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Saengnipanthkul S, Sirikarn P, Chongviriyaphan N, Densupsoontorn N, Phosuwattanakul J, Apiraksakorn A, Sitthikarnkha P, Techasatian L, Uppala R, Lumbiganon P. Development and Validation of a Pediatric Hospital-Acquired Malnutrition (PHaM) Risk Score to Predict Nutritional Deterioration in Hospitalized Pediatric Patients: A Secondary Analysis Based on a Multicenter Prospective Cohort Study. Nutrients 2024; 16:2898. [PMID: 39275214 DOI: 10.3390/nu16172898] [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: 06/14/2024] [Revised: 08/11/2024] [Accepted: 08/28/2024] [Indexed: 09/16/2024] Open
Abstract
(1) Background: Hospital-acquired malnutrition in pediatric patients leads to adverse outcomes. This study aimed to develop and validate a pediatric hospital-acquired malnutrition (PHaM) risk score to predict nutritional deterioration. (2) Methods: This was a derivative retrospective cohort study for developing a PHaM risk score. The study included data from children aged 1 month-18 years admitted to pediatric wards in four tertiary care hospitals for at least 72 h between December 2018 and May 2019. Data on pediatric patients' characteristics, medical history, nutritional status, gastrointestinal symptoms, and outcomes were used for tool development. Logistic regression identified risk factors for nutritional deterioration, defined as a decline in BMI z-score ≥ 0.25 SD and/or ≥2% weight loss. A PHaM risk score was developed based on these factors and validated with an independent prospective cohort from July 2020 to March 2021. (3) Results: The study used a derivative cohort of 444 patients and a validation cohort of 373 patients. Logistic regression identified gastrointestinal symptoms, disease severity, fever, lower respiratory tract infection, and reduced food intake as predictors. The PHaM risk score (maximum 9 points) showed good discrimination and calibration (AUC 0.852, 95% CI: 0.814-0.891). Using a cut-off at 2.5 points, the scale had 63.0% sensitivity, 88.6% specificity, 76.1% positive predictive value, and 80.6% negative predictive value (NPV) when applied to the derivative cohort. The accuracy improved on the validation cohort, with 91.9% sensitivity and 93.0% NPV. (4) Conclusions: This PHaM risk score is a novel and probably effective tool for predicting nutritional deterioration in hospitalized pediatric patients, and its implementation in clinical practice could enhance nutritional care and optimize outcomes.
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Affiliation(s)
- Suchaorn Saengnipanthkul
- Department of Pediatrics, Faculty of Medicine, Srinagarind Hospital, Khon Kaen University, Khon Kaen 40002, Thailand
| | - Prapassara Sirikarn
- Department of Epidemiology and Biostatistics, Faculty of Public Health, Khon Kaen University, Khon Kaen 40002, Thailand
| | - Nalinee Chongviriyaphan
- Division of Nutrition, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
| | - Narumon Densupsoontorn
- Division of Nutrition, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | - Jeeraparn Phosuwattanakul
- Division of Nutrition, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
| | | | - Phanthila Sitthikarnkha
- Department of Pediatrics, Faculty of Medicine, Srinagarind Hospital, Khon Kaen University, Khon Kaen 40002, Thailand
| | - Leelawadee Techasatian
- Department of Pediatrics, Faculty of Medicine, Srinagarind Hospital, Khon Kaen University, Khon Kaen 40002, Thailand
| | - Rattapon Uppala
- Department of Pediatrics, Faculty of Medicine, Srinagarind Hospital, Khon Kaen University, Khon Kaen 40002, Thailand
| | - Pagakrong Lumbiganon
- Department of Pediatrics, Faculty of Medicine, Srinagarind Hospital, Khon Kaen University, Khon Kaen 40002, Thailand
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Pinzón-Espitia OL, Castañeda López JF, Pardo González CA. [Risk of malnutrition and food insecurity in pediatric cancer patients. The NutriCare Study]. NUTR HOSP 2024. [PMID: 39054863 DOI: 10.20960/nh.05152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2024] Open
Abstract
INTRODUCTION cancer and its treatments have been associated with poor nutritional status in children and adolescents. OBJECTIVE to establish the nutritional risk of pediatric patients and the degree of food and nutritional insecurity in the homes of children and adolescents with cancer who have been hospitalized in a high complexity pediatric oncology center. METHODS a prospective observational study conducted at the Fundación Hospital Pediátrico la Misericordia - HOMI. It included a sample of 41 children and adolescents aged 0 to 17 years and 11 months with a diagnosis of childhood cancer during the study period. The participants recruited during hospitalization had the application of the SCAN nutritional screening tool for childhood cancer, Spanish version, validated in HOMI and the Latin American and Caribbean Scale of Food and Nutritional Security - ELCSA, adapted and validated in Colombia. RESULTS 76 % (n = 31) of the patients were classified as "At risk of malnutrition" using the SCAN-SP nutritional screening tool. It was observed that 56 % of all households had a proportion of food insecurity, of which the classification of food (in)security was mild in 29 %, moderate in 20 % and severe in 7 % of households with children under 18 years of age. CONCLUSION in the framework of the nutritional care process, it is important to take into account factors that include a complete nutritional risk assessment and evaluation that includes the measurement of food security.
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Affiliation(s)
- Olga Lucía Pinzón-Espitia
- Facultad de Medicina. Universidad Nacional de Colombia. Fundación Hospital Pediátrico La Misericordia - HOMI. 3Escuela de Medicina y Ciencias de la Salud. Universidad del Rosario
| | - Jhon Fredy Castañeda López
- Facultad de Medicina. Universidad Nacional de Colombia. Fundación Hospital Pediátrico La Misericordia - HOMI
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Brunet-Wood K, Tul-Noor Z, Bandsma RHJ, Carter L, Fleming-Carroll B, Gramlich L, Hutchison K, Huysentruyt K, Kalnins D, Marchand V, Martinez A, Pai N, Vachon M, Hulst JM. Development of the Pediatric Integrated Nutrition Pathway for Acute Care (P-INPAC) using a modified Delphi technique. Appl Physiol Nutr Metab 2024; 49:700-711. [PMID: 38320255 DOI: 10.1139/apnm-2023-0180] [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: 02/08/2024]
Abstract
One in three hospitalized children have disease-related malnutrition (DRM) upon admission to hospital, and all children are at risk for further nutritional deterioration during hospital stay; however, systematic approaches to detect DRM in Canada are lacking. To standardise and improve hospital care, the multidisciplinary pediatric working group of the Canadian Malnutrition Taskforce aimed to develop a pediatric, inpatient nutritional care pathway based on available evidence, feasibility of resources, and expert consensus. The working group (n = 13) undertook a total of four meetings: an in-person meeting to draft the pathway based on existing literature and modelled after the Integrated Nutrition Pathway for Acute Care (INPAC) in adults, followed by three online surveys and three rounds of online Delphi consensus meetings to achieve agreement on the draft pathway. In the first Delphi survey, 32 questions were asked, whereas in the second and third rounds 27 and 8 questions were asked, respectively. Consensus was defined as any question/issue in which at least 80% agreed. The modified Delphi process allowed the development of an evidence-informed, consensus-based pathway for inpatients, the Pediatric Integrated Nutrition Pathway for Acute Care (P-INPAC). It includes screening <24 h of admission, assessment with use of Subjective Global Nutritional Assessment (SGNA) <48 h of admission, as well as prevention, and treatment of DRM divided into standard, advanced, and specialized nutrition care plans. Research is necessary to explore feasibility of implementation and evaluate the effectiveness by integrating P-INPAC into clinical practice.
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Affiliation(s)
- Kim Brunet-Wood
- Canadian Malnutrition Task Force, Canadian Nutrition Society, Ottawa, ON K1C 6A8, Canada
| | - Zujaja Tul-Noor
- Division of Paediatric Gastroenterology, Hepatology and Nutrition, Department of Paediatrics, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
| | - Robert H J Bandsma
- Division of Paediatric Gastroenterology, Hepatology and Nutrition, Department of Paediatrics, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
- Department of Nutritional Sciences, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Laura Carter
- Nutrition Services, Alberta Health Services, Edmonton, AB, Canada
| | - Bonnie Fleming-Carroll
- SickKids Learning Institute, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
| | - Leah Gramlich
- Division of Gastroenterology, University of Alberta, Edmonton, AB T6G 2G3, Canada
| | - Kim Hutchison
- Health Sciences Centre, Winnipeg, MB R3A 1R9, Canada
| | - Koen Huysentruyt
- Department of Pediatric Gastroenterology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel (VUB), 1090 Brussels, Belgium
| | - Daina Kalnins
- Department of Clinical Dietetics, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
| | - Valerie Marchand
- Division of Paediatric Gastroenterology, Hepatology and Nutrition, Department of Paediatrics, Ste-Justine UHC, University of Montreal, Montreal, QC H3T 1C5, Canada
| | - Andrea Martinez
- Division of Paediatric Gastroenterology, Hepatology and Nutrition, Department of Paediatrics, IWK Health Centre, University of Dalhousie, Halifax, NS B3K 6R8, Canada
| | - Nikhil Pai
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, McMaster Children's Hospital, Hamilton, ON, Canada
| | - Mélanie Vachon
- Department of Clinical Nutrition, Centre Hospitalier Universitaire de Québec-Université Laval, Quebec, QC, G1R 2J6, Canada
| | - Jessie M Hulst
- Division of Paediatric Gastroenterology, Hepatology and Nutrition, Department of Paediatrics, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
- Department of Nutritional Sciences, University of Toronto, Toronto, ON M5S 1A8, Canada
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Development and Validation of a New Screening Tool with Non-Invasive Indicators for Assessment of Malnutrition Risk in Hospitalised Children. CHILDREN 2022; 9:children9050731. [PMID: 35626908 PMCID: PMC9140013 DOI: 10.3390/children9050731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 05/06/2022] [Accepted: 05/12/2022] [Indexed: 11/17/2022]
Abstract
There is no evidence of the most effective nutritional screening tool for hospitalized children. The present study aimed to develop a quick, simple, and valid screening tool for identifying malnutrition risk of hospital admission with non-invasive indicators. A cross-sectional study was conducted. Children`s nutritional baseline using a questionnaire, subjective malnutritional risk, and Subjective Global Nutritional Assessment were assessed on admission. Concurrent validity was assessed using American Society for Parenteral and Enteral Nutrition (ASPEN)and Academy of Nutrition and Dietetics assessment and Subjective Global Nutritional Assessment tool. A new screening tool Simple Pediatric Nutritional risk Screening tool (SPENS) was developed, and sensitivity, specificity and reliability were evaluated. A total of 180 children aged from 1 month to 18 years were included (142 in the development phase and 38 in the validation phase). SPENS consist of four variables and shows almost perfect agreement with subjective malnutritional risk assessment (κ = 0.837) with high sensitivity and specificity (93.3% and 91.3% respectively). Compared with Subjective Global Nutritional Assessment and ASPEN and Academy of Nutrition and Dietetics assessment, SPENS had sensitivity 92.9% and 86.7%, a specificity of 87.5% and 87.0%, and an overall agreement of 0.78 and 0.728, respectively. Due to the fast, simple, easy, and practical to use, screening the SPENS can be performed by nurses, physicians, and dieticians.
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Becker PJ, Brunet-Wood MK. Pediatric malnutrition screening and assessment tools: Analyzing the gaps. Nutr Clin Pract 2021; 37:1088-1104. [PMID: 34664733 DOI: 10.1002/ncp.10793] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Pediatric healthcare professionals know that children who are malnourished have worse clinical outcomes than do their well-nourished peers. The body of evidence in the literature on the topic of pediatric malnutrition (PMN) is growing and supports this conclusion. The goal of this article is to present the current state of practice related to PMN screening, the use of malnutrition risk screening (MNRS) tools, malnutrition assessment, and the use of malnutrition assessment tools. The purpose is also to discuss best practice for MNRS and assessment and to consider the gaps in practice where additional work is needed.
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Affiliation(s)
| | - M Kim Brunet-Wood
- Pediatric Working Group, Canadian Malnutrition Task Force, St Albert, Alberta, Canada
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Litchford A, Wengreen H, Savoie-Roskos MR. Tools available to screen for child feeding dysfunction: A systematic review. Appetite 2021; 167:105611. [PMID: 34332001 DOI: 10.1016/j.appet.2021.105611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 06/23/2021] [Accepted: 07/23/2021] [Indexed: 11/16/2022]
Abstract
INTRODUCTION The aim of this systematic review is to identify existing pediatric feeding screening tools that have been shown to be valid and reliable in identifying feeding dysfunction in children. METHOD A database search produced 5862 relevant articles to be screened based on pre-determined inclusion/exclusion criteria. After full text review of 183 articles, 64 articles were included in the review. RESULTS Forty-four studies detailed development and validation of unique feeding screening tools for the pediatric population. The remaining twenty studies were validations studies of already developed screening tools. DISCUSSION Multiple screening tools identified were effective in determining feeding dysfunction in children. Several tools employed excellent techniques to measure reliability and validity for diverse pediatric populations. Careful consideration of the tools listed in this review will help practitioners determine the best method for feeding screening in their facility.
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Affiliation(s)
- April Litchford
- Utah State University, 01 South Main Brigham City, Utah, 84302, USA.
| | - Heidi Wengreen
- Utah State University, 8700 Old Main Hill, Logan, UT, 84322, USA.
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Abstract
PURPOSE OF REVIEW There is ongoing interest in nutritional screening tools in pediatrics to facilitate the identification of children at risk for malnutrition who need further assessment and possible nutritional intervention. The choice for a specific tool depends on various factors. This review aims to provide an overview of recent progress in pediatric nutritional screening methods. RECENT FINDINGS We present recent studies about newly developed or adjusted tools, the applicability of nutritional screening tools in specific populations, and how to implement screening in the overall process of improving nutritional care in the pediatric hospital setting. SUMMARY Three new screening tools have been developed for use on admission to hospital: two for the mixed pediatric hospitalized population and one for infants. A simple weekly rescreening tool to identify hospital-acquired nutritional deterioration was developed for use in children with prolonged hospital stay. Different from most previous studies that only assessed the relationship between the nutritional risk score and anthropometric parameters of malnutrition, new studies in children with cancer, burns, and biliary atresia show significant associations between high nutritional risk and short-term outcome measures such as increased complication rate and weight loss. For implementation of a nutritional care process incorporating nutritional screening in daily practice, simplicity seems to be of great importance.
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Affiliation(s)
- Jessie M Hulst
- Department of Paediatrics, Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, Canada
| | - Koen Huysentruyt
- Department of Paediatrics, Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, Canada
- Department of Pediatrics, Paediatric Gastroenterology, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Koen F Joosten
- Department of Pediatrics, Pediatric Intensive Care, Erasmus MC- Sophia Children's Hospital, Rotterdam, the Netherlands
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