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de Mello LB, da Silva JA, Clemente HA, Neto JAB, Mello CS. Nutritional risk and clinical outcomes of COVID-19 in hospitalized children and adolescents: a multicenter cohort. J Pediatr (Rio J) 2023; 99:641-647. [PMID: 37478896 PMCID: PMC10594002 DOI: 10.1016/j.jped.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 05/31/2023] [Accepted: 06/01/2023] [Indexed: 07/23/2023] Open
Abstract
OBJECTIVE To verify the association between nutritional risk on admission and clinical outcomes of COVID-19 in hospitalized children and adolescents. METHODS Multicenter cohort study was conducted in two cities in the northeastern region of Brazil, with children under 18 years of age laboratory diagnosed with COVID-19. Sociodemographic data and nutritional risk screening by STRONGKids (low, medium and high risk) were collected remotely and in hospital records, respectively. The outcomes assessed were the need for ICU admission, length of stay (< 10 days or ≥ 10 days), critical cases, and death. Multivariable logistic regression models were used to evaluate the effects of high nutritional risk on COVID-19 clinical outcomes. RESULTS 103 individuals were evaluated, of these 35 (34.0%) had low risk, 44 (42.7%) medium risk, and 24 (23.3%) had high risk of malnutrition. In multivariate analysis, ICU bed admission (OR: 4.57; 95%CI, 1.39-4.97; p = 0.01), hospitalization longer than or equal to ten days (OR: 3.96; 95%CI, 1.22-2.83; p = 0.02) and critical cases (OR: 4.35; 95%CI, 1.08-7.55; p = 0.04) were associated with high nutritional risk. Death was not associated with high nutritional risk. CONCLUSIONS Children and adolescents with high nutritional risk by STRONGkids at hospital admission were more likely to be admitted to the ICU, have hospitalization longer than or equal to ten days, and have critical cases when infected with SARS-CoV-2.
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Affiliation(s)
- Leilah B de Mello
- Universidade Federal da Bahia (UFBA), Escola de Nutrição, Nutrição Clínica, Salvador, BA, Brazil
| | - José Adailton da Silva
- Universidade Federal do Rio Grande do Norte (UFRN), Faculdade de Ciências da Saúde do Trairi, Saúde Coletiva, Natal, RN, Brazil
| | - Heleni A Clemente
- Universidade Federal do Rio Grande do Norte (UFRN), Faculdade de Ciências da Saúde do Trairi, Saúde Coletiva, Natal, RN, Brazil
| | - João A Barros Neto
- Universidade Federal de Alagoas (UFAL), Faculdade de Nutrição, Processos Interativos dos Órgãos e Sistemas, Maceió, AL, Brazil
| | - Carolina S Mello
- Universidade Federal da Bahia (UFBA), Escola de Nutrição, Pediatria e Ciências Aplicadas à Pediatria, Salvador, BA, Brazil.
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Zhang Y, Lu L, Yang L, Yan W, Yu Q, Sheng J, Mao X, Feng Y, Tang Q, Cai W, Wang Y. Evaluation of a new digital pediatric malnutrition risk screening tool for hospitalized children with congenital heart disease. BMC Pediatr 2023; 23:126. [PMID: 36934232 PMCID: PMC10024365 DOI: 10.1186/s12887-023-03899-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 02/08/2023] [Indexed: 03/20/2023] Open
Abstract
BACKGROUND In a cohort of hospitalized children with congenital heart disease (CHD), a new digital pediatric malnutrition screening tool as a mobile application was validated, and its effectiveness and clinical value were determined as a prospective study. METHODS AND RESULTS Children with CHD (n = 1125) were screened for malnutrition risk. The incidence of risk and the differences among various age groups and types of CHD were characterized. The optimal threshold for the tool to determine if there is a risk of malnutrition is score 2, while the Youden index was 79.1%, and the sensitivity and specificity were 91.2% and 87.9%, respectively. Based on such criterion, 351 children were at risk of malnutrition accounting for 31.20% of the total. Compared with the non-malnutritional risk group, the median age for the group at risk for malnutrition was younger (8.641 months [4.8, 23.1] vs. 31.589 months [12.4, 54.3], P < 0.01), and the length of stay was longer (12.000 [8.0, 17.0] vs. (8.420 [5.0, 12.0], P < 0.01]. There were significant differences in malnutrition risk among different age groups (χ2 = 144.933, P < 0.01), and children under one year of age exhibited the highest risk for malnutrition and more extended hospital stay (H = 78.085, P < 0.01). The risk of malnutrition among children with cyanotic CHD was higher than in those with non-cyanotic CHD (χ2 = 104.384, P < 0.01). CONCLUSIONS The new digital pediatric malnutrition screening tool showed high sensitivity and specificity in children with CHD. The tool indicated that the malnutrition risk for young children and children with cyanotic or Bethesda moderate and complex CHD was higher, and the hospitalization time was longer than in the non-risk group. The tool provides a rational approach to targeted nutrition intervention and support and may improve clinical outcomes.
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Affiliation(s)
- Yajie Zhang
- Division of Pediatric Gastroenterology and Nutrition, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Institute for Pediatric Research, Shanghai, China
- Department of Pediatric Surgery, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Laboratory of Pediatric Gastroenterology and Nutrition, Shanghai, China
| | - Lina Lu
- Division of Pediatric Gastroenterology and Nutrition, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Laboratory of Pediatric Gastroenterology and Nutrition, Shanghai, China
| | - Ling Yang
- Pediatric Heart Center, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Weihui Yan
- Division of Pediatric Gastroenterology and Nutrition, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Laboratory of Pediatric Gastroenterology and Nutrition, Shanghai, China
| | - Qun Yu
- Department of Nursing, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jinye Sheng
- Department of Clinical Nutrition, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xiaomeng Mao
- Department of Clinical Nutrition, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yi Feng
- Department of Clinical Nutrition, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Qingya Tang
- Department of Clinical Nutrition, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Wei Cai
- Division of Pediatric Gastroenterology and Nutrition, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
- Shanghai Institute for Pediatric Research, Shanghai, China.
- Department of Pediatric Surgery, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
- Shanghai Key Laboratory of Pediatric Gastroenterology and Nutrition, Shanghai, China.
| | - Ying Wang
- Division of Pediatric Gastroenterology and Nutrition, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
- Shanghai Key Laboratory of Pediatric Gastroenterology and Nutrition, Shanghai, China.
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Zamberlan P, Carlotti APDCP, Viani KHC, Rodriguez IS, Simas JDC, Silvério AB, Volpon LC, de Carvalho WB, Delgado AF. Increased nutrition risk at admission is associated with longer hospitalization in children and adolescents with COVID-19. Nutr Clin Pract 2022; 37:393-401. [PMID: 35226766 PMCID: PMC9088697 DOI: 10.1002/ncp.10846] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 01/12/2022] [Accepted: 01/22/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND We investigated the association of nutritional risk and inflammatory marker level with length of stay (LOS) in children and adolescents hospitalized for COVID-19 infection in two pediatric teaching hospitals in a developing country. METHODS This was a cross-sectional analytical retrospective study performed in two pediatric hospitals. We included the data from all children and adolescents who were hospitalized with a SARS-CoV-2 infection between March and December 2020. Demographic, anthropometric, clinical, and laboratory data were extracted from electronic medical records. Nutritional risk was assessed according to the STRONGkids tool within 24 hours of admission and was categorized into two levels: ≥4 (high risk) and <4 (moderate or low risk). Means or medians were compared between nutritional risk groups using the t test and Mann-Whitney U test, respectively. The association of nutritional risk and inflammatory markers with LOS was estimated using the Kaplan-Meier method and log-rank test. Cox proportional-hazard and linear regression models were performed, and adjusted for sex, age, and respiratory symptoms. RESULTS From a total of 73 patients, 20 (27.4%) had a STRONGkids score ≥4 at admission, which was associated with a longer LOS even after adjusting (β = 12.30; 1.74-22.9 95% CI; P = 0.023). The same association was observed between LOS and all laboratory markers except for D-dimer. CONCLUSION Among children and adolescents with COVID-19, a STRONGkids score ≥4 at admission, lower values of albumin, lymphocytes, and hemoglobin, and higher CRP values were associated with longer LOS.
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Affiliation(s)
- Patrícia Zamberlan
- Division of NutritionInstituto da Criança e do Adolescente, Hospital das Clínicas da Universidade de São PauloSão PauloBrazil
| | | | - Karina Helena Canton Viani
- Division of NutritionInstituto da Criança e do Adolescente, Hospital das Clínicas da Universidade de São PauloSão PauloBrazil
| | - Isadora Souza Rodriguez
- Pediatric Intensive Care UnitInstituto da Criança e do Adolescente, Hospital das Clínicas da Universidade de São PauloSão PauloBrazil
| | - Josiane de Carvalho Simas
- Pediatric Intensive Care UnitInstituto da Criança e do Adolescente, Hospital das Clínicas da Universidade de São PauloSão PauloBrazil
| | - Ariadne Beatriz Silvério
- Department of PediatricsFaculdade de Medicina de Ribeirão Preto, Universidade de São PauloSão PauloBrazil
| | - Leila Costa Volpon
- Department of PediatricsFaculdade de Medicina de Ribeirão Preto, Universidade de São PauloSão PauloBrazil
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Ventura JC, Silveira TT, Bechard L, McKeever L, Mehta NM, Moreno YMF. Nutritional screening tool for critically ill children: a systematic review. Nutr Rev 2021; 80:1392-1418. [PMID: 34679168 DOI: 10.1093/nutrit/nuab075] [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: 11/13/2022] Open
Abstract
CONTEXT Nutritional screening tools (NSTs) are used to identify patients who are at risk of nutritional status (NS) deterioration and associated clinical outcomes. Several NSTs have been developed for hospitalized children; however, none of these were specifically developed for Pediatric Intensive Care Unit (PICU) patients. OBJECTIVE A systematic review of studies describing the development, application, and validation of NSTs in hospitalized children was conducted to critically appraise their role in PICU patients. DATA SOURCES PubMed, Embase, Web of Science, Scopus, SciELO, LILACS, and Google Scholar were searched from inception to December 11, 2020. DATA EXTRACTION The review included 103 studies that applied NSTs at hospital admission. The NST characteristics collected included the aims, clinical setting, variables, and outcomes. The suitability of the NSTs in PICU patients was assessed based on a list of variables deemed relevant for this population. DATA ANALYSIS From 19 NSTs identified, 13 aimed to predict NS deterioration. Five NSTs were applied in PICU patients, but none was validated for this population. NSTs did not include clinical, NS, laboratory, or dietary variables that were deemed relevant for the PICU population. CONCLUSION None of the available NSTs were found to be suitable for critically ill children, so a new NST should be developed for this population. AQ6. SYSTEMATIC REVIEW REGISTRATION PROSPERO registration no. CRD42020167898.
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Affiliation(s)
- Julia C Ventura
- Julia C. Ventura, Taís T. Silveira, and Yara M. F. Moreno are with the Graduate Program in Nutrition, Federal University of Santa Catarina, Florianópolis, SC, Brazil. L. Bechard and N. M. Mehta are with the Division of Critical Care Medicine, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts, USA. L. McKeever is with the Perelman School of Medicine, at the University of Pennsylvania, Philadelphia, Pennsylvania, USA. N. M. Mehta is with the Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA. Yara M. F. Moreno is with the Department of Nutrition, Federal University of Santa Catarina, Florianópolis, SC, Brazil
| | - Taís T Silveira
- Julia C. Ventura, Taís T. Silveira, and Yara M. F. Moreno are with the Graduate Program in Nutrition, Federal University of Santa Catarina, Florianópolis, SC, Brazil. L. Bechard and N. M. Mehta are with the Division of Critical Care Medicine, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts, USA. L. McKeever is with the Perelman School of Medicine, at the University of Pennsylvania, Philadelphia, Pennsylvania, USA. N. M. Mehta is with the Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA. Yara M. F. Moreno is with the Department of Nutrition, Federal University of Santa Catarina, Florianópolis, SC, Brazil
| | - Lori Bechard
- Julia C. Ventura, Taís T. Silveira, and Yara M. F. Moreno are with the Graduate Program in Nutrition, Federal University of Santa Catarina, Florianópolis, SC, Brazil. L. Bechard and N. M. Mehta are with the Division of Critical Care Medicine, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts, USA. L. McKeever is with the Perelman School of Medicine, at the University of Pennsylvania, Philadelphia, Pennsylvania, USA. N. M. Mehta is with the Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA. Yara M. F. Moreno is with the Department of Nutrition, Federal University of Santa Catarina, Florianópolis, SC, Brazil
| | - Liam McKeever
- Julia C. Ventura, Taís T. Silveira, and Yara M. F. Moreno are with the Graduate Program in Nutrition, Federal University of Santa Catarina, Florianópolis, SC, Brazil. L. Bechard and N. M. Mehta are with the Division of Critical Care Medicine, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts, USA. L. McKeever is with the Perelman School of Medicine, at the University of Pennsylvania, Philadelphia, Pennsylvania, USA. N. M. Mehta is with the Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA. Yara M. F. Moreno is with the Department of Nutrition, Federal University of Santa Catarina, Florianópolis, SC, Brazil
| | - Nilesh M Mehta
- Julia C. Ventura, Taís T. Silveira, and Yara M. F. Moreno are with the Graduate Program in Nutrition, Federal University of Santa Catarina, Florianópolis, SC, Brazil. L. Bechard and N. M. Mehta are with the Division of Critical Care Medicine, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts, USA. L. McKeever is with the Perelman School of Medicine, at the University of Pennsylvania, Philadelphia, Pennsylvania, USA. N. M. Mehta is with the Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA. Yara M. F. Moreno is with the Department of Nutrition, Federal University of Santa Catarina, Florianópolis, SC, Brazil
| | - Yara M F Moreno
- Julia C. Ventura, Taís T. Silveira, and Yara M. F. Moreno are with the Graduate Program in Nutrition, Federal University of Santa Catarina, Florianópolis, SC, Brazil. L. Bechard and N. M. Mehta are with the Division of Critical Care Medicine, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts, USA. L. McKeever is with the Perelman School of Medicine, at the University of Pennsylvania, Philadelphia, Pennsylvania, USA. N. M. Mehta is with the Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA. Yara M. F. Moreno is with the Department of Nutrition, Federal University of Santa Catarina, Florianópolis, SC, Brazil
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