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Rudie C, Persaud S, Hron BM, Raymond M, Huh SY. Survey of nutrition screening practices in pediatric hospitals across the United States. Nutr Clin Pract 2024. [PMID: 39049548 DOI: 10.1002/ncp.11193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 06/26/2024] [Accepted: 06/28/2024] [Indexed: 07/27/2024] Open
Abstract
BACKGROUND Nutrition screening on admission is critically important to systematically identify patients with undernutrition given the known relationship with deleterious clinical outcomes. Limited data exist regarding optimal processes and criteria for pediatric nutrition screening. Therefore, we sought to characterize nutrition screening practices in pediatric hospitals. METHODS A total of 365 inpatient pediatric hospitals in the United States were identified, eligible, and contacted. Eligible hospitals included general pediatric hospitals, adult hospitals with pediatric units, and specialty pediatric hospitals. One respondent at each eligible hospital was asked to complete a 33-question survey of admission nutrition screening practices. RESULTS Of 268 survey respondents, 37% represented pediatric units in adult hospitals, 35% general pediatric hospitals, and 28% pediatric specialty or psychiatric hospitals. A total of 98.5% endorsed the existence of a screening process on admission. Anthropometrics (eg, body mass index z score, 84%) and nutrition status (eg, change in intake, 67%) were the most common screening criteria applied. A nutrition screening instrument was used in 37% of institutions, and only 31% of institutions reported using pediatric-specific screening instruments. Pediatric units within adult hospitals were 1.38 times more likely to use a screening instrument validated in any population. Barriers to nutrition screening included the lack of a standard screening procedure and insufficient staff to conduct screening. Fifty-four percent of respondents reported a desire to change their hospital's nutrition screening process. CONCLUSION Most pediatric hospitals screen for nutrition risk on admission. However, methods and criteria varied widely across pediatric hospitals, highlighting the importance of standardized best practices.
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Affiliation(s)
- Coral Rudie
- Center for Nutrition, Division of Gastroenterology, Hepatology, and Nutrition, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Sabrina Persaud
- Center for Nutrition, Division of Gastroenterology, Hepatology, and Nutrition, Boston Children's Hospital, Boston, Massachusetts, USA
- Clinical Education, Informatics, Quality, and Professional Practice Department, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Bridget M Hron
- Center for Nutrition, Division of Gastroenterology, Hepatology, and Nutrition, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Michelle Raymond
- Center for Nutrition, Division of Gastroenterology, Hepatology, and Nutrition, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Susanna Y Huh
- Center for Nutrition, Division of Gastroenterology, Hepatology, and Nutrition, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
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Huysentruyt K, Brunet-Wood K, Bandsma R, Gramlich L, Fleming-Carroll B, Hotson B, Byers R, Lovelace H, Persad R, Kalnins D, Martinez A, Marchand V, Vachon M, Hulst JM. Canadian Nationwide Survey on Pediatric Malnutrition Management in Tertiary Hospitals. Nutrients 2021; 13:nu13082635. [PMID: 34444796 PMCID: PMC8397996 DOI: 10.3390/nu13082635] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 07/13/2021] [Accepted: 07/17/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Disease-associated malnutrition (DAM) is common in hospitalized children. This survey aimed to assess current in-hospital practices for clinical care of pediatric DAM in Canada. Methods: An electronic survey was sent to all 15 tertiary pediatric hospitals in Canada and addressed all pillars of malnutrition care: screening, assessment, treatment, monitoring and follow-up. Results: Responses of 120 health care professionals were used from all 15 hospitals; 57.5% were medical doctors (MDs), 26.7% registered dietitians (RDs) and 15.8% nurses (RNs). An overarching protocol for prevention, detection and intervention of pediatric malnutrition was present or “a work in progress”, according to 9.6% of respondents. Routine nutritional screening on admission was sometimes or always performed, according to 58.8%, although the modality differed among hospitals and profession. For children with poor nutritional status, lack of nutritional follow-up after discharge was reported by 48.5%. Conclusions: The presence of a standardized protocol for the clinical assessment and management of DAM is uncommon in pediatric tertiary care hospitals in Canada. Routine nutritional screening upon admission has not been widely adopted. Moreover, ongoing nutritional care of malnourished children after discharge seems cumbersome. These findings call for the adoption and implementation of a uniform clinical care pathway for malnutrition among pediatric hospitals.
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Affiliation(s)
- Koen Huysentruyt
- Division of Paediatric Gastroenterology, Hepatology and Nutrition, Department of Paediatrics, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; (R.B.); (J.M.H.)
- Department of Pediatric Gastroenterology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel (VUB), 1090 Brussels, Belgium
- Correspondence:
| | - Kim Brunet-Wood
- Canadian Malnutrition Task Force, Canadian Nutrition Society, Ottawa, ON K1C 6A8, Canada;
| | - Robert Bandsma
- Division of Paediatric Gastroenterology, Hepatology and Nutrition, Department of Paediatrics, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; (R.B.); (J.M.H.)
- Department of Nutritional Sciences, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Leah Gramlich
- Division of Gastroenterology, University of Alberta, Edmonton, AB T6G 2G3, Canada;
| | - Bonnie Fleming-Carroll
- SickKids Learning Institute, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada;
| | - Brenda Hotson
- Health Sciences Centre, Winnipeg, MB R3A 1R9, Canada;
| | - Rebecca Byers
- Canadian Nutrition Society, Ottawa, ON K1C 6A8, Canada;
| | - Heather Lovelace
- Nutritional Services, BC Children’s Hospital, Vancouver, BC V6H 3N1, Canada;
| | - Rabin Persad
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, University of Alberta, Edmonton, AB T6G 1C9, Canada;
| | - Daina Kalnins
- Department of Clinical Dietetics, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada;
| | - Andrea Martinez
- Division of Paediatric Gastroenterology, Hepatology and Nutrition, Department of Paediatrics, IWK Health Centre, University of Dalhousie, Halifax, NS B3K 6R8, Canada;
| | - Valerie Marchand
- Division of Paediatric Gastroenterology, Hepatology and Nutrition, Department of Paediatrics, Ste-Justine UHC, University of Montreal, Montreal, QC H3T 1C5, Canada;
| | - Mélanie Vachon
- Department of Clinical Nutrition, Quebec University Hospital, 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; (R.B.); (J.M.H.)
- Department of Nutritional Sciences, University of Toronto, Toronto, ON M5S 1A8, Canada
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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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Jacquot A, Valla FV, Mura T, Tume LN, Bertet H, Ford-Chessel C, Milesi C, Cambonie G, De Luca A, Gaillard-Le Roux B. NUTRI-REAPED study: nutritional assessment of French critically ill children and nutrition practice survey in French-speaking pediatric intensive care units. Ann Intensive Care 2019; 9:15. [PMID: 30671679 PMCID: PMC6342745 DOI: 10.1186/s13613-019-0493-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 01/14/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Impaired nutritional status is adversely associated with suboptimal outcomes in critically ill children. Undernutrition at pediatric intensive care unit (PICU) admission ranges from 15 to 65%. A lack of knowledge of the nutritional status of children in French PICUs prevents us from specifically targeting education. This study aims to describe the nutritional status of children in French PICUs and to assess nutritional practices and physicians' knowledge of nutrition, in order to focus NutriSIP (the French-speaking PICU nutrition group) future education programs. A prospective observational multicenter point prevalence study was conducted in French PICUs, recruiting all children admitted over three different weeks. Anthropometric measurements were taken (weight, height/length, mid-upper arm, and head circumferences), in order to calculate nutritional indices. Nutritional status was defined according to WHO Body Mass Index z-score and dynamic assessment based on growth faltering detection. Concurrently, PICU physicians and PICU nurses from seven French-speaking countries completed a survey to ascertain knowledge about local nutritional care practices and overall nutrition knowledge. PICU physicians' responses were compared to PICU nurses' responses (previously published). RESULTS Four hundred and thirty-two children were included in the observational study from 27 French PICUs. Undernutrition was diagnosed in 18.5% of them, young age and underlying chronic condition being the two independent risk factors. Faltering growth was diagnosed in 4.8% and overweight in 7.4%. Subjective nutritional assessment was not accurate. Thirty-eight French-speaking PICUs completed the survey. These showed nutritional practices frequently did not comply with international guidelines, especially regarding nutritional goals, and the reasons for withholding enteral nutrition. Comparison between physicians' and nurses' responses to the survey showed large discrepancies. CONCLUSION Undernutrition is frequent at admission in French PICUs. Nutritional status should be assessed using a holistic approach, because of the potential impact on outcome. French-speaking PICU healthcare professionals need further nutrition education, in order to improve nutritional practices to comply with international recommendations. This study will serve as a baseline to focus NutriSIP teaching programs in the future.
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Affiliation(s)
- Aurélien Jacquot
- Pediatric Intensive Care, Arnaud de Villeneuve University Hospital, 371 avenue du doyen G Giraud, 34295, Montpellier Cedex 5, France
| | - Frédéric Victor Valla
- Pediatric Intensive Care, CarMEN INSERM, UMR 1060 Equipe INFOLIP, Hospices civils de Lyon, Hôpital Femme Mère Enfant, 59 bd Pinel, 69500, Lyon-Bron, France
| | - Thibault Mura
- Clinical Research and Epidemiology Unit, CIC 1411, University Hospital, Montpellier, France
| | - Lyvonne Nicole Tume
- Faculty of Health and Applied Sciences, University of the West of England, Bristol, BS16 1DD, UK.,PICU Bristol Children's Hospital, Upper Maudlin Street, Bristol, UK
| | - Héléna Bertet
- Clinical Research and Epidemiology Unit, CIC 1411, University Hospital, Montpellier, France
| | - Carole Ford-Chessel
- Pediatric Intensive Care, CarMEN INSERM, UMR 1060 Equipe INFOLIP, Hospices civils de Lyon, Hôpital Femme Mère Enfant, 59 bd Pinel, 69500, Lyon-Bron, France
| | - Christophe Milesi
- Pediatric Intensive Care, Arnaud de Villeneuve University Hospital, 371 avenue du doyen G Giraud, 34295, Montpellier Cedex 5, France
| | - Gilles Cambonie
- Pediatric Intensive Care, Arnaud de Villeneuve University Hospital, 371 avenue du doyen G Giraud, 34295, Montpellier Cedex 5, France
| | - Arnaud De Luca
- Nutrition Unit, INSERM UMR1069, University Hospital of Tours, Tours, France
| | - Bénédicte Gaillard-Le Roux
- Pediatric Intensive Care, Hôpital Femme Mère Enfant, CHU de Nantes, 38 boulevard Jean Monnet, 44093, Nantes, France.
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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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Italian pediatric nutrition survey. Clin Nutr ESPEN 2017; 21:72-78. [PMID: 30014872 DOI: 10.1016/j.clnesp.2017.05.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 04/02/2017] [Accepted: 05/08/2017] [Indexed: 11/22/2022]
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Durá-Travé T, San Martin-García I, Gallinas-Victoriano F, Vaquero Iñigo I, González-Benavides A. Prevalence of malnutrition in hospitalised children: retrospective study in a Spanish tertiary-level hospital. JRSM Open 2016; 7:2054270416643889. [PMID: 27688894 PMCID: PMC5011311 DOI: 10.1177/2054270416643889] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVE To analyse the prevalence of malnutrition among paediatric patients at the time of hospital admission throughout a calendar year in a tertiary-level hospital and to identify those patients and/or groups of pathologies with a higher risk of malnutrition. DESIGN Observational (retrospective evaluation of nutrition status). SETTING Navarra Hospital Complex, Pamplona, Spain. PARTICIPANTS A total of 852 patients hospitalised in 2013 in a Spanish tertiary-level paediatric hospital (462 males and 390 females). MAIN OUTCOME MEASURES Sex, age, body mass index at the moment of admission and days of hospitalisation and diagnosis codified according to the International Classification of Diseases were registered. RESULTS The prevalence of malnutrition patients registered at the moment of admission was 8.2%. Diseases of the nervous system (22.9%), together with diseases of the respiratory system (22.9%), infectious diseases (18.6%), congenital malformations (11.4%) and diseases of the genitourinary system (8.6%) account for 84.4% of the cases with malnutrition. CONCLUSIONS The overall prevalence rate for malnutrition in paediatric patients at the moment of admission in our hospital was 8.2%, being a figure similar to those published in occidental countries. It should be mandatory to accomplish an initial screening and follow-up during hospitalisation of younger patients and those suffering from diseases of the nervous and/or respiratory system and, especially, from congenital diseases.
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Affiliation(s)
- Teodoro Durá-Travé
- Department of Pediatrics, Faculty of Medicine, University of Navarra, 31008 Pamplona, Spain
- Department of Pediatrics, Navarra Hospital Complex, 31008 Pamplona, Spain
- Instituto de Investigación Sanitaria de Navarra (IdisNA), 31008 Pamplona, Spain
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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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10
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Huysentruyt K, Goyens P, Alliet P, Bontems P, Van Hautem H, Philippet P, Vandenplas Y, De Schepper J. More training and awareness are needed to improve the recognition of undernutrition in hospitalised children. Acta Paediatr 2015; 104:801-7. [PMID: 25847425 DOI: 10.1111/apa.13014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Revised: 01/17/2015] [Accepted: 03/19/2015] [Indexed: 11/28/2022]
Abstract
AIM Reports suggest that 10% of hospitalised children in Europe are undernourished. We investigated whether nutritional screening tools (NST) were used in Belgian secondary-level hospitals, examined strategies for detecting undernutrition and identified barriers preventing the systematic management of undernutrition. METHODS A nationwide questionnaire-based survey of paediatric departments in Belgian secondary-level hospitals was carried out from September 2013 to February 2014. Respondents were dived into French-speaking (Walloon + Brussels) and Dutch-speaking (Flemish) departments. RESULTS We received replies from 71 of the 97 (73.2%) departments. Half of the departments - 39.5% Flemish speaking and 71.4% Walloon speaking - carried out nutritional screening. Undernutrition was identified by measuring weight and length or height (92.7% of cases), clinical appraisal (74.7%), mid-upper arm circumference and/or skin fold thickness (19.7%). There was no protocol for undernutrition in many Flemish (60.5%)- and Walloon (28.6%)-speaking departments. Reasons given for not screening were as follows: lack of training (46.9%), ignorance of NST (42.2%) and lack of time (29.7%). CONCLUSION Half of the paediatric departments in Belgian secondary-level hospitals did not carry out nutritional screening, and differences in current practices and attitudes may be due to cultural and/or educational differences.
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Affiliation(s)
- Koen Huysentruyt
- Department of Paediatrics; Universitair Ziekenhuis Brussel; Vrije Universiteit Brussel (VUB); Brussels Belgium
| | - Philippe Goyens
- Nutrition and Metabolism Unit; Department of Paediatrics; University Children's Hospital Queen Fabiola; Brussels Belgium
| | | | - Patrick Bontems
- Department of Paediatrics; Centre Hospitalier Universitaire Tivoli; La Louvière Belgium
| | - Hilde Van Hautem
- Department of Paediatrics; Sint-Maria Hospital; Halle Belgium; for VVK (Vlaamse Vereniging voor Kindergeneeskunde)
| | - Pierre Philippet
- Department of Paediatrics; CHC - Espérance; Liège Belgium; for GBPF (Groupement Belge des Pédiatres de Langue Française)
| | - Yvan Vandenplas
- Department of Paediatrics; Universitair Ziekenhuis Brussel; Vrije Universiteit Brussel (VUB); Brussels Belgium
| | - Jean De Schepper
- Department of Paediatrics; Universitair Ziekenhuis Brussel; Vrije Universiteit Brussel (VUB); Brussels Belgium
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Baxter JAB, Al-Madhaki FI, Zlotkin SH. Prevalence of malnutrition at the time of admission among patients admitted to a Canadian tertiary-care paediatric hospital. Paediatr Child Health 2014; 19:413-7. [PMID: 25382997 DOI: 10.1093/pch/19.8.413] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/25/2014] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Malnutrition among hospitalized children is known to negatively influence their response to therapy and to prolong their admission. It also has short- and long-term consequences for growth, development and well-being. It is commonly regarded as a condition affecting children in low-income countries; however, malnutrition has been found to be variably prevalent among hospitalized children in higher-income countries. At the time the present study was conducted, it had been >30 years since the nutritional status of Canadian hospitalized children was last published. OBJECTIVES To determine and communicate the prevalence of malnutrition among children in a Canadian tertiary-care paediatric hospital at the time of their admission. METHODS In the present cross-sectional study, anthropometric measures were obtained from 322 children admitted to The Hospital for Sick Children in Toronto, Ontario. Nutritional indexes (BMI for age, weight for age, weight for length/height and length/height for age) were generated from anthropometric measures using the WHO igrowup software, and summarized according to WHO definitions. RESULTS The overall prevalence of malnutrition using BMI for age was 39.6% (95% CI 33% to 46%), of which 8.8% and 30.8% of participants were under- and overnourished, respectively. Furthermore, 6.9% (95% CI 3% to 13%) were determined to be acutely malnourished (weight for length/height <-2 SD) and 13.4% (95% CI 10% to 18%) chronically malnourished (length/height for age <-2 SD). CONCLUSION The high prevalence of overall malnutrition observed among study participants suggests that initial screening using simple anthropometric measures should be conducted on hospital admission so that patients can receive appropriate nutrition-specific care.
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Affiliation(s)
- Jo-Anna B Baxter
- The Hospital for Sick Children, Centre for Global Child Health, Toronto, Ontario
| | - Fatma Ibrahim Al-Madhaki
- The Hospital for Sick Children, Centre for Global Child Health, Toronto, Ontario; ; Department of Pediatrics, Hamad Medical Corporation, Doha, State of Qatar
| | - Stanley H Zlotkin
- The Hospital for Sick Children, Centre for Global Child Health, Toronto, Ontario; ; Departments of Paediatrics, Nutritional Sciences, and Public Health, University of Toronto, Toronto, Ontario
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12
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Prevalence of undernutrition during hospitalisation in a children’s hospital: what happens during admission? Eur J Clin Nutr 2014; 68:730-5. [DOI: 10.1038/ejcn.2014.21] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Revised: 01/04/2014] [Accepted: 01/14/2014] [Indexed: 11/08/2022]
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Huysentruyt K, Alliet P, Muyshont L, Devreker T, Bontems P, Vandenplas Y. Hospital-related undernutrition in children: still an often unrecognized and undertreated problem. Acta Paediatr 2013; 102:e460-6. [PMID: 23826824 DOI: 10.1111/apa.12344] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Revised: 06/14/2013] [Accepted: 07/02/2013] [Indexed: 11/28/2022]
Abstract
AIM To evaluate the nutritional status of hospitalized children in Belgian hospitals and to analyse the impact of undernutrition on the degree of weight loss and duration of hospitalization. METHODS In each hospital (one tertiary and three secondary hospitals), 100 consecutively hospitalized children were eligible for inclusion. Of these, 379 were included for analysis. Body weight, length and mid-upper arm circumference were measured at admission and body weight also at discharge. RESULTS The median (range) age was 2.1 (0.8-17) years. On admission, 29 (7.7%) children were chronically malnourished and, depending on the parameter, between 2.4% and 9.8% acutely undernourished, while 12.1% had at least one subnormal parameter. Median (range) duration of hospitalization was four (1-64) days. Median (range) weight change was 0.0% (-15.6% - +13.9%). Weight loss of >2% was significantly (p < 0.05) more prevalent in tertiary (20.0%) than in secondary (10.2%) hospitals. Median hospital duration was 50% longer for chronically malnourished children (6.0 vs 4.0 days; p < 0.01). Only 36 children received a nutritional intervention. CONCLUSION Acute undernutrition and chronic undernutrition remain frequent findings in hospitalized children in Belgium. Children with chronic undernutrition had a 50% longer hospital stay. Hospital-related undernutrition is an often unrecognized problem, because only one-third of the acutely malnourished children received nutritional support.
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Affiliation(s)
- K Huysentruyt
- Department of Paediatrics; UZ Brussel; Brussels; Belgium
| | - P Alliet
- Department of Paediatrics; Jessa Hospital; Hasselt; Belgium
| | - L Muyshont
- Department of Paediatrics; Centre Hospitalier Universitaire de Charleroi; Charleroi; Belgium
| | - T Devreker
- Department of Paediatrics; UZ Brussel; Brussels; Belgium
| | - P Bontems
- Department of Paediatrics; Centre Hospitalier Universitaire Tivoli; La Louvière; Belgium
| | - Y Vandenplas
- Department of Paediatrics; UZ Brussel; Brussels; Belgium
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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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15
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Hankard R, Colomb V, Piloquet H, Bocquet A, Bresson JL, Briend A, Chouraqui JP, Darmaun D, Dupont C, Frelut ML, Girardet JP, Goulet O, Rieu D, Simeoni U, Turck D, Vidailhet M. Dépister la dénutrition de l’enfant en pratique courante. NUTR CLIN METAB 2013. [DOI: 10.1016/j.nupar.2012.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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16
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Dépister la dénutrition de l’enfant en pratique courante. Arch Pediatr 2012; 19:1110-7. [DOI: 10.1016/j.arcped.2012.07.024] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2012] [Accepted: 07/04/2012] [Indexed: 11/18/2022]
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De Luca A, Piloquet H, Mansilla M, Simon D, Fischbach M, Caldari D, Dorigny B, Ingrand P, Hankard R. Évaluation tricentrique de l’état nutritionnel chez l’enfant hospitalisé. Arch Pediatr 2012; 19:545-6. [DOI: 10.1016/j.arcped.2012.02.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2012] [Accepted: 02/24/2012] [Indexed: 11/30/2022]
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Abstract
PURPOSE OF REVIEW Malnutrition is highly prevalent in hospitalized children and has been associated with relevant clinical outcomes. The scope of this review is to describe the five screening tools and the recent European Society for Parenteral and Enteral Nutrition (ESPEN) research project aimed at establishing agreed, evidence-based criteria for malnutrition and screening tools for its diagnosis in hospitalized children. RECENT FINDINGS Five nutrition screening tools have recently been developed to identify the risk of malnutrition in hospitalized children. These tools have been tested to a limited extent by their authors in the original published studies but have not been validated by other independent studies. So far, such screening tools have not been established widely as part of standard pediatric care. SUMMARY Although nutrition screening and assessment are recommended by European Society for Parenteral and Enteral Nutrition and the European Society for Pediatric Gastroenterology Hepatology and Nutrition and are often accepted to be required by healthcare facilities, there is no standardized approach to nutritional screening for pediatric inpatients. The near future will provide us with comparative data on the existing tools which may contribute to delineating a standard for useful nutrition screening in pediatrics.
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Affiliation(s)
- Corina Hartman
- Institute of Gastroenterology, Nutrition and Liver Diseases, Sackler Faculty of Medicine, Tel-Aviv University, Schneider Children's Medical Center of Israel, Clalit Health Services, Petach Tikva, Israel.
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A longitudinal evaluation of growth outcomes at hospital discharge of very-low-birth-weight preterm infants. Eur J Clin Nutr 2011; 66:474-80. [PMID: 22085867 DOI: 10.1038/ejcn.2011.191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND/OBJECTIVES To quantify the rate of progressive failure of very-low-birth-weight (VLBW) infants over time in the neonatal intensive care unit to meet growth milestones. SUBJECTS/METHODS In a prospective longitudinal study, 114 VLBW preterm infants (1500 g) of both sexes, with normal and/or low weight for gestational age were included. At the start, weight, length, mid-upper arm (MUAC), thigh and cephalic circumferences were measured. Weight/age (W/A), length/age and weight/length (±2 z-score) indices were calculated. All measurements were taken at inclusion, at 7, 15 and 30 days of hospitalization. Chi-square test, analysis of variance and repeated-measures tests were estimated. RESULTS Thirteen cases (14%) died and were excluded soon after the first determinations. In all, 9 (8.9%) died during the study, 12 (11.9%) were discharged before 30 days of life and 80 (79.2%) completed the study. At 7 days, the percentage of preterm infants with an index of W/A <-2 z-scores increased from 44 to 67% (44-68 subjects; P<0.01), with no changes afterwards; the indicator MUAC <-2 z-scores increased at 7 days from 23 to 49% (23-49 subjects); at 15 from 23 to 65% (23-61 subjects) and at 30 days from 23 to 79% (23-63 subjects; P<0.001). CONCLUSIONS Clinicians could use these indicators for earlier detection of growth failure in VLBW infants in order to target more aggressive nutrition early.
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Hankard R. Pratique du dépistage de la dénutrition chez l’enfant. Arch Pediatr 2011. [DOI: 10.1016/s0929-693x(11)71012-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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21
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État nutritionnel de l’enfant hospitalisé au centre hospitalier de Tourcoing. Arch Pediatr 2011; 18:461-2. [DOI: 10.1016/j.arcped.2011.01.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2010] [Revised: 12/20/2010] [Accepted: 01/24/2011] [Indexed: 11/22/2022]
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Mahdavi AM, Ostadrahimi A, Safaiyan A. Subjective global assessment of nutritional status in children. MATERNAL AND CHILD NUTRITION 2011; 6:374-81. [PMID: 21050391 DOI: 10.1111/j.1740-8709.2009.00214.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
This study was aimed to compare the subjective and objective nutritional assessments and to analyse the performance of subjective global assessment (SGA) of nutritional status in diagnosing undernutrition in paediatric patients. One hundred and forty children (aged 2-12 years) hospitalized consecutively in Tabriz Paediatric Hospital from June 2008 to August 2008 underwent subjective assessment using the SGA questionnaire and objective assessment, including anthropometric and biochemical measurements. Agreement between two assessment methods was analysed by the kappa (κ) statistic. Statistical indicators including (sensitivity, specificity, predictive values, error rates, accuracy, powers, likelihood ratios and odds ratio) between SGA and objective assessment method were determined. The overall prevalence of undernutrition according to the SGA (70.7%) was higher than that by objective assessment of nutritional status (48.5%). Agreement between the two evaluation methods was only fair to moderate (κ = 0.336, P < 0.001). The sensitivity, specificity, positive and negative predictive value of the SGA method for screening undernutrition in this population were 88.235%, 45.833%, 60.606% and 80.487%, respectively. Accuracy, positive and negative power of the SGA method were 66.428%, 56.074% and 41.25%, respectively. Likelihood ratio positive, likelihood ratio negative and odds ratio of the SGA method were 1.628, 0.256 and 6.359, respectively. Our findings indicated that in assessing nutritional status of children, there is not a good level of agreement between SGA and objective nutritional assessment. In addition, SGA is a highly sensitive tool for assessing nutritional status and could identify children at risk of developing undernutrition.
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Affiliation(s)
- Aida Malek Mahdavi
- School of Health & Nutrition, Tabriz University of Medical Sciences, Golgasht St., Attar Neishaboory Ave, Tabriz, Iran.
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Mahdavi AM, Safaiyan A, Ostadrahimi A. Subjective vs objective nutritional assessment study in children: a cross-sectional study in the northwest of Iran. Nutr Res 2009; 29:269-74. [DOI: 10.1016/j.nutres.2009.03.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2009] [Revised: 03/18/2009] [Accepted: 03/26/2009] [Indexed: 01/10/2023]
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Abstract
PURPOSE OF REVIEW Hospital protein-energy malnutrition and its adverse consequences were already described back in 1980. The purpose of this review is to describe the current prevalence of malnutrition in hospitalized children and to describe current risk groups. RECENT FINDINGS Different definitions have been used to describe malnutrition. According to WHO criteria, the SD score with a cutoff of less than -2 should be used to define malnutrition and to compare prevalence data. Using the SD score for weight for height or equivalent criteria, the prevalence of acute malnutrition over the last 10 years in hospitalized children in Germany, France, the UK and the USA varied between 6.1 and 14%, whereas in Turkey up to 32% of patients with malnutrition were reported. Acute malnutrition is still highly prevalent in children with an underlying disease; however, the prevalence rate seems lower in children with cystic fibrosis and malignancies. SUMMARY The prevalence of acute malnutrition of children admitted to hospital is still considerably high, but there is a scarcity of data concerning the nutritional status during hospital admission. Screening tools to identify children at risk of developing malnutrition might be helpful.
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[Effect of the adaptation of the food of the hospitalized child on the cover of the nutritional needs]. Arch Pediatr 2008; 15:1263-9. [PMID: 18556180 DOI: 10.1016/j.arcped.2008.04.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2007] [Revised: 03/21/2008] [Accepted: 04/19/2008] [Indexed: 11/22/2022]
Abstract
AIMS Denutrition remains a major concern in hospitalized children. Daily experience suggests that the meals proposed by hospital dietetic service, although well-balanced and in accordance with the recommendations, may be poorly accepted and consumed by children. The aims of this study were to assess the effect of modification of foods offer on energy intakes as well as nutriments and minerals and trace elements in hospitalized children. PATIENTS AND METHODS During a 1-month period, 25 consecutive children (range 4-17 years; 13 girls), hospitalized in our pediatric department were included in the study (reasons for hospitalisation comprised: medical reasons [n=7], orthopedic problem [n=16] or surgery [n=2]). They had no restricted diet and received the usual pediatric hospital feeding according to the French recommended dietary allowances (RDA) (D1). They were compared to 21 children--matched for age, sex, nutritional status and pathology, hospitalized during the following 1-month period--who received a modified diet (D2), elaborated by dieticians according to the child's preference and excluded or limited food usually nonconsumed by the children. Food consumption was prospectively measured for 24h by analysis of the nonconsumed foods, as well as browsing and extra food brought by the family. Analysis of energy, carbohydrate, lipid, protein, iron and calcium intake was made using Bilnut 3 software (Nutrisoft, France). RESULTS D2 covered 119+/-37% of the median energy needs versus 89+/-37% for D1 (p<0.05). The median energy needs were more often reached with D2 as compared to D1 (62% versus 32%, p<0.05). Protein intake was high in both groups, more importantly with D2 (266+/-111% of RDA versus 193+/-77% with D1, p<0.05). We observed no difference between the 2 diets in regards of fat/carbohydrate balance and iron intake. Calcium intake was increased with the adapted diet: 68+/-26% of RDA with D2 versus 49+/-26% with D1 (p<0.01). CONCLUSION Adapting food offers to preference influences food and caloric intakes in hospitalized children. This could be an efficient strategy to prevent acute undernutrition in hospital.
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Caldari D. Prise en charge nutritionnelle : une exigence pour tous ! Arch Pediatr 2008; 15:797-9. [DOI: 10.1016/s0929-693x(08)71915-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Alphonse M, Hankard R. Évaluation de l'état nutritionnel et des besoins de l'enfant et de l'adolescent. NUTR CLIN METAB 2005. [DOI: 10.1016/j.nupar.2005.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Marteletti O, Caldari D, Guimber D, Mention K, Michaud L, Gottrand F. Dépistage de la malnutrition chez l'enfant hospitalisé : influence de la structure d'accueil dans la prise en charge. Arch Pediatr 2005; 12:1226-31. [PMID: 16051076 DOI: 10.1016/j.arcped.2005.02.020] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2004] [Accepted: 02/24/2005] [Indexed: 11/22/2022]
Abstract
OBJECTIVES The aims of this study were to assess the prevalence of malnutrition in a pediatric population hospitalized in a French regional hospital and to evaluate the influence of type of hospital unit (pediatric or not) in the screening and the management of malnutrition. PATIENTS AND METHODS This one-day cross-sectional survey was performed in three different seasons during 2003. Every child aged 2 months to 16 years old, hospitalized for more than 48 hours was included. Weight for height, Z-score and Body Mass Index Z-score were used for nutritional assessment. Type of hospitalisation unit, date of admission, associated diagnosis, screening and treatment of malnutrition were also taken into account. RESULTS Two hundred and eighty hospitalized children were undernourished (11%) and thirty-one children were obese (11%) with no difference in prevalence of malnutrition between pediatric and non-pediatric units. At the time of the study, malnutrition was recognized in one third of the children, at a similar rate whatever the type of hospitalized unit. The children hospitalized in pediatrics wards benefited more frequently from nutritional intervention, i.e. dietician care (43 vs. 16% P < 0.01). CONCLUSION Prevalence of malnutrition in hospitalized children is low and the same in pediatric or non-pediatric units. Screening of malnutrition remains unsatisfactory in hospital. However, malnutrition is more frequently treated in pediatric unit compared with non-pediatric unit.
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Affiliation(s)
- O Marteletti
- Unité de gastroentérologie, hépatologie et nutrition pédiatriques, clinique de pédiatrie, hôpital Jeanne-de-Flandre, CHRU de Lille, 59045 Lille cedex, France.
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