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Persaud S, Hron BM, Rudie C, Mantell P, Kahlon PS, Ariagno K, Ozonoff A, Trivedi S, Yugar C, Mehta NM, Raymond M, Duggan CP, Huh SY. Improving anthropometric measurements in hospitalized children: A quality-improvement project. Nutr Clin Pract 2024; 39:685-695. [PMID: 38153693 PMCID: PMC11068491 DOI: 10.1002/ncp.11112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 10/16/2023] [Accepted: 11/24/2023] [Indexed: 12/29/2023] Open
Abstract
BACKGROUND The objective of this quality-improvement project was to increase documentation rates of anthropometrics (measured weight, length/height, and body mass index [BMI], which are critical to identify patients at malnutrition (undernutrition) risk) from <50% to 80% within 24 hours of hospital admission for pediatric patients. METHODS Multidisciplinary champion teams on surgical, cardiac, and intensive care (ICU) pilot units were established to identify and iteratively test interventions addressing barriers to documentation from May 2016 to June 2018. Percentage of patients with documented anthropometrics <24 h of admission was assessed monthly by statistical process control methodology. Percentage of patients at malnutrition (undernutrition) risk by anthropometrics was compared by χ2 for 4 months before and after intervention. RESULTS Anthropometric documentation rates significantly increased (P < 0.001 for all): BMI, from 11% to 89% (surgical), 33% to 57% (cardiac), and 16% to 51% (ICU); measured weight, from 24% to 88% (surgical), 69% to 83% (cardiac), and 51% to 67% (ICU); and length/height, from 12% to 89% (surgical), 38% to 57% (cardiac), and 26% to 63% (ICU). Improvement hospital-wide was observed (BMI, 42% to 70%, P < 0.001) with formal dissemination tactics. For pilot units, moderate/severe malnutrition (undernutrition) rates tripled (1.2% [24 of 2081] to 3.4% [81 of 2374], P < 0.001). CONCLUSION Documentation of anthropometrics on admission substantially improved after establishing multidisciplinary champion teams. Goal rate (80%) was achieved within 26 months for all anthropometrics in the surgical unit and for weight in the cardiac unit. Improved documentation rates led to significant increase in identification of patients at malnutrition (undernutrition) risk.
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Affiliation(s)
- Sabrina Persaud
- Clinical Education, Informatics, Quality and Professional Practice Department, Boston Children’s Hospital, Boston, Massachusetts, USA
- Center for Nutrition and Division of Gastroenterology, Hepatology and Nutrition, Boston Children’s Hospital, Boston, Massachusetts, USA
| | - Bridget M. Hron
- Center for Nutrition and Division of Gastroenterology, Hepatology and Nutrition, Boston Children’s Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Coral Rudie
- Center for Nutrition and Division of Gastroenterology, Hepatology and Nutrition, Boston Children’s Hospital, Boston, Massachusetts, USA
| | - Patricia Mantell
- Clinical Education, Informatics, Quality and Professional Practice Department, Boston Children’s Hospital, Boston, Massachusetts, USA
| | - Prerna S. Kahlon
- Program for Patient Safety and Quality, Boston Children’s Hospital, Boston, Massachusetts, USA
| | - Katelyn Ariagno
- Center for Nutrition and Division of Gastroenterology, Hepatology and Nutrition, Boston Children’s Hospital, Boston, Massachusetts, USA
| | - Al Ozonoff
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
- Division of Infectious Diseases, Boston Children’s Hospital, Boston, Massachusetts, USA
| | - Shrunjal Trivedi
- Center for Applied Pediatric Quality Analytics, Boston Children’s Hospital, Boston, Massachusetts, USA
| | - Carlos Yugar
- Center for Applied Pediatric Quality Analytics, Boston Children’s Hospital, Boston, Massachusetts, USA
| | - Nilesh M. Mehta
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Boston, Massachusetts, USA
| | - Michelle Raymond
- Center for Nutrition and Division of Gastroenterology, Hepatology and Nutrition, Boston Children’s Hospital, Boston, Massachusetts, USA
| | - Christopher P. Duggan
- Center for Nutrition and Division of Gastroenterology, Hepatology and Nutrition, Boston Children’s Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Susanna Y. Huh
- Center for Nutrition and Division of Gastroenterology, Hepatology and Nutrition, Boston Children’s Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
- Ironwood Pharmaceuticals, Boston, Massachusetts, USA
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2
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Roy A, Rahaman M. Prevalence of Undernutrition and Change Detection among under five years Children of Empowered Action Group States in India: Scrutinizing from National Family Health Survey, 2016-2021. Ecol Food Nutr 2023; 62:223-242. [PMID: 37614031 DOI: 10.1080/03670244.2023.2247333] [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] [Indexed: 08/25/2023]
Abstract
Change detection and prevalence of child undernutrition among the Empowered Action Group (EAG) states of India were studied using National Family Health Survey-4 and 5 data. The results identified that the prevalence of undernutrition in most of the EAG states is still more than 30%. Although stunting and underweight have decreased in all EAG states, this pattern is higher than that of the national level but the prevalence of wasting has only increased in Bihar. Strengthening public health initiatives and collaborative endeavor between organizations, enhancing mother's education, increasing awareness, and raising the economic as well as sociopolitical empowerment of mothers are essential for addressing the undernutrition issue.
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Affiliation(s)
- Arabinda Roy
- Department of Geography, Dr. Meghnad Saha College (affiliated to University of Gour Banga), Itahar, Uttar Dinajpur, India
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3
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Chowdhury MRK, Rahman MS, Billah B, Rashid M, Almroth M, Kader M. Prevalence and factors associated with severe undernutrition among under-5 children in Bangladesh, Pakistan, and Nepal: a comparative study using multilevel analysis. Sci Rep 2023; 13:10183. [PMID: 37349482 PMCID: PMC10287716 DOI: 10.1038/s41598-023-36048-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 05/28/2023] [Indexed: 06/24/2023] Open
Abstract
Despite economic growth and poverty reduction, under-5 child undernutrition is still rampant in South Asian countries. This study explored the prevalence and risk factors of severe undernutrition among under-5 children in Bangladesh, Pakistan, and Nepal for comparison using the Composite Index of Severe Anthropometric Failure. We utilised information on under-5 children from recent Demographic Health Surveys. We used multilevel logistic regression models for data analysis. The prevalence of severe undernutrition among under-5 children was around 11.5%, 19.8%, and 12.6% in Bangladesh, Pakistan, and Nepal, respectively. Children from the lowest socioeconomic quintile, and children born with low birth weight were key factors associated with severe undernutrition in these countries. The factors, parental education, maternal nutritional status, antenatal and postnatal care, and birth order were not homogeneous in explaining the determinants of child severe undernutrition across the countries. Our results suggest that the poorest households, and low birth weight of children have significant effects on severe undernutrition among under-5 children in these countries, which should be considered to formulate an evidence-based strategy to reduce severe undernutrition in South Asia.
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Affiliation(s)
- Mohammad Rocky Khan Chowdhury
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Md Shafiur Rahman
- Research Center for Child Mental Development, Hamamatsu University School of Medicine, Hamamatsu, Japan
- United Graduate School of Child Development, Osaka University, Kanazawa University, Hamamatsu University School of Medicine, Chiba University, University of Fukui, Osaka, Japan
| | - Baki Billah
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Mamunur Rashid
- Department of Public Health and Sports Science, Faculty of Occupational and Health Sciences, University of Gävle, Gävle, Sweden
| | - Melody Almroth
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Manzur Kader
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
- Department of Medicine Solna, Clinical Epidemiology Division, Karolinska Institutet, Maria Aspmans Gata 30A, 17176, Stockholm, Sweden.
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4
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Pereira DS, da Silva VM, Luz GD, Silva FM, Dalle Molle R. Nutrition risk prevalence and screening tools' validity in pediatric patients: A systematic review. JPEN J Parenter Enteral Nutr 2023; 47:184-206. [PMID: 36336352 DOI: 10.1002/jpen.2462] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 10/23/2022] [Accepted: 11/01/2022] [Indexed: 11/09/2022]
Abstract
Nutrition screening (NS) allows health professionals to identify patients at nutritional risk (NR), enabling early nutrition intervention. This study aimed to systematically review the criterion validity of NS tools for hospitalized non-critical care pediatric patients and to estimate the prevalence of NR in this population. This research was performed using PubMed, Embase, and Scopus databases until June 2021. The reviewers extracted the studies' general information, the population characteristics, the NR prevalence, and the NS tools' concurrent and predictive validity data. Quality evaluation was performed using the Newcastle-Ottawa Scale, adapted Newcastle-Ottawa Scale, and Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2). The primary studies were qualitatively analyzed, and descriptive statistics were calculated to describe the NR prevalence. Of the total 3944 studies found, 49 met the inclusion criteria. Ten different pediatric NS tools were identified; the most frequently used were Screening Tool for Risk on Nutritional Status and Growth (STRONGkids), Screening Tool for the Assessment of Malnutrition in Pediatrics (STAMP), and Pediatric Yorkhill Malnutrition Score (PYMS). The mean NR prevalence was 59.85% (range, 14.6%-96.9%). Among all NS tools analyzed, STRONGkids and PYMS showed the best diagnostic performance. STRONGkids had the most studies of predictive validity showing that the NR predicted a higher hospital length of stay (odds ratio [OR], 1.96-8.02), health complications during hospitalization (OR, 3.4), and the necessity for nutrition intervention (OR, 18.93). Considering the diagnostic accuracy, robust and replicated findings of predictive validity, and studies' quality, STRONGkids performed best in identifying NR in the pediatric population among the tools identified.
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Affiliation(s)
- Danielly S Pereira
- Programa de Pós-Graduação em Ciências da Nutrição, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Rio Grande do Sul, Brazil
| | - Vitória M da Silva
- Curso de Graduação em Nutrição, Centro Universitário Cesuca, Cachoeirinha, Rio Grande do Sul, Brazil
| | - Gabriela D Luz
- Curso de Graduação em Nutrição, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Rio Grande do Sul, Brazil
| | - Flávia M Silva
- Programa de Pós-Graduação em Ciências da Nutrição, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Rio Grande do Sul, Brazil.,Curso de Graduação em Nutrição, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Rio Grande do Sul, Brazil
| | - Roberta Dalle Molle
- Programa de Pós-Graduação em Ciências da Nutrição, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Rio Grande do Sul, Brazil
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Ferrante G, Fasola S, Piazza M, Tenero L, Zaffanello M, La Grutta S, Piacentini G. Vitamin D and Healthcare Service Utilization in Children: Insights from a Machine Learning Approach. J Clin Med 2022; 11:jcm11237157. [PMID: 36498731 PMCID: PMC9738108 DOI: 10.3390/jcm11237157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 11/15/2022] [Accepted: 11/23/2022] [Indexed: 12/05/2022] Open
Abstract
Vitamin D deficiency and insufficiency is a global health issue: an association has been demonstrated between vitamin D deficiency and a myriad of acute and chronic illnesses. Data regarding vitamin D status among children hospitalized with non-critical illnesses are scanty. We aimed to: (1) identify profiles of children hospitalized due to non-critical illnesses, using vitamin D levels as the driving outcome; (2) assess the association between patient profiles and length of stay. The study included 854 patients (1−17 years old) who underwent blood tests for detecting vitamin D levels. A regression tree was used to stratify patients. The relationship between vitamin D levels and length of stay was explored using Poisson regression. The regression tree identified three subgroups. Group A (16%): African, North African, Hispanic, and Indian patients. Group B (62%): Caucasian and Asian patients hospitalized for respiratory, metabolic, ill-defined, infective, and genitourinary diseases. Group C (22%): Caucasian and Asian patients hospitalized for digestive, nervous, and musculoskeletal diseases, blood and skin diseases, and injuries. Mean serum vitamin D level (ng/mL) was 13.7 (SD = 9.4) in Group A, 20.5 (10.0) in Group B, and 26.2 (12.6) in Group C. Group B was associated with the highest BMI z-score (p < 0.001) and the highest frequency of preterm births (p = 0.041). Mean length of stay was longer in Group A than in the other groups (p < 0.001) and decreased significantly by 9.8% (p = 0.024) in Group A and by 5% (p = 0.029) in Group B per 10 ng/mL increase in vitamin D level. We identified three subgroups of hospitalized children, defined according to ethnicity and discharge diagnosis, and characterized by increasing vitamin D levels. Vitamin D levels were associated with length of hospitalization.
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Affiliation(s)
- Giuliana Ferrante
- Department of Surgery, Dentistry, Pediatrics and Gynaecology, Pediatric Division, University of Verona, 37134 Verona, Italy
| | - Salvatore Fasola
- Institute of Translational Pharmacology, National Research Council, 90146 Palermo, Italy
| | - Michele Piazza
- Department of Surgery, Dentistry, Pediatrics and Gynaecology, Pediatric Division, University of Verona, 37134 Verona, Italy
- Correspondence:
| | - Laura Tenero
- AOUI Verona—Azienda Ospedaliera Universitaria Integrata of Verona, University of Verona, 37126 Verona, Italy
| | - Marco Zaffanello
- Department of Surgery, Dentistry, Pediatrics and Gynaecology, Pediatric Division, University of Verona, 37134 Verona, Italy
| | - Stefania La Grutta
- Institute of Translational Pharmacology, National Research Council, 90146 Palermo, Italy
| | - Giorgio Piacentini
- Department of Surgery, Dentistry, Pediatrics and Gynaecology, Pediatric Division, University of Verona, 37134 Verona, Italy
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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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7
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Prevalence and change detection of child growth failure phenomena among under-5 children: A comparative scrutiny from NFHS-4 and NFHS-5 in West Bengal, India. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2021. [DOI: 10.1016/j.cegh.2021.100857] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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8
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Kareem ZU, Panuganti SK, Bhatia S. Case Report: Energy- and Nutrient-Dense Formula for Growth Faltering: A Report of Two Cases From India. Front Nutr 2021; 8:588177. [PMID: 33718416 PMCID: PMC7952321 DOI: 10.3389/fnut.2021.588177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 01/22/2021] [Indexed: 11/13/2022] Open
Abstract
Infants hospitalized for critical illnesses are at a high risk of undernutrition because of increased nutrient requirements (due to increased metabolism) and decreased nutrient intake (due to disease-related problems such as anorexia or feeding difficulties). This can result in a slowing down of their normal growth, referred to as “growth faltering.” Appropriate nutritional management of these infants is extremely important to avoid long-term adverse outcomes. Administration of energy- and nutrient-dense formula (ENDF; 100 kcal energy and 2.6 g protein per 100 mL, with added micronutrients) can be an effective means of increasing the nutrient and energy intake of these children. Despite the high prevalence of undernutrition and growth faltering among pediatric patients in India, there is a paucity of literature on the use of ENDF in Indian infants. Herein, we report the successful use of ENDF for the nutritional management of two infants hospitalized for growth faltering because of severe upper airway obstruction. The aim of nutritional management was to achieve satisfactory weight gain, which can lead to spontaneous resolution of upper airway obstruction. ENDF was initially administered to provide 50–100 kcal/kg/day, and the dose was gradually increased to 160–185 kcal/kg/day. Both infants tolerated the formula well and showed satisfactory weight gain. These cases clearly demonstrate that early administration of ENDF is an effective means of increasing nutrient and energy intake of critically ill infants, thereby facilitating catchup growth, without any notable adverse effects.
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Affiliation(s)
- Zahid Ul Kareem
- Department of Pediatric Critical Care, Ankura Children's Hospital, Hyderabad, India
| | - Suresh Kumar Panuganti
- Department of Pediatric Critical Care, NICE Hospital for Women, Newborns and Children, Hyderabad, India
| | - Shikha Bhatia
- Healthcare Nutrition Science, Nutricia International Pvt. Ltd., Mumbai, India
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9
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Pan L, Liu Y, Feng Y, Fei J, Zhao Z, Liu S, Hong L. Nutrition risk profile of 62 408 inpatients based on electronic health records in a tertiary children's hospital. Nutrition 2021; 85:111137. [PMID: 33549946 DOI: 10.1016/j.nut.2020.111137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 12/15/2020] [Accepted: 12/21/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVES This study aimed to evaluate the nutrition risk profile of hospitalized children with electronic health record-based nutrition risk screening. Additionally, this study analyzed the association between high nutrition risk and clinical outcomes. METHODS Children discharged from Shanghai Children's Medical Center between 2017 and 2018 were enrolled and nutritionally screened. Nutrition risk scores using the Screening Tool for Assessment of Malnutrition in Pediatrics (STAMP), length of stay (LOS), and costs of hospitalization were recorded. Enrolled patients were categorized into two groups: the low and medium nutrition risk (LMNR) group, with scores ranging from 0 to 3, and the high nutrition risk (HNR) group, with scores ≥4. RESULTS Out of 62 408 subjects, 17.4% were at HNR. Patients with congenital heart diseases (83.9%), hematology-oncology diseases (26.0%) and gastroenterological diseases (21.4%) were affected most. Infants had the highest HNR rates (35.5%) of any age group. Surgical patients (20.7%) had a higher rate of HNR than non-surgical patients (9.5%). The HNR group had longer LOS (10.0 d versus 3.0 d, P < 0.001), higher total hospital costs (53 680.1 Chinese yuan [CNY] versus 8810.1 CNY, P < 0.001), and higher costs of antibiotics (441.0 CNY versus 0.0 CNY, P < 0.001) compared to the LMNR group. As STAMP score values increased, growing LOS and costs of hospitalization, medications, and antibiotics were observed. CONCLUSIONS A high prevalence of HNR was found in patients of Shanghai Children's Medical Center. Surgeries, specific disease, and infancy were important HNR risk factors. HNR scores using STAMP might predict prolonged LOS and higher medical costs.
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Affiliation(s)
- Liya Pan
- Department of Clinical Nutrition, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yunman Liu
- Department of Clinical Nutrition, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yi Feng
- Department of Clinical Nutrition, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jun Fei
- Department of Clinical Nutrition, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhuoqi Zhao
- Department of Clinical Nutrition, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shijian Liu
- Clinical Research Center, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Li Hong
- Department of Clinical Nutrition, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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10
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Lara-Pompa NE, Hill S, Williams J, Macdonald S, Fawbert K, Valente J, Kennedy K, Shaw V, Wells JC, Fewtrell M. Use of standardized body composition measurements and malnutrition screening tools to detect malnutrition risk and predict clinical outcomes in children with chronic conditions. Am J Clin Nutr 2020; 112:1456-1467. [PMID: 32520318 DOI: 10.1093/ajcn/nqaa142] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 05/15/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Better tools are needed to diagnose and identify children at risk of clinical malnutrition. OBJECTIVES We aimed to compare body composition (BC) and malnutrition screening tools (MSTs) for detecting malnutrition on admission; and examine their ability to predict adverse clinical outcomes [increased length of stay (LOS) and complications] in complex pediatric patients. METHODS This was a prospective study in children 5-18 y old admitted to a tertiary pediatric hospital (n = 152). MSTs [Pediatric Yorkhill Malnutrition Score (PYMS), Screening Tool for the Assessment of Malnutrition in Pediatrics (STAMP), and Screening Tool for Risk of Impaired Nutritional Status and Growth (STRONGkids)] were completed on admission. Weight, height, and BC [fat mass (FM) and lean mass (LM) by DXA] were measured (n = 118). Anthropometry/BC and MSTs were compared with each other and with clinical outcomes. RESULTS Subjects were significantly shorter with low LM compared to reference data. Depending on the diagnostic criteria used, 3%-17% were classified as malnourished. Agreement between BC/anthropometric parameters and MSTs was poor. STAMP and STRONGkids identified children with low weight, LM, and height. PYMS, and to a lesser degree STRONGkids, identified children with increased LOS, as did LM compared with weight or height. Patients with complications had lower mean ± SD LM SD scores (-1.38 ± 1.03 compared with -0.74 ± 1.40, P < 0.05). In multivariable models, PYMS high risk and low LM were independent predictors of increased LOS (OR: 3.76; 95% CI: 1.36, 10.35 and OR: 3.69; 95% CI: 1.24, 10.98, respectively). BMI did not predict increased LOS or complications. CONCLUSIONS LM appears better than weight and height for predicting adverse clinical outcomes in this population. BMI was a poor diagnostic parameter. MSTs performed differently in associations to BC/anthropometry and clinical outcomes. PYMS and LM provided complementary information regarding LOS. Studies on specific patient populations may further clarify the use of these tools and measurements.
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Affiliation(s)
- Nara E Lara-Pompa
- Childhood Nutrition Research Centre, University College London Great Ormond St Institute of Child Health, London, United Kingdom
| | - Susan Hill
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Jane Williams
- Childhood Nutrition Research Centre, University College London Great Ormond St Institute of Child Health, London, United Kingdom
| | - Sarah Macdonald
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Katherine Fawbert
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Jane Valente
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Kathy Kennedy
- Childhood Nutrition Research Centre, University College London Great Ormond St Institute of Child Health, London, United Kingdom
| | - Vanessa Shaw
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Jonathan C Wells
- Childhood Nutrition Research Centre, University College London Great Ormond St Institute of Child Health, London, United Kingdom
| | - Mary Fewtrell
- Childhood Nutrition Research Centre, University College London Great Ormond St Institute of Child Health, London, United Kingdom
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11
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Xu L, Gong S, Yuan LK, Chen JY, Yang WY, Zhu XC, Yu SY, Huang R, Tian S, Ding HY, He MD, Xiao SJ. Enhanced recovery after surgery for the treatment of congenital duodenal obstruction. J Pediatr Surg 2020; 55:2403-2407. [PMID: 32571537 DOI: 10.1016/j.jpedsurg.2020.04.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 04/19/2020] [Accepted: 04/21/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Enhanced recovery after surgery (ERAS) has been widely used in adult surgery. However, ERAS has not been reported in neonatal surgery. The present prospective study explored the application value of ERAS in treating congenital duodenal obstruction (CDO). METHODS A total of 68 cases of CDO were collected from October 1, 2017 to July 31, 2019. We divided patients with a prenatal diagnosis of congenital duodenal obstruction into the ERAS group and those who were diagnosed the disease after birth into the control group. The ERAS group adopted ERAS-related measures, and the control group followed the usual measures. The study compared the differences in the gestational age, birth weight, length of hospital stay (LOS), complications, feeding intolerance, and weight one month after surgery between the two groups. RESULTS A total of 49 patients were included in the analysis, including 23 who were allocated to the ERAS group and 26 to the control group. The LOS was 9.696±1.222 days in the ERAS group and 12.654±1.686 days in the control group, resulting in a significantly shorter LOS in the ERAS group than in the control group (p<0.001). One month after surgery, the neonates in the ERAS group weighted significantly more than those in the control group. No differences were observed in birth weight, gestational age, and the incidence of complications or feeding intolerance between the two groups. CONCLUSION In this single-center study, the implementation of neonate-specific ERAS for CDO surgery was feasible and safe and led to a shorter LOS without increasing the incidence of complications or feeding intolerance. TYPE OF STUDY Treatment Study LEVEL OF EVIDENCE: Level III.
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Affiliation(s)
- Lu Xu
- Department of Neonatal Surgery, Guangdong Women and Children Hospital, Guangzhou, China
| | - Shu Gong
- Department of Radiology, Guangdong Women and Children Hospital, Guangzhou, China
| | - Li-Ke Yuan
- Department of Neonatal Surgery, Guangdong Women and Children Hospital, Guangzhou, China
| | - Jia-Ying Chen
- Department of Neonatal Surgery, Guangdong Women and Children Hospital, Guangzhou, China
| | - Wen-Yi Yang
- Reproductive Health and Infertility Center, Guangdong Women and Children Hospital, Guangzhou, China
| | - Xiao-Chun Zhu
- Department of Neonatal Surgery, Guangdong Women and Children Hospital, Guangzhou, China
| | - Su-Yan Yu
- Department of Neonatal Surgery, Guangdong Women and Children Hospital, Guangzhou, China
| | - Rong Huang
- Department of Neonatal Surgery, Guangdong Women and Children Hospital, Guangzhou, China
| | - Song Tian
- Department of Neonatal Surgery, Guangdong Women and Children Hospital, Guangzhou, China
| | - Hui-Yang Ding
- Department of Neonatal Surgery, Guangdong Women and Children Hospital, Guangzhou, China
| | - Mu-Dan He
- Department of Anesthesiology, Guangdong Women and Children Hospital, Guangzhou, China
| | - Shang-Jie Xiao
- Guangdong Women and Children's Hospital, Guangzhou Medical University.
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12
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Validity and reliability of the Turkish version of three screening tools (PYMS, STAMP, and STRONG-kids) in hospitalized children. Clin Nutr ESPEN 2020; 39:96-103. [PMID: 32859335 DOI: 10.1016/j.clnesp.2020.07.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 07/08/2020] [Accepted: 07/17/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND There are different malnutrition screening tools developed in the English language, but limited data available on the validity of their versions translated into other languages. The aim of this study is to construct a Turkish version of PYMS, STRONG-kids, and STAMP and to determine their validity and reliability in a pediatric population. METHODS The present study was conducted at two stages. First, the process of translating PYMS, STRONG-kids, and STAMP into the Turkish language was performed. In the second stage, the validity and reliability were evaluated in the new version of the tools. The anthropometric assessment was used as the reference standard in evaluating the validity of criteria. The reliability was observed through inter-rater and intra-rater agreement. RESULTS 202 children in total were involved in the present study, 42 of whom took part in the reliability phase. The inter-rater agreement between one dietitian and one nurse was kappa (κ) = 0.955 (95% CI 0.904-1.000) for PYMS, 0.901 (95% CI 0.828-0.974) for STRONG-kids, and 0.963 (95% CI 0.912-1.000) for STAMP (almost perfect agreement). Sensitivity of the PYMS, STRONG-kids, and STAMP were 96.8%, 87.1%, and 77.4%, respectively. Specificity of the PYMS, STRONG-kids, and STAMP was found to be 65.0%, 30%, and 60.0%, respectively. CONCLUSION The inter-rater and intra-rater reliability of the three tools were determined to be good. While PYMS was found to be more sensitive in detecting the malnutrition risk when compared to the other tools, STRONG-kids had the lowest specificity according to the agreement between tool results and anthropometric assessment.
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13
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Factors influencing malnutrition risk in hospitalized pediatric patients and the application of STRONGkids scoring. JOURNAL OF SURGERY AND MEDICINE 2020. [DOI: 10.28982/josam.683554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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14
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Ezeofor IO, Garcia AL, Wright CM. Criteria for undernutrition screening in hospitalised infants under 6 months: a diagnostic accuracy study in a resource-poor setting. Arch Dis Child 2020; 105:524-529. [PMID: 31852658 DOI: 10.1136/archdischild-2019-318313] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 11/30/2019] [Accepted: 12/02/2019] [Indexed: 11/04/2022]
Abstract
PURPOSE We aimed to describe the prevalence of undernutrition in hospitalised infants aged under 6 months and test the utility of simple index measures to detect undernutrition. DESIGN Diagnostic accuracy study: weight, length, mid-upper arm circumference (MUAC), triceps and subscapular skinfolds were measured in infants aged 2 weeks to 6 months admitted to a Teaching Hospital in Enugu, Nigeria. Index criteria : low (<-2SD) weight-for-age Z-scores (WAZ), weight-for-length Z-scores (WLZ); MUAC <11 cm. Reference definition: weight faltering (conditional weight gain below fifth percentile for healthy Nigerian infants) or sum of skinfolds (SSF) <10 mm. RESULTS Of 125 hospitalised infants, only 5% (6) were admitted specifically for undernutrition, but low SSF were found in 33% (41) and, 24% (25) with known birth weight had weight faltering, giving an undernutrition prevalence of 36%. Low WAZ was the most discriminating predictor of undernutrition (sensitivity 69%, positive predictive value 86%, likelihood ratio 5.5; area under receiver operator curves 0.90) followed by MUAC (73%, 73%, 4.9; 0.86), while WLZ performed least well (49%, 67%, 2.9; 0.84). Where both MUAC and WAZ were low, there was sensitivity 90%, positive predictive value 82% and likelihood ratio 8.7. CONCLUSIONS Infants aged under 6 months admitted to hospital in Nigeria had a high prevalence of undernutrition. In young, high-risk population, a low WAZ alone was a valuable screening criterion, while combining weight with MUAC gave even higher discrimination. Measurement of length to calculate WLZ was a less useful predictor in this population.
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Affiliation(s)
- Ifeyinwa Obiageli Ezeofor
- Child Health, School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Ada Lizbeth Garcia
- Human Nutrition, School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Charlotte Margaret Wright
- Child Health, School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
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15
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Wibowo N, Irwinda R, Rachman L. First trimester maternal upper arm circumference correlated to placental size and neonatal anthropometry. MEDICAL JOURNAL OF INDONESIA 2020. [DOI: 10.13181/mji.oa.192950] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND First maternal nutrition, represented by anthropometrics, is an important factor for fetal growth. This study aimed to determine the correlation between maternal nutritional status of first trimester pregnant women with placental size and neonatal anthropometry.
METHODS A retrospective cohort study (N = 134) was conducted in Jakarta and Riau during August–September 2017. Correlation between first trimester maternal nutritional status, placental size (placental weight and volume), and neonatal anthropometry (birth weight, birth length, head circumference, and abdominal circumference) were examined using Spearman correlation test.
RESULTS High maternal body mass index and upper arm circumference (UAC) are weakly correlated with high birth weight (r = 0.281, p<0.001 and r = 0.271, p<0.001), birth length (r = 0.176, p = 0.022 and r= 0.238, p = 0.002), head circumference (r = 0.251, p = 0.001 and r = 0.297, p<0.001), abdominal circumference (r = 0.227, p = 0.003 and r = 0.226, p = 0.003), placental weight (r = 0.198, p = 0.01 and r = 0.228, p<0.001), and placental volume (r = 0.194, p = 0.01 and r = 0.203, p = 0.008). In addition, high maternal height is also weakly correlated with high birth weight (r = 0.157, p = 0.043) and birth length (r = 0.158, p = 0.041).
CONCLUSIONS UAC can be reliably used to assess the nutritional status of pregnant women and to predict placental and newborn sizes.
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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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17
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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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Zaher S, White D, Ridout J, Valla F, Branco R, Meyer R, Pathan N. Association between enteral macronutrient delivery and inflammatory response in critically ill children. Clin Nutr 2018; 38:2287-2296. [PMID: 30352749 DOI: 10.1016/j.clnu.2018.10.001] [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: 04/27/2018] [Revised: 09/17/2018] [Accepted: 10/02/2018] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND AIMS An important goal of nutrition support in paediatric critical illness is minimising catabolism. While focussing on providing full energy requirements, macronutrient balance is often neglected. Studies suggest that there is interplay between nutrition and inflammation. We aimed to assess the amount of enteral macronutrients delivered compared to estimated requirements, and the association between delivered macronutrients and systemic inflammation in critically ill children. METHOD We prospectively evaluated energy and macronutrient intake in critically ill children who required at least 72 h of mechanical ventilation. Data on enteral energy and macronutrient intake was collected and expressed as a percentage of the estimated requirements. Circulating levels of inflammatory cytokines were measured by ELISA and association assessed with delivery of macronutrients from the previous 24 h. RESULTS A total of 87 children (0-16 years) were included in this study. By day 3 the median (IQR) intake of energy, fat, carbohydrate (CHO) and protein were 75% (50-103), 85% (43-120), 63% (42-102) and 45% (23-65) respectively. We have also shown that delivery of enteral fat and protein was associated with elevation in the levels of tumour necrosis factor alpha (TNF-α) and interleukin-6 (IL-6). CONCLUSION The inflammatory response in critically ill children is influenced by the amount of enteral fat and protein delivered. Our data suggests that within the feed delivered, fat is often higher than protein and CHO. It is crucial to take into account the proportion of macronutrients required and not only aim to achieve the energy goal.
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Affiliation(s)
- Sara Zaher
- Department of Paediatrics, University of Cambridge, Hills Road, Cambridge, CB2 0QQ, UK; Clinical Nutrition Department, Faculty of Applied Medical Sciences, Taibah University, Saudi Arabia.
| | - Deborah White
- Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, UK
| | - Jenna Ridout
- Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, UK
| | - Frederic Valla
- Hospices Civils de Lyon, Paediatric Intensive Care, Hôpital Femme Mère Enfant, 59 bd Pinel, Lyon-Bron, FR 69500, France
| | - Ricardo Branco
- Department of Paediatrics, University of Cambridge, Hills Road, Cambridge, CB2 0QQ, UK; Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, UK
| | - Rosan Meyer
- Imperial College London, Kensington, London, SW7 2AZ, UK
| | - Nazima Pathan
- Department of Paediatrics, University of Cambridge, Hills Road, Cambridge, CB2 0QQ, UK; Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, UK
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20
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Abstract
OBJECTIVES Malnutrition during infancy has long-term adverse consequences for both physical and psychological development. Early detection of malnutrition among hospitalized infants is essential to provide optimal nutrition support. The primary aim of the present study was to investigate the nutritional status of hospitalized infants using 2 methods: the Subjective Global Nutritional Assessment (SGNA) and anthropometric measurement. We also investigated diagnostic category associated with nutritional status, the mean anthropometric z scores, and explored the association between malnutrition and nutrition focused variables. METHODS Nutritional status of 110 hospitalized infants ages 31 days to 12 months was investigated using the SGNA and anthropometric measurements converted to z scores. RESULTS Utilizing the SGNA, 78 (70.9%) infants were classified as having normal nutritional status, 30 (27.3%) were moderately malnourished, and 2 (1.8%) were severely malnourished. The proportion of infants with acute malnutrition (weight-for-length z score <-2) was 16.4%, and chronic malnutrition (length-for-age z score <-2) was 3.6%. The mean anthropometric z scores of infants were significantly lower in infants identified as moderately and severely malnourished using the SGNA. Decrease in serial weight (odds ratio [OR] 44.4; 95% confidence interval [CI]: 4.3-451.5), having prolonged gastrointestinal symptoms (OR 18.8; 95% CI: 1.5-234.7), and reduced nutrition-related functional capacity (OR 27.6; 95% CI 2.5-301.7) were associated with malnutrition after adjusting for sex, age, and length of hospital stay. CONCLUSIONS Regardless of the method applied, cases of malnutrition amongst hospitalized infants were identified. The SGNA is a comprehensive approach to identifying malnutrition in hospitalized infants.
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21
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Jahanihashemi H, Noroozi M, Zavoshy R, Afkhamrezaei A, Jalilolghadr S, Esmailzadehha N. Malnutrition and birth related determinants among children in Qazvin, Iran. Eur J Public Health 2017; 27:559-562. [PMID: 28472277 DOI: 10.1093/eurpub/ckx043] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background Little is known about the effect of birth weight, birth order and number of siblings on the nutritional status in children in Iran, especially in Qazvin province. The aim of this study was to provide the current data on malnutrition and birth related determinants among children in Qazvin, Iran. This study was conducted in six cities of Qazvin province (Iran), during December 2009-December 2010. Data on age, weight and height were taken and birth weight, number of children in family, birth order, parental career and educational state and family caretaker were collected by a questionnaire that a trained team filled in. Sample size was1351, almost 225 children under 6-years-old from each city participated in the study (692 boys and 659 girls). In each city, subjects were randomly selected among children who had profiles at health centers. The overall prevalence of wasting, stunting and underweight was 10.3%, 5.8% and 4.8% respectively. There was association between 'birth weight' and wasting ( P = 0.022), stunting ( P = 0.032) and underweight ( P < 0.001). A non-significant association was obtained between factors 'number of children at home' and 'birth order' with wasting, stunting and underweight. These data suggest that birth weight can influence malnutrition indicators; therefore, knowing risk factors of malnutrition in population subgroups is important for planners in country because it helps the future studies concentrate on the most determining ones.
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Affiliation(s)
- Hassan Jahanihashemi
- Department of Biostatistics, Children Growth Research Center, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Mostafa Noroozi
- Department of Nutrition, Children Growth Research Center, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Roza Zavoshy
- Department of Nutrition, Children Growth Research Center, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Amir Afkhamrezaei
- Department of Biostatistics, Children Growth Research Center, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Shabnam Jalilolghadr
- Department of Pediatrics, Children Growth Research Center, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Neda Esmailzadehha
- Metabolic Diseases Research Center, Qazvin University of Medical Sciences, Qazvin, Iran
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Abstract
Malnutrition continues to be a major public health challenge especially in South Asian developing countries. The aim of the present review is to spotlight the magnitude of the prevalence of malnutrition and its dynamics in South Asian region and to suggest potential approaches for the prevention and control of this issue of public health significance. An extensive review of literature, covering malnutrition and its determinants, health and economic consequences and pragmatic preventive strategies was performed on computer based bibliographic databases (PubMed, Google Scholar, Scopus, Medline and Sciencedirect.com ) to retrieve abstracts and full texts for India, Pakistan, Bangladesh, Sri Lanka and Nepal. All relevant titles and abstracts were examined and evaluated for malnutrition and its prevalence in South Asia. The results revealed malnutrition to be a major public health problem and a potential cause of high disease burden and mortality in South Asia. Compelling evidence suggests malnutrition to be the leading cause of stunting, wasting and underweight with drastic economic consequences among vulnerable populations. Reduced cognitive performance and low productivity have also been associated with micronutrients malnutrition. Suboptimal breastfeeding, inadequate food supply, micronutrient deficiencies, low household income, poor health care system, increased healthcare costs, illiteracy, unhygienic and substandard living, inappropriate child's care and the caregiver, food insecurity and on top of that vicious cycle of poverty, have been recognized as principal indicators for growing malnutrition prevalence in South Asia. Global organizations, local governments, program managers, NGOs, academia, industry in particular and the society at large need to take up the challenge to completely confiscate malnutrition from the region for economic prosperity and a healthier future.
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Affiliation(s)
- Saeed Akhtar
- a Department of Food Science and Nutrition , Bahauddin Zakariya University , Multan , Pakistan
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23
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Brunet-Wood K, Simons M, Evasiuk A, Mazurak V, Dicken B, Ridley D, Larsen B. Surgical fasting guidelines in children: Are we putting them into practice? J Pediatr Surg 2016; 51:1298-302. [PMID: 27166876 DOI: 10.1016/j.jpedsurg.2016.04.006] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Revised: 04/07/2016] [Accepted: 04/11/2016] [Indexed: 02/04/2023]
Abstract
BACKGROUND Patients are traditionally kept fasting (NPO) from midnight prior to surgery, to prevent aspiration during anesthesia. NPO time is continued postoperatively, out of concern for ileus. Prolonged periods of NPO place the pediatric population at risk for under-nutrition. Published guidelines for preoperative NPO times have been shown to be safe. The aim of this study was to investigate current pre- and postoperative feeding practices of children at a pediatric tertiary care hospital. METHODS Medical charts were used to extract data prospectively from 53 patients undergoing general, neurosurgical, or urological procedures. Date and time of NPO periods were recorded as well as the physician's postoperative diet orders and diet progression. Surgical procedures were classified as complex or noncomplex by the surgeons. Data were summarized and compared to published recommendations. RESULTS Preoperative NPO times were greater than recommended in 70% of patients studied (n=37). Median time spent NPO preoperatively was not significantly different between complex (11.5h) and noncomplex groups (10.8h). Postoperative NPO time was significantly greater for complex procedures than for noncomplex. Most patients received some postoperative NPO time, even when it was not included in the physician diet order. CONCLUSION Observed preoperative NPO time exceeded current recommendations in this study.
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Affiliation(s)
| | - Mariska Simons
- Department of Agricultural, Life, and Environmental Sciences, University of Alberta.
| | - Amanda Evasiuk
- Department of Agricultural, Life, and Environmental Sciences, University of Alberta.
| | - Vera Mazurak
- Department of Agricultural, Life, and Environmental Sciences, University of Alberta.
| | - Bryan Dicken
- Department of Pediatrics, University of Alberta.
| | | | - Bodil Larsen
- Nutrition Services, Alberta Health Services; Department of Agricultural, Life, and Environmental Sciences, University of Alberta; Department of Pediatrics, University of Alberta.
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Abdelhadi RA, Bouma S, Bairdain S, Wolff J, Legro A, Plogsted S, Guenter P, Resnick H, Slaughter-Acey JC, Corkins MR. Characteristics of Hospitalized Children With a Diagnosis of Malnutrition. JPEN J Parenter Enteral Nutr 2016; 40:623-35. [DOI: 10.1177/0148607116633800] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 01/21/2016] [Indexed: 12/17/2022]
Affiliation(s)
| | - Sandra Bouma
- University of Michigan C.S. Mott Children’s Hospital, Ann Arbor, Michigan, USA
| | | | - Jodi Wolff
- Rainbow Babies and Children’s Hospital, Solon, Ohio, USA
| | - Amanda Legro
- Miller Children’s and Women’s Hospital, Long Beach, California, USA
| | | | - Peggi Guenter
- American Society for Parenteral and Enteral Nutrition, Silver Spring, Maryland, USA
| | - Helaine Resnick
- American Society for Parenteral and Enteral Nutrition, Silver Spring, Maryland, USA
| | - Jaime C. Slaughter-Acey
- College of Nursing & Health Professions School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA
| | - Mark R. Corkins
- University of Tennessee Health Sciences Center, Memphis, Tennessee, USA
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Is undernutrition prognostic of infection complications in children undergoing surgery? A systematic review. J Hosp Infect 2016; 93:12-21. [PMID: 26897556 DOI: 10.1016/j.jhin.2015.12.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 12/30/2015] [Indexed: 11/22/2022]
Abstract
BACKGROUND Healthcare-associated infections are costly and are increasingly viewed as an indicator of the quality of care. Although strategies to reduce infections have become widespread, few studies have formally investigated the role of undernutrition on the development of infection-related complications in children after surgery. AIM To perform a systematic review of the literature to determine if undernutrition is prognostic of postoperative infection complications in children. METHODS Electronic bibliographic and research databases were searched from 1950 to 2014. Inclusion criteria were studies in children (age <18 years) evaluating pre-operative nutritional status and reporting postoperative infection complications. Quality assessment was performed independently by two reviewers, with disagreements resolved by a third reviewer. The quality of the evidence was judged to be low in the majority of studies. FINDINGS Ten cohort and two case-control studies met the inclusion criteria. Five studies reported an outcome combining infection-related complications, with the remainder reporting individual infection complications. Six studies reported surgical site infection (SSI) alone or in combination with other infection complications. Direct comparison between studies was difficult due to clinical and diagnostic heterogeneity. Unadjusted analyses (for patient or clinical variables) were suggestive of a relationship between undernutrition and infection complications. In studies controlling for other variables, the analyses did not remain significant for SSI. CONCLUSION There was low-quality evidence that undernutrition may be predictive of postoperative infection complications in children, with the exception of SSI. However, inconsistencies in nutritional and outcome assessments made it difficult to draw conclusions. Larger, high-quality studies are warranted to further investigate a potential prognostic relationship.
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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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27
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Associating nutritional risk with clinical outcomes in paediatric patients: an appraisal of different tools. Proc Nutr Soc 2016. [DOI: 10.1017/s0029665116001993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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28
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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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Huysentruyt K, Devreker T, Dejonckheere J, De Schepper J, Vandenplas Y, Cools F. Accuracy of Nutritional Screening Tools in Assessing the Risk of Undernutrition in Hospitalized Children. J Pediatr Gastroenterol Nutr 2015; 61:159-66. [PMID: 25885879 DOI: 10.1097/mpg.0000000000000810] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The aim of the present study was to evaluate the predictive accuracy of screening tools for assessing nutritional risk in hospitalized children in developed countries. METHODS The study involved a systematic review of literature (MEDLINE, EMBASE, and Cochrane Central databases up to January 17, 2014) of studies on the diagnostic performance of pediatric nutritional screening tools. Methodological quality was assessed using a modified QUADAS tool. Sensitivity and specificity were calculated for each screening tool per validation method. A meta-analysis was performed to estimate the risk ratio of different screening result categories of being truly at nutritional risk. RESULTS A total of 11 studies were included on ≥1 of the following screening tools: Pediatric Nutritional Risk Score, Screening Tool for the Assessment of Malnutrition in Paediatrics, Paediatric Yorkhill Malnutrition Score, and Screening Tool for Risk on Nutritional Status and Growth. Because of variation in reference standards, a direct comparison of the predictive accuracy of the screening tools was not possible. A meta-analysis was performed on 1629 children from 7 different studies. The risk ratio of being truly at nutritional risk was 0.349 (95% confidence interval [CI] 0.16-0.78) for children in the low versus moderate screening category and 0.292 (95% CI 0.19-0.44) in the moderate versus high screening category. CONCLUSIONS There is insufficient evidence to choose 1 nutritional screening tool over another based on their predictive accuracy. The estimated risk of being at "true nutritional risk" increases with each category of screening test result. Each screening category should be linked to a specific course of action, although further research is needed.
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Affiliation(s)
- Koen Huysentruyt
- *Department of Pediatrics, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel (VUB), Brussels †SGS Life Science Services, Mechelen ‡Department of Neonatology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel (VUB), Brussels, Belgium
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Praglowski N. Family-style dining on a child and adolescent psychiatry unit: a quality improvement project to reduce weight changes in patients. JOURNAL OF CHILD AND ADOLESCENT PSYCHIATRIC NURSING 2015; 28:92-6. [PMID: 25865830 DOI: 10.1111/jcap.12107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Improving nutritional standards for children has become a national health initiative. However, children who are hospitalized are often at additional risk for poor nutrition and diet. Following a change to family-style dining, nursing staff noted significant patient weight changes. We undertook a quality improvement project to address this issue and promote healthy weight maintenance. METHODS Nursing staff requested changes to the types of foods served and placed limits on how much patients were permitted to eat. We also developed a nutrition group to educate the patients on healthy food choices. RESULTS We were able to reduce weight changes in patients on our unit from a mean change of 2.5 kg (5.5 lb) to a mean change of 0.01 kg (0.027 lb). CONCLUSIONS Patient education, healthy food offerings, and limiting the amount of food eaten at meals had positive outcomes on patient weights during a child and adolescent psychiatry hospitalization.
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Affiliation(s)
- Nancy Praglowski
- Child and Adolescent Psychiatry, The Johns Hopkins Hospital, Baltimore, MD, USA
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31
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White M, Dennis N, Ramsey R, Barwick K, Graham C, Kane S, Kepreotes H, Queit L, Sweeney A, Winderlich J, Wong See D, Littlewood R. Prevalence of malnutrition, obesity and nutritional risk of Australian paediatric inpatients: a national one-day snapshot. J Paediatr Child Health 2015; 51:314-20. [PMID: 25123425 DOI: 10.1111/jpc.12709] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/11/2014] [Indexed: 11/30/2022]
Abstract
AIM Low prevalence rates of malnutrition at 2.5% to 4% have previously been reported in two tertiary paediatric Australian hospitals. The current study is the first to measure the prevalence of malnutrition, obesity and nutritional risk of paediatric inpatients in multiple hospitals throughout Australia. METHODS Malnutrition, obesity and nutritional risk prevalence were investigated in 832 and 570 paediatric inpatients, respectively, in eight tertiary paediatric hospitals and eight regional hospitals across Australia on a single day. Malnutrition and obesity prevalence was determined using z-scores and body mass index (BMI) percentiles. High nutritional risk was determined as a Paediatric Yorkhill Malnutrition Score of 2 or more. RESULTS The prevalence rates of malnourished, wasted, stunted, overweight and obese paediatric patients were 15%, 13.8%, 11.9%, 8.8% and 9.9%, respectively. Patients who identified as Aboriginal and Torres Strait Islander were more likely to have lower height-for-age z-scores (P < 0.01); however, BMI and weight-for-age z-scores were not significantly different. Children who were younger, from regional hospitals or with a primary diagnosis of cardiac disease or cystic fibrosis had significantly lower anthropometric z-scores (P = 0.05). Forty-four per cent of patients were identified as at high nutritional risk and requiring further nutritional assessment. CONCLUSIONS The prevalence of malnutrition and nutritional risk of Australian paediatric inpatients on a given day was much higher when compared with the healthy population. In contrast, the proportion of overweight and obese patients was less.
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Affiliation(s)
- Melinda White
- Department of Dietetics and Food Services, Royal Children's Hospital, Brisbane, Queensland, Australia
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Hecht C, Weber M, Grote V, Daskalou E, Dell'Era L, Flynn D, Gerasimidis K, Gottrand F, Hartman C, Hulst J, Joosten K, Karagiozoglou-Lampoudi T, Koetse HA, Kolaček S, Książyk J, Niseteo T, Olszewska K, Pavesi P, Piwowarczyk A, Rousseaux J, Shamir R, Sullivan PB, Szajewska H, Vernon-Roberts A, Koletzko B. Disease associated malnutrition correlates with length of hospital stay in children. Clin Nutr 2015; 34:53-9. [DOI: 10.1016/j.clnu.2014.01.003] [Citation(s) in RCA: 131] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Revised: 12/04/2013] [Accepted: 01/06/2014] [Indexed: 11/25/2022]
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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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Durakbaşa ÇU, Fettahoğlu S, Bayar A, Mutus M, Okur H. The Prevalence of Malnutrition and Effectiveness of STRONGkids Tool in the Identification of Malnutrition Risks among Pediatric Surgical Patients. Balkan Med J 2014; 31:313-21. [PMID: 25667785 DOI: 10.5152/balkanmedj.2014.14374] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2014] [Accepted: 09/27/2014] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND High prevalence of malnutrition along with the risk for the development of malnutrition in hospitalised children has been reported. However, this problem remains largely unrecognised by healthcare workers. AIMS To determine the prevalence of malnutrition and effectiveness of STRONGkids nutritional risk screening (NRS) tool in the identification of malnutrition risk among pediatric surgical patients. STUDY DESIGN Cross-sectional study. METHODS A total of 494 pediatric surgical patients (median age 59 months, 75.8% males) were included in this prospective study conducted over 3 months. SD-scores <-2 for Body Mass Index (BMI) for age or weight-for-height (WFH) and height-for-age (HFA) were considered to indicate acute and chronic malnutrition, respectively. The STRONGkids NRS tool was used to determine risk for malnutrition. RESULTS Malnutrition was detected in 13.4% in this group of pediatric surgical patients. Acute malnutrition was identified in 10.1% of patients and more commonly in patients aged ≤60 months than aged >60 months (13.4 vs. 6.6%, p=0.012). Chronic malnutrition was identified in 23 (4.6%) of patients with no significant difference between age groups. There were 7 (1.4%) children with coexistent acute and chronic malnutrition. The STRONGkids tool revealed that 35.7% of patients were either in the moderate or high risk group for malnutrition. Malnutrition, as revealed by anthropometric measurements, was more likely in the presence of gastrointestinal (26.9%, p=0.004) and inguinoscrotal/penile surgery (4.0%, p=0.031), co-morbidities affecting nutritional status (p<0.001) and inpatient admissions (p=0.014). Among patients categorized as low risk for malnutrition, there were more outpatients than inpatients (89.3 vs. 10.7%, p<0.001) and more elective surgery cases than emergency surgery cases (93.4 vs. 6.6%, p<0.001). CONCLUSION Providing data on the prevalence of malnutrition and risk of malnutrition in a prospectively recruited group of hospitalised pediatric surgical patients, the data acquired in the present study emphasise the need to raise clinician's awareness about the importance of nutritional status assessment among hospitalised pediatric patients and the benefits of identifying patients at the risk of nutritional depletion before malnutrition occurs. Our findings support the use of the STRONGkids tool among pediatric surgical patients to identify patients at risk for malnutrition and to increase the physician's awareness of nutritional assessment among hospitalised patients upon admission.
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Affiliation(s)
- Çiğdem Ulukaya Durakbaşa
- Department of Pediatric Surgery, İstanbul Medeniyet University Faculty of Medicine, İstanbul, Turkey
| | - Selma Fettahoğlu
- Department of Pediatric Surgery, İstanbul Medeniyet University Faculty of Medicine, İstanbul, Turkey
| | - Ahu Bayar
- Department of Pediatric Surgery, İstanbul Medeniyet University Faculty of Medicine, İstanbul, Turkey
| | - Murat Mutus
- Department of Pediatric Surgery, İstanbul Medeniyet University Faculty of Medicine, İstanbul, Turkey
| | - Hamit Okur
- Department of Pediatric Surgery, İstanbul Medeniyet University Faculty of Medicine, İstanbul, Turkey
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Lakdawalla DN, Mascarenhas M, Jena AB, Vanderpuye-Orgle J, LaVallee C, Linthicum MT, Snider JT. Impact of Oral Nutrition Supplements on Hospital Outcomes in Pediatric Patients. JPEN J Parenter Enteral Nutr 2014; 38:42S-9S. [DOI: 10.1177/0148607114549769] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Darius N. Lakdawalla
- Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, California
| | | | - Anupam B. Jena
- Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts
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White M, Lawson K, Ramsey R, Dennis N, Hutchinson Z, Soh XY, Matsuyama M, Doolan A, Todd A, Elliott A, Bell K, Littlewood R. Simple Nutrition Screening Tool for Pediatric Inpatients. JPEN J Parenter Enteral Nutr 2014; 40:392-8. [DOI: 10.1177/0148607114544321] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Accepted: 06/30/2014] [Indexed: 11/16/2022]
Affiliation(s)
- Melinda White
- Department of Dietetics and Food Services, Royal Children’s Hospital, Children’s Health Queensland Hospital and Health Service, Herston, Queensland, Australia
| | - Karen Lawson
- Department of Nutrition and Dietetics, Mater Children’s Hospital, South Brisbane, Queensland, Australia
| | - Rebecca Ramsey
- School of Exercise and Nutrition Sciences, Nutrition and Dietetics Program, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - Nicole Dennis
- Department of Dietetics and Food Services, Royal Children’s Hospital, Children’s Health Queensland Hospital and Health Service, Herston, Queensland, Australia
| | - Zoe Hutchinson
- Nutrition and Dietetics Department, Nambour Hospital, Nambour, Queensland, Australia
| | - Xin Ying Soh
- School of Exercise and Nutrition Sciences, Nutrition and Dietetics Program, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - Misa Matsuyama
- School of Public Health, Griffith University, Southport, Queensland, Australia
| | - Annabel Doolan
- Department of Nutrition and Dietetics, Mater Health Services, South Brisbane, Queensland, Australia
| | - Alwyn Todd
- Mater Health Services and Griffith Health Institute, Griffith University, Queensland, Australia
- Raymond Terrace, South Brisbane, Queensland, Australia
| | - Aoife Elliott
- Department of Nutrition and Dietetics, Mater Health Services, South Brisbane, Queensland, Australia
| | - Kristie Bell
- Department of Dietetics and Food Services, Royal Children’s Hospital, Children’s Health Queensland Hospital and Health Service, Herston, Queensland, Australia
| | - Robyn Littlewood
- Department of Dietetics and Food Services, Royal Children’s Hospital, Children’s Health Queensland Hospital and Health Service, Herston, Queensland, Australia
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Pacheco-Acosta JC, Gomez-Correa AC, Florez ID, Cortés JE, Velez D, Gomez J, Munera M, Arboleda S. Incidence of Nutrition Deterioration in Nonseriously Ill Hospitalized Children Younger Than 5 Years. Nutr Clin Pract 2014; 29:692-7. [DOI: 10.1177/0884533614533122] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
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Xu Z, Li Y, Yang X, Wang J, Li J. Early Detection of Coagulation Abnormalities in Patients at Nutritional Risk: The Novel Role of Thromboelastography. Am Surg 2014. [DOI: 10.1177/000313481408000129] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
It is believed that malnutrition is common among hospitalized patients and associated with increased risk of morbidity and mortality. It is unclear if it is more likely to cause coagulation disorders in patients with malnutrition. We, therefore, investigate the feasibility of using thromboelastography (TEG) in early detection of coagulation abnormalities in patients at nutritional risk. Fifty successive adult patients with gastrointestinal disease were prospectively divided into one of two groups according to nutritional risk score (less than 3 and 3 or greater). Blood samples were collected at admission for analysis of standard biochemical parameters, routine coagulation tests, and TEG parameters. A total of 62 per cent of patients (n = 31) were at nutritional risk. Serum concentrations of prealbumin, transferrin, total protein, low-density lipoprotein, high-density lipoprotein, and cholesterol were much lower in the nutritional risk group than in the no-risk group ( P ≤ 0.05). There was no significant difference in routine coagulation tests, whereas most of the TEG parameters showed significant differences between the two groups. The overall coagulation function was worse in patients at nutritional risk than in patients with good nutritional status ( P ≤ 0.01). TEG appears to be more sensitive for the detection of coagulation abnormalities compared with routine coagulation tests in patients at nutritional risk. The phenomenon described in this article should be useful in further studies of patients with malnutrition.
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Affiliation(s)
- Ziwei Xu
- Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
- Department of Surgery, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Yousheng Li
- Department of Surgery, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Xiufang Yang
- Department of Surgery, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Jian Wang
- Department of Surgery, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Jieshou Li
- Department of Surgery, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
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Spagnuolo MI, Liguoro I, Chiatto F, Mambretti D, Guarino A. Application of a score system to evaluate the risk of malnutrition in a multiple hospital setting. Ital J Pediatr 2013; 39:81. [PMID: 24373709 PMCID: PMC3901031 DOI: 10.1186/1824-7288-39-81] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Accepted: 12/17/2013] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND An increased but unpredictable risk of malnutrition is associated with hospitalization, especially in children with chronic diseases. We investigated the applicability of Screening Tool for Risk of Impaired Nutritional Status and Growth (STRONGkids), an instrument proposed to estimate the risk of malnutrition in hospitalized children. We also evaluated the role of age and co-morbidities as risk for malnutrition. METHODS The STRONGkids consists of 4 items providing a score that classifies a patient in low, moderate, high risk for malnutrition. A prospective observational multi-centre study was performed in 12 Italian hospitals. Children 1-18 years consecutively admitted and otherwise unselected were enrolled. Their STRONGkids score was obtained and compared with the actual nutritional status expressed as BMI and Height for Age SD-score. RESULTS Of 144 children (75 males, mean age 6.5 ± 4.5 years), 52 (36%) had an underlying chronic disease. According to STRONGkids, 46 (32%) children were at low risk, 76 (53%) at moderate risk and 22 (15%) at high risk for malnutrition. The latter had significantly lower Height for Age values (mean SD value -1.07 ± 2.08; p = 0.008) and BMI values (mean SD-values -0.79 ± 2.09; p = 0.0021) in comparison to other groups. However, only 29 children were actually malnourished. CONCLUSIONS The STRONGkids is easy to administer. It is highly sensitive but not specific. It may be used as a very preliminary screening tool to be integrated with other clinical data in order to reliably predict the risk of malnutrition.
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Affiliation(s)
| | | | | | | | - Alfredo Guarino
- Department of Translational Medical Science - Section of Pediatrics, University of Naples "Federico II", Naples, Italy.
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40
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The STRONGkids nutritional screening tool in hospitalized children: A validation study. Nutrition 2013; 29:1356-61. [DOI: 10.1016/j.nut.2013.05.008] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2013] [Revised: 04/16/2013] [Accepted: 05/12/2013] [Indexed: 01/04/2023]
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Moeeni V, Walls T, Day AS. Nutritional status and nutrition risk screening in hospitalized children in New Zealand. Acta Paediatr 2013; 102:e419-23. [PMID: 23692547 DOI: 10.1111/apa.12299] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2013] [Revised: 05/07/2013] [Accepted: 05/17/2013] [Indexed: 12/01/2022]
Abstract
AIM Children requiring hospitalization are at risk of malnutrition. This study aimed to define the nutritional status of paediatric inpatients in comparison with healthy children and to compare and contrast the feasibility and validity of three nutritional risk screening (NRS) tools in the hospitalized children. METHODS A total of 162 children admitted to Christchurch Hospital were assessed along with a similar group of healthy children. Their nutritional state was assessed and classified using standard criteria. The NRS tools were applied, and patients were classified into low-, medium- and high-risk groups. The feasibility and validity of the tools were assessed. RESULTS Under-nutrition was more frequent in the inpatient group (9.9% vs. 3.7%; p = 0.04), whereas both groups had similar rates of overweight/obesity. NRS tools were able to identify between 81% and 100% of the malnourished patients in the medium- to high-risk groups. Undernourished patients had longer hospital stay than well-nourished patients. CONCLUSION Hospitalized children have higher rates of under-nutrition than healthy children in NZ. The three NRS tools were able to identify children at nutritional risk with differing utility. In this setting, STRONGkids was the most reliable tool.
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Affiliation(s)
- Vesal Moeeni
- Department of Paediatrics; University of Otago; Christchurch New Zealand
| | - Tony Walls
- Department of Paediatrics; University of Otago; Christchurch New Zealand
| | - Andrew S Day
- Department of Paediatrics; University of Otago; Christchurch New Zealand
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Sissaoui S, De Luca A, Piloquet H, Guimber D, Colomb V, Peretti N, Bouniol A, Breton A, Chouraqui JP, Coste ME, Djeddi D, Dorigny B, Goulet O, Gottrand F, Hermouet P, Lambe C, Leke A, Leprince S, Mas E, Massicot P, Renard P, Thomassin N, Triolo V, Turquet A, Vanrenterghem A, Fischbach M, Ingrand P, Hankard R. Large scale nutritional status assessment in pediatric hospitals. ACTA ACUST UNITED AC 2013. [DOI: 10.1016/j.clnme.2013.02.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Current world literature. Curr Opin Endocrinol Diabetes Obes 2012; 19:429-34. [PMID: 22931856 DOI: 10.1097/med.0b013e328358c698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Higashiyama Y, Kubota M, Oshima S, Mibu M, Yasui Y, Nagai A. Assessment of Japanese healthy children’s nutritional status using Waterlow classification. Health (London) 2012. [DOI: 10.4236/health.2012.411158] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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