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Luz GD, Pereira DS, Minho JB, Dias PDC, Moraes ES, da Silva VM, Dutra APBS, Silva FM, Dalle Molle R. Association of handgrip strength with nutritional status and clinical outcomes in hospitalized pediatric patients. Clin Nutr ESPEN 2024; 61:413-419. [PMID: 38777463 DOI: 10.1016/j.clnesp.2024.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 03/17/2024] [Accepted: 04/11/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND & AIMS Malnutrition in children and adolescents is prevalent at hospital admission and the incidence increases with length of stay. Malnourished patients have loss of muscle mass and strength, compromising their functionality. Handgrip strength (HGS) is a nutritional marker understudied in pediatrics although it is capable of detecting nutritional deprivation before changes in body composition are observed. Therefore, this study aimed to evaluate the association between reduced HGS at hospital admission, compromised nutritional status and worse clinical outcomes of pediatric patients. METHODS Cohort study conducted with patients aged 6-18 years admitted to a pediatric ward. Nutritional status was assessed in the first 48 h of hospital admission using the z-score of height for age (H/A) and body mass index for age (BMI/A), percentile of mid-arm muscle circumference for age (MAMC/A) and the pediatric global subjective nutritional assessment (SGNA). HGS was measured using a digital dynamometer and considered reduced when the maximum value of three measurements was below the 5th percentile for sex and age. The clinical outcomes analyzed were length of hospital stay and frequency of readmission within 3 months after hospital discharge. RESULTS A total of 135 patients were evaluated (median age 10.9 years, 55.6% male) and 17.8% had reduced HGS. Patients with reduced HGS had lower H/A z-score (-0.50 vs 0.22, p = 0.012) and a higher frequency of reduced MAMC when compared to those with normal HGS (8% vs 13%, p = 0.007). Reduced HGS was not associated with malnutrition (OR = 0.63; 95%CI 0.23-1.77), prolonged hospital stay (OR = 1.89; 95%CI 0.72-4.92) or readmission to hospital 3 months after hospital discharge (OR = 1.82; 95%CI 0.67-4.93), in a model adjusted for the clinical condition. CONCLUSION Reduced HGS was not a predictor of malnutrition and clinical outcomes. However, it was associated with lower H/A Z-score and MAMC/A percentile values and can be used as a complementary measure in the nutritional status assessment of hospitalized pediatric patients.
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Affiliation(s)
- Gabriela Duarte Luz
- Programa de Pós-Graduação em Ciências da Nutrição, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
| | - Danielly Steffen Pereira
- Programa de Pós-Graduação em Ciências da Nutrição, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
| | - Jéssica Batista Minho
- Programa de Pós-Graduação em Ciências da Nutrição, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
| | - Patrícia Daniele Chrisóstomo Dias
- Programa de Pós-Graduação em Ciências da Nutrição, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
| | - Emilly Santos Moraes
- Curso de Graduação em Nutrição, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
| | | | | | - Flávia Moraes Silva
- Programa de Pós-Graduação em Ciências da Nutrição, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil; Curso de Graduação em Nutrição, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
| | - Roberta Dalle Molle
- Programa de Pós-Graduação em Ciências da Nutrição, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil.
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Impact of the HAS 2019 French guidelines on the frequency of hospital undernutrition in children. Arch Pediatr 2023; 30:36-41. [PMID: 36473753 DOI: 10.1016/j.arcped.2022.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 07/25/2022] [Accepted: 11/11/2022] [Indexed: 12/12/2022]
Abstract
In 2019, the French National Authority for Health (Haute Autorité de Santé, HAS) published guidelines on the diagnosis of undernutrition. The present article focuses on the impact of switching from the 2012 guidelines of the Nutrition Committee of the French Paediatric Society (CNSFP) to the HAS guidelines on the frequency of hospital undernutrition in children. We selected for the period 2010-2019 from the ePINUT database: (1) all children aged more than 2 years with (2) clinically confirmed nutritional status in (3) French sites. The frequency of undernutrition was 15.4% vs. 28.8% using the CNSFP and HAS criteria, respectively (p < 0.01; n = 6304). When compared to non-malnourished children regardless of the criteria used, malnourished children: (1) stayed longer in hospital (CNSFP: 9.0 ± 11.8 vs. 6.5 ± 8.7 days, p < 0.01; HAS: 7.8 ± 10.1 vs. 6.4 ± 8.4 days, p < 0.01), (2) gained more weight during hospitalization (% of weight at admission) (CNSFP: +1.4 ± 4.1 vs. -0.3 ± 3.5%, p < 0.01; HAS: +2.3 ± 4.7 vs. -0.1 ± 3.4%, p < 0.01), and (3) received nutritional support more frequently during hospitalization (CNSFP: 20% vs. 5%, p < 0.01; HAS: 13% vs. 4%, p < 0.01). Switching to the HAS guidelines resulted in an almost twofold higher frequency of undernutrition in hospitalized children. Initiation of nutritional care remained low considering the nutritional status. The present study warrants interventional studies to determine which children may benefit more from nutritional therapy to improve their outcome.
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Hulst JM, Huysentruyt K, Gerasimidis K, Shamir R, Koletzko B, Chourdakis M, Fewtrell M, Joosten KF. A Practical Approach to Identifying Pediatric Disease-Associated Undernutrition: A Position Statement from the ESPGHAN Special Interest Group on Clinical Malnutrition. J Pediatr Gastroenterol Nutr 2022; 74:693-705. [PMID: 35258497 DOI: 10.1097/mpg.0000000000003437] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
ABSTRACT Disease-associated undernutrition (DAU) is still common in hospitalized children and is generally accepted to be associated with adverse effects on disease outcomes; hence making proper identification and assessment essential in the management of the sick child. There are however several barriers to routine screening, assessment, and treatment of sick children with poor nutritional status or DAU, including limited resources, lack of nutritional awareness, and lack of agreed nutrition policies. We recommend all pediatric facilities to 1) implement procedures for identification of children with (risk of) DAU, including nutritional screening, criteria for further assessment to establish diagnosis of DAU, and follow-up, 2) assess weight and height in all children asa minimum, and 3) have the opportunity for children at risk to be assessed by a hospital dietitian. An updated descriptive definition of pediatric DAU is proposed as "Undernutrition is a condition resulting from imbalanced nutrition or abnormal utilization of nutrients which causes clinically meaningful adverse effects on tissue function and/or body size/composition with subsequent impact on health outcomes." To facilitate comparison of undernutrition data, it is advised that in addition to commonly used criteria for undernutrition such as z score < -2 for weight-for-age, weight-for-length, or body mass index <-2, an unintentional decline of >1inthese z scores over time should be considered as an indicator requiring further assessment to establish DAU diagnosis. Since the etiology of DAU is multifactorial, clinical evaluation and anthropometry should ideally be complemented by measurements of body composition, assessment of nutritional intake, requirements, and losses, and considering disease specific factors.
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Affiliation(s)
- Jessie M Hulst
- Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, Ontario
- the Department of Pediatrics & Department of Nutritional Sciences, University of Toronto, Toronto, Canada
| | - Koen Huysentruyt
- Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, Ontario
- the Department of Pediatric Gastroenterology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Konstantinos Gerasimidis
- the Human Nutrition, School of Medicine, Dentistry and Nursing, University of Glasgow, New Lister Building, Glasgow Royal Infirmary, Glasgow, UK
| | - Raanan Shamir
- the Institute of Gastroenterology, Nutrition and Liver diseases, Schneider Children's Medical Center, Petah Tikva, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Berthold Koletzko
- the LMU - Ludwig-Maximilians-Universitat Munich, Div. Metabolic and Nutritional Medicine, Department Paediatrics, Dr von Hauner Children's Hospital, LMU University Hospitals, Munich, Germany
| | - Michail Chourdakis
- the School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Mary Fewtrell
- the UCL Great Ormond Street Institute of Child Health, UCL, London, UK
| | - Koen F Joosten
- the Department of Pediatrics and Pediatric Surgery, Erasmus Medical Center - Sophia Children's Hospital, Rotterdam, The Netherlands
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Rabeh Rania B, Sonia M, Adel B, Nada M, Salem Y, Samir B. Évolution du statut nutritionnel d’une cohorte d’enfants tunisiens au cours de l’hospitalisation : facteurs de risque de la dénutrition hospitalière. NUTR CLIN METAB 2022. [DOI: 10.1016/j.nupar.2021.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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De Luca A, Patel M, Mantha O, Peretti N, Hankard R. Promoting the awareness of hospital malnutrition in children: ePINUT 10th anniversary in 2020. NUTR CLIN METAB 2021. [DOI: 10.1016/j.nupar.2021.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Wallon C, Binet A, Bernardo K, Le Touze A, Lesage V, Laffon M, Lardy H, Hankard R, De Luca A. Weight-for-height Z-score improves in half of undernourished children hospitalized in surgical wards. Arch Pediatr 2020; 27:403-407. [PMID: 33069563 DOI: 10.1016/j.arcped.2020.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 07/23/2020] [Accepted: 09/19/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Overall, 10-15% of hospitalized children are undernourished. The present study focuses on pediatric surgical wards. We assessed the impact of undernutrition upon admission on the weight-for-height Z-score (Z-WFH) during hospitalization for surgery. Secondary aims were to investigate the influence of associated factors and to report on the use of nutritional support. METHODS All children hospitalized for a surgical procedure between July 2015 and March 2016 were included in this monocentric, prospective study. Children were divided into two groups: whether the Z-WFH upon admission was below -2 standard deviations (undernourished) or not (not undernourished). RESULTS A total of 161 of 278 eligible children were included; 27 were undernourished (17%). The change in Z-WFH during hospitalization was greater in undernourished children (0.31±0.11 vs. -0.05±0.05, P=0.005). Of undernourished children, 49% recovered a Z-WFH above -2 SD during hospitalization. There was no difference between undernourished children and not undernourished children regarding age, length of hospital stay, pre- and post-operative duration of nil per os, duration of surgical procedure, ASA score, emergency level of the surgical procedure, and enteral/parenteral nutrition. CONCLUSION Our data suggest that the Z-WFH of undernourished children upon admission improved during hospitalization.
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Affiliation(s)
- C Wallon
- Unité mobile de nutrition, CHRU de Tours, 2, boulevard Tonnellé, 37044 Tours cedex 9, France
| | - A Binet
- Service de chirurgie viscérale, urologique, plastique et brûlés, CHRU de Tours, 49, boulevard Béranger, 37044 Tours cedex 9, France
| | - K Bernardo
- Unité mobile de nutrition, CHRU de Tours, 2, boulevard Tonnellé, 37044 Tours cedex 9, France; UMR 1069 « Nutrition Croissance et Cancer », Inserm, université de Tours, 10, boulevard Tonnellé, 37000 Tours, France
| | - A Le Touze
- Service de chirurgie viscérale, urologique, plastique et brûlés, CHRU de Tours, 49, boulevard Béranger, 37044 Tours cedex 9, France
| | - V Lesage
- Service anesthésie-réanimation 1, CHRU de Tours, 2, boulevard Tonnellé, 37044 Tours cedex 9, France
| | - M Laffon
- Service anesthésie-réanimation 1, CHRU de Tours, 2, boulevard Tonnellé, 37044 Tours cedex 9, France; Université de Tours, 37044 Tours, France
| | - H Lardy
- Service de chirurgie viscérale, urologique, plastique et brûlés, CHRU de Tours, 49, boulevard Béranger, 37044 Tours cedex 9, France; HUGOPEREN, PEDSTART, Inserm, F-CRIN, 2, boulevard Tonnellé, 37044 Tours cedex 9, France; Université de Tours, 37044 Tours, France
| | - R Hankard
- Unité mobile de nutrition, CHRU de Tours, 2, boulevard Tonnellé, 37044 Tours cedex 9, France; UMR 1069 « Nutrition Croissance et Cancer », Inserm, université de Tours, 10, boulevard Tonnellé, 37000 Tours, France; HUGOPEREN, PEDSTART, Inserm, F-CRIN, 2, boulevard Tonnellé, 37044 Tours cedex 9, France; Université de Tours, 37044 Tours, France
| | - A De Luca
- Unité mobile de nutrition, CHRU de Tours, 2, boulevard Tonnellé, 37044 Tours cedex 9, France; UMR 1069 « Nutrition Croissance et Cancer », Inserm, université de Tours, 10, boulevard Tonnellé, 37000 Tours, France.
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Vásquez-Cárdenas L, Pinzón-Espitia OL. Revisión sistemática y análisis comparativo de las herramientas de tamizaje nutricional en pediatría validadas en Europa y Canadá. REVISTA DE LA FACULTAD DE MEDICINA 2020. [DOI: 10.15446/revfacmed.v68n1.73180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Introducción. El tamizaje nutricional es una herramienta efectiva que permite establecer el riesgo de desnutrición hospitalaria, por consiguiente es importante revisar las directrices respecto a su uso en pediatría.Objetivo. Ofrecer recomendaciones sobre el uso de las herramientas de tamizaje nutricional validadas en Canadá y Europa en población colombiana. Materiales y métodos. Se realizó una revisión sistemática siguiendo la metodología PRISMA. Para la evaluación de la calidad de la evidencia se utilizó la herramienta U.S Preventive Services Task Force, formulada para medir acciones preventivas por la Canadian Task Force on the Periodic Health Examination.Resultados. Se incluyeron 15 estudios que cumplían los criterios de selección y se identificaron 7 herramientas (PYMS, iPYMS, PeDiSMART, PNR, STAMP, PMST y STRONGkids). Según los lineamientos de la Sociedad Europea de Nutrición Clínica y Metabolismo, la PYMS, la iPYMS y la STRONGkids evalúan simultáneamente variables pronósticas como estado nutricional actual, estabilidad, progresión esperada e influencia de la enfermedad. En cuanto a validez concurrente, el análisis de datos muestra que la PYMS, la iPYMS y la PMST tienen sensibilidades >85% y que la PYMS tiene especificidad >85%. Respecto a reproducibilidad, la PEDISMART, la STRONGkids, la STAMP y la PYMS tienen una concordancia inter-observadores aceptable (k>0.41).Conclusión. Según la evidencia analizada en términos de variables pronósticas, validez concurrente y reproducibilidad, se sugiere el empleo en la práctica clínica de la herramienta PYMS, mientras que para el uso de la STAMP y la iPYMS las instituciones deben evaluar su aplicabilidad.
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Pérez Moreno J, de la Mata Navazo S, López-Herce Arteta E, Tolín Hernani M, González Martínez F, Isabel González Sánchez M, Rodríguez Fernández R. Influence of nutritional status on clinical outcomes in hospitalised children. An Pediatr (Barc) 2019. [DOI: 10.1016/j.anpede.2019.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Pérez Moreno J, de la Mata Navazo S, López-Herce Arteta E, Tolín Hernani M, González Martínez F, González Sánchez MI, Rodríguez Fernández R. Influencia del estado nutricional en la evolución clínica del niño hospitalizado. An Pediatr (Barc) 2019; 91:328-335. [DOI: 10.1016/j.anpedi.2019.01.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 01/11/2019] [Accepted: 01/20/2019] [Indexed: 01/01/2023] Open
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McCarthy A, Delvin E, Marcil V, Belanger V, Marchand V, Boctor D, Rashid M, Noble A, Davidson B, Groleau V, Spahis S, Roy C, Levy E. Prevalence of Malnutrition in Pediatric Hospitals in Developed and In-Transition Countries: The Impact of Hospital Practices. Nutrients 2019; 11:nu11020236. [PMID: 30678232 PMCID: PMC6412458 DOI: 10.3390/nu11020236] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 01/02/2019] [Accepted: 01/13/2019] [Indexed: 01/04/2023] Open
Abstract
Presently, undernutrition still goes undetected in pediatric hospitals despite its association with poor clinical outcomes and increased annual hospital costs, thus affecting both the patient and the health care system. The reported prevalence of undernutrition in pediatric patients seeking care or hospitalized varies considerably, ranging from 2.5 to 51%. This disparity is mostly due to the diversity of the origin of populations studied, methods used to detect and assess nutritional status, as well as the lack of consensus for defining pediatric undernutrition. The prevalence among inpatients is likely to be higher than that observed for the community at large, since malnourished children are likely to have a pre-existent disease or to develop medical complications. Meanwhile, growing evidence indicates that the nutritional status of sick children deteriorates during the course of hospitalization. Moreover, the absence of systematic nutritional screening in this environment may lead to an underestimation of this condition. The present review aims to critically discuss studies documenting the prevalence of malnutrition in pediatric hospitals in developed and in-transition countries and identifying hospital practices that may jeopardize the nutritional status of hospitalized children.
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Affiliation(s)
- Andrea McCarthy
- Research Centre, CHU Sainte-Justine, Montreal, QC H3T 1C5, Canada.
- Departments of Nutrition, University of Montreal, Montreal, QC H3C 3J7, Canada.
| | - Edgard Delvin
- Research Centre, CHU Sainte-Justine, Montreal, QC H3T 1C5, Canada.
- Departments of Biochemistry, University of Montreal, Montreal, QC H3C 3J7, Canada.
| | - Valerie Marcil
- Research Centre, CHU Sainte-Justine, Montreal, QC H3T 1C5, Canada.
- Departments of Nutrition, University of Montreal, Montreal, QC H3C 3J7, Canada.
| | - Veronique Belanger
- Research Centre, CHU Sainte-Justine, Montreal, QC H3T 1C5, Canada.
- Departments of Nutrition, University of Montreal, Montreal, QC H3C 3J7, Canada.
| | - Valerie Marchand
- Research Centre, CHU Sainte-Justine, Montreal, QC H3T 1C5, Canada.
- Departments of Pediatrics, University of Montreal, Montreal, QC H3C 3J7, Canada.
| | - Dana Boctor
- Pediatric Gastroenterology, Alberta Children's Hospital, University of Calgary, Calgary, AL T2N 1N4, Canada.
| | - Mohsin Rashid
- Dalhousie University and IWK Health Center, Halifax, NS B3H 1S6, Canada.
| | - Angela Noble
- Dalhousie University and IWK Health Center, Halifax, NS B3H 1S6, Canada.
| | | | - Veronique Groleau
- Departments of Pediatrics, University of Montreal, Montreal, QC H3C 3J7, Canada.
| | - Schohraya Spahis
- Research Centre, CHU Sainte-Justine, Montreal, QC H3T 1C5, Canada.
- Departments of Nutrition, University of Montreal, Montreal, QC H3C 3J7, Canada.
| | - Claude Roy
- Research Centre, CHU Sainte-Justine, Montreal, QC H3T 1C5, Canada.
- Departments of Pediatrics, University of Montreal, Montreal, QC H3C 3J7, Canada.
| | - Emile Levy
- Research Centre, CHU Sainte-Justine, Montreal, QC H3T 1C5, Canada.
- Departments of Nutrition, University of Montreal, Montreal, QC H3C 3J7, Canada.
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De Longueville C, Robert M, Debande M, Podlubnai S, Defourny S, Namane SA, Pace A, Brans C, Cayrol E, Goyens P, De Laet C. Evaluation of nutritional care of hospitalized children in a tertiary pediatric hospital. Clin Nutr ESPEN 2018; 25:157-162. [PMID: 29779812 DOI: 10.1016/j.clnesp.2018.02.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Accepted: 02/27/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND AND AIMS Hospitalized children are at risk of malnutrition. The aim of the present study was to evaluate a clinical practice in a tertiary hospital. The nutritional team developed a specific software for screening of malnutrition and risk of malnutrition (Evalnut) that provides also recommendations for the nutritional management of the patient. The data recorded into this program and the tool itself were analyzed and optimizations are highlighted. METHODS A retrospective study analyzed the data collected in 2015 during 4931 consecutive hospitalizations (3984 children) at the University Children's Hospital Queen Fabiola. Pivot tables analysis (Excel) of the database of the screening tool was compared with the clinical practice of the dietitians. First data processing excluded records with abnormal or missing values. Impact of nutritional care analysis needs at least 2 evaluations and a positive patient's height trend. In case of height equality, only length of hospital stays less than 2 weeks were kept. RESULTS This study highlighted inaccurate database records related to imperfections of the computer program, missing or erroneous measures and incomplete encoding. First analysis on 3219 valid hospitalizations showed statistical correlations. Prevalence of malnutrition on admission was 33%, split into 14,5% acute malnutrition, 15% chronic malnutrition and 3,5% mixed malnutrition. Overall, 30,3% of the children were categorized at risk of developing malnutrition during their stay. Positive impact of nutritional management on the resulting nutritional status was demonstrated on the second data selection (352 hospitalizations): WFH median (interquartile range) increased from 96,1% (87,1-106,4) on admission to 96,9% (89,1-106,1) (p < 0,01) on discharge. An optimization of the existing software was finally proposed. CONCLUSION In our hospital, the dietitians are the most aware on the importance of nutritional assessment and management during hospitalization. Encouraging results are obtained. Inclusion of a nutritional program in the medical file is useful to raise interest amongst caregivers and is particularly valuable for the nutritional follow up of the patients by the nutrition team.
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Affiliation(s)
- Caroline De Longueville
- Hôpital Universitaire des Enfants Reine Fabiola, Avenue Jean-Joseph Crocq 15, B 1020, Brussels, Belgium.
| | - Martine Robert
- Hôpital Universitaire des Enfants Reine Fabiola, Avenue Jean-Joseph Crocq 15, B 1020, Brussels, Belgium.
| | - Marjorie Debande
- Hôpital Universitaire des Enfants Reine Fabiola, Avenue Jean-Joseph Crocq 15, B 1020, Brussels, Belgium.
| | - Sylviane Podlubnai
- Hôpital Universitaire des Enfants Reine Fabiola, Avenue Jean-Joseph Crocq 15, B 1020, Brussels, Belgium.
| | - Sophie Defourny
- Hôpital Universitaire des Enfants Reine Fabiola, Avenue Jean-Joseph Crocq 15, B 1020, Brussels, Belgium.
| | - Sid-Ali Namane
- Hôpital Universitaire des Enfants Reine Fabiola, Avenue Jean-Joseph Crocq 15, B 1020, Brussels, Belgium.
| | - Aude Pace
- Hôpital Universitaire des Enfants Reine Fabiola, Avenue Jean-Joseph Crocq 15, B 1020, Brussels, Belgium.
| | - Camille Brans
- Hôpital Universitaire des Enfants Reine Fabiola, Avenue Jean-Joseph Crocq 15, B 1020, Brussels, Belgium.
| | - Elodie Cayrol
- Hôpital Universitaire des Enfants Reine Fabiola, Avenue Jean-Joseph Crocq 15, B 1020, Brussels, Belgium.
| | - Philippe Goyens
- Hôpital Universitaire des Enfants Reine Fabiola, Avenue Jean-Joseph Crocq 15, B 1020, Brussels, Belgium; Laboratory of Pediatrics, Université Libre de Bruxelles, Avenue Jean-Joseph Crocq 15 CP 402, B 1020, Brussels, Belgium.
| | - Corinne De Laet
- Hôpital Universitaire des Enfants Reine Fabiola, Avenue Jean-Joseph Crocq 15, B 1020, Brussels, Belgium.
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The costs of disease related malnutrition in hospitalized children. Clin Nutr ESPEN 2018; 23:228-233. [DOI: 10.1016/j.clnesp.2017.09.009] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Revised: 09/10/2017] [Accepted: 09/26/2017] [Indexed: 11/24/2022]
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Abstract
The prevalence of disease-related undernutrition in hospitalized children has not decreased significantly in the last decades in Europe. A recent large multicentric European study reported a percentage of underweight children ranging across countries from 4.0% to 9.3%. Nutritional screening has been put forward as a strategy to detect and prevent undernutrition in hospitalized children. It allows timely implementation of adequate nutritional support and prevents further nutritional deterioration of hospitalized children. In this article, a hands-on practical guideline for the implementation of a nutritional care program in hospitalized children is provided. The difference between nutritional status (anthropometry with or without additional technical investigations) at admission and nutritional risk (the risk of the need for a nutritional intervention or the risk for nutritional deterioration during hospital stay) is the focus of this article. Based on the quality control circle principle of Deming, a nutritional care algorithm, with detailed instructions specific for the pediatric population was developed and implementation in daily practice is proposed. Further research is required to prove the applicability and the merit of this algorithm. It can, however, serve as a basis to provide European or even wider guidelines.
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Velandia S, Hodgson MI, Le Roy C. [Nutritional assessment in hospitalized children in a Paediatric service]. ACTA ACUST UNITED AC 2016; 87:359-365. [PMID: 27318770 DOI: 10.1016/j.rchipe.2016.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Revised: 01/29/2016] [Accepted: 05/02/2016] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Malnutrition in hospitalized children is associated with increased morbidity and mortality. OBJECTIVE To determine the nutritional status in children admitted to the Hospital Clínico de la Universidad Católica de Chile. PATIENTS AND METHOD A retrospective, cross-sectional study was conducted on hospital patients less than 17 years old within the period from November 2010 to April 2011. A record was made of the demographic data, admission diagnosis, biochemistry results (albumin, haemoglobin, haematocrit), hospital stay, and anthropometry data. Nutritional diagnosis was expressed as standard deviation (SD) for weight-for-height (WFH) by WHO in children younger than 5 y, and body mass index (BMI) by CDC-NCHS in older children. Height-for-age (HFA) ≤-2SD indicated stunted growth. RESULTS A total of 365 children, including 201 boys (55.1%), were evaluated. The median age was 3.35 years (IQR: 1.2-8.2). The most frequent reason for admission was heart disease (30.4%). The median hospital stay was 2 days (IQR: 2.0-4.0). Undernutrition was observed in 3.3% of the children, 8% were nutritionally at risk, 15% were overweight, and 10.9% were obese. As regards HFA, short stature was reported in 12.9%. There was a significant relationship between lower age and heart disease, and higher age with gastrointestinal and neurological diseases. By ordinal logistic regression for each year of age, the weight/height ratio (ZP/T) increases by 6.9% (OR=1.07). The biochemistry results (albumin, haemoglobin and haematocrit levels) were not associated with nutritional status. CONCLUSIONS A high percentage of children at risk of undernutrition was found. The percentage overweight was similar to the general Chilean paediatric population. Early detection will allow an opportune intervention, and nutritional monitoring at discharge.
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Affiliation(s)
- Silvia Velandia
- Departamento de Gastroenterología y Nutrición Pediátrica, División de Pediatría, Escuela de Medicina Pontificia Universidad Católica de Chile, Santiago, Chile.
| | - Maria Isabel Hodgson
- Departamento de Gastroenterología y Nutrición Pediátrica, División de Pediatría, Escuela de Medicina Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Catalina Le Roy
- Departamento de Gastroenterología y Nutrición Pediátrica, División de Pediatría, Escuela de Medicina Pontificia Universidad Católica de Chile, Santiago, Chile
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Nutrition parentérale pédiatrique : audit des pratiques professionnelles au groupement hospitalier Est de Lyon. NUTR CLIN METAB 2016. [DOI: 10.1016/j.nupar.2016.04.064] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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16
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Lefranc V, de Luca A, Hankard R. Protein-energy malnutrition is frequent and precocious in children with cri du chat syndrome. Am J Med Genet A 2016; 170A:1358-62. [DOI: 10.1002/ajmg.a.37597] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Accepted: 01/27/2016] [Indexed: 11/08/2022]
Affiliation(s)
- Violaine Lefranc
- Pédiatrie Multidisciplinaire-Nutrition de l'Enfant; CHU Poitiers; Poitiers France
| | - Arnaud de Luca
- Pédiatrie Multidisciplinaire-Nutrition de l'Enfant; CHU Poitiers; Poitiers France
- Inserm, CIC1402; Poitiers France
- University of Poitiers; Poitiers France
| | - Régis Hankard
- Inserm U 1069; Tours France
- University of Tours; Tours France
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17
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Caldari D, Hankard R, de Luca A, Peretti N, Thibault R, Bachmann P, Coti P, Guex E, Zeanandin G, Quilliot D. Référentiel de pratiques professionnelles : le dépistage de la dénutrition chez l’enfant hospitalisé. NUTR CLIN METAB 2016. [DOI: 10.1016/j.nupar.2015.12.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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18
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Shaughnessy EE, Kirkland LL. Malnutrition in Hospitalized Children: A Responsibility and Opportunity for Pediatric Hospitalists. Hosp Pediatr 2016; 6:37-41. [PMID: 26644045 DOI: 10.1542/hpeds.2015-0144] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- Erin E Shaughnessy
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio; and
| | - Lisa L Kirkland
- Division of Hospital Medicine, Mayo Clinic, Rochester, Minnesota
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19
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Daskalou E, Galli-Tsinopoulou A, Karagiozoglou-Lampoudi T, Augoustides-Savvopoulou P. Malnutrition in Hospitalized Pediatric Patients: Assessment, Prevalence, and Association to Adverse Outcomes. J Am Coll Nutr 2015; 35:372-80. [PMID: 26709552 DOI: 10.1080/07315724.2015.1056886] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Malnutrition is a frequent finding in pediatric health care settings in the form of undernutrition or excess body weight. Its increasing prevalence and impact on overall health status, which is reflected in the adverse outcomes, renders imperative the application of commonly accepted and evidence-based practices and tools by health care providers. Nutrition risk screening on admission and nutrition status evaluation are key points during clinical management of hospitalized pediatric patients, in order to prevent health deterioration that can lead to serious complications and growth consequences. In addition, anthropometric data based on commonly accepted universal growth standards can give accurate results for nutrition status. Both nutrition risk screening and nutrition status assessment are techniques that should be routinely implemented, based on commonly accepted growth standards and methodology, and linked to clinical outcomes. The aim of the present review was to address the issue of hospital malnutrition in pediatric settings in terms of prevalence, outline nutrition status evaluation and nutrition screening process using different criteria and available tools, and present its relationship with outcome measures. Key teaching points • Malnutrition-underweight or excess body weight-is a frequent imbalance in pediatric settings that affects physical growth and results in undesirable clinical outcomes. • Anthropometry interpretation through growth charts and nutrition screening are cornerstones for the assessment of malnutrition.To date no commonly accepted anthropometric criteria or nutrition screening tools are used in hospitalized pediatric patients. • Commonly accepted nutrition status and screening processes based on the World Health Organization's growth standards can contribute to the overall hospital nutrition care of pediatric patients.
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Affiliation(s)
- Efstratia Daskalou
- a Clinical Nutrition Laboratory "Christos Mantzoros", Nutrition & Dietetics Department, Alexander Technological Educational Institute of Thessaloniki , Thessaloniki , GREECE ;,b 4th Pediatric Department (A.G.-T.), 1st Pediatric Department (P.A.-S.) , Medical School, Aristotle University of Thessaloniki , Thessaloniki , GREECE
| | - Assimina Galli-Tsinopoulou
- a Clinical Nutrition Laboratory "Christos Mantzoros", Nutrition & Dietetics Department, Alexander Technological Educational Institute of Thessaloniki , Thessaloniki , GREECE ;,b 4th Pediatric Department (A.G.-T.), 1st Pediatric Department (P.A.-S.) , Medical School, Aristotle University of Thessaloniki , Thessaloniki , GREECE
| | - Thomais Karagiozoglou-Lampoudi
- a Clinical Nutrition Laboratory "Christos Mantzoros", Nutrition & Dietetics Department, Alexander Technological Educational Institute of Thessaloniki , Thessaloniki , GREECE ;,b 4th Pediatric Department (A.G.-T.), 1st Pediatric Department (P.A.-S.) , Medical School, Aristotle University of Thessaloniki , Thessaloniki , GREECE
| | - Persefone Augoustides-Savvopoulou
- a Clinical Nutrition Laboratory "Christos Mantzoros", Nutrition & Dietetics Department, Alexander Technological Educational Institute of Thessaloniki , Thessaloniki , GREECE ;,b 4th Pediatric Department (A.G.-T.), 1st Pediatric Department (P.A.-S.) , Medical School, Aristotle University of Thessaloniki , Thessaloniki , GREECE
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20
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Williams LA, Ware RS, Davies PSW. Back to basics: an audit of measurement of infant growth at presentation to hospital. AUST HEALTH REV 2015; 39:539-543. [PMID: 25844721 DOI: 10.1071/ah14165] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2014] [Accepted: 02/04/2015] [Indexed: 11/23/2022]
Abstract
Objectives Infants who present or are admitted to hospital with illness or with inadequate growth and development are those most at risk of decreased nutritional status. However, not all infants who present or are admitted to hospital have their growth assessed. The aim of the present study was to identify how frequently anthropometric measurements were documented in charts of infants presenting and/or admitted to a tertiary paediatric hospital. Methods A systematic random sample of hospital charts of infants who had presented to the emergency department between 1 July 2011 and 30 June 2012 was audited retrospectively for the presence of appropriate documentation of measurement. Results In all, 465 charts were audited, representing 10% of infants who presented to the emergency department in the year. The frequency of anthropometric measures was: birthweight 103 (22%), presentation weight 275 (59%), length 8 (2%), head circumference 15 (3%), percentiles 27 (6%) and body mass index score 1 (0%). Age of the infant was significantly associated with recording of birthweight. There were no significant relationships found between gender, socioeconomic status, gestational age, delivery type and recording of diagnosis and birthweight. Conclusions Infant measurements were not recorded on many occasions. Assessment of growth as a marker of illness or nutritional deficit has been poorly assessed in this group. This is a missed opportunity to assess infant growth in this population, which has been found to be at risk of decreased nutritional status. Identification and treatment of growth deficits are a cost-effective method of optimising infant health worldwide. What is known about this topic? Infants who present or are admitted to hospital with illness or with inadequate growth and development are those most at risk of decreased nutritional status. What does this paper add? Not all infants who present or are admitted to hospital have their growth assessed. What are the implications for practitioners? It is important in a paediatric setting to identify who is responsible for measuring and recording infant growth. Measurement of weight, height and head circumference is a basic, low-cost method of measuring infant growth in the hospital setting.
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Affiliation(s)
- Lesley Alison Williams
- Children's Nutrition Research Centre, Child Health Research Centre, Level 3, RCHF Building, University of Queensland, Herston, Qld 4029, Australia. Email
| | - Robert S Ware
- School of Population Health, University of Queensland, Herston, Qld 4029, Australia. Email
| | - Peter S W Davies
- Children's Nutrition Research Centre, Child Health Research Centre, Level 3, RCHF Building, University of Queensland, Herston, Qld 4029, Australia. Email
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Insuffisance pondérale chez l’enfant de 3–4ans dans la Vienne. Arch Pediatr 2014; 21:544-5. [DOI: 10.1016/j.arcped.2014.02.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Revised: 01/22/2014] [Accepted: 02/18/2014] [Indexed: 11/22/2022]
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22
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Hankard R, Colomb V, Piloquet H, Bocquet A, Bresson JL, Briend A, Chouraqui JP, Darmaun D, Dupont C, Frelut ML, Girardet JP, Goulet O, Rieu D, Simeoni U, Turck D, Vidailhet M. Dépister la dénutrition de l’enfant. NUTR CLIN METAB 2013. [DOI: 10.1016/j.nupar.2013.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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