feeding strategies are urgently needed to improve CMC’s health outcomes and reduce the burden of undernutrition on the healthcare systems.