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Malnutrition Risk in Hospitalized Children: A Descriptive Study of Malnutrition‐Related Characteristics and Development of a Pilot Pediatric Risk‐Assessment Tool
Author(s) -
Wong Vega Molly,
Beer Stacey,
Juarez Marisa,
Srivaths Poyyapakkam R.
Publication year - 2019
Publication title -
nutrition in clinical practice
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.725
H-Index - 71
eISSN - 1941-2452
pISSN - 0884-5336
DOI - 10.1002/ncp.10200
Subject(s) - medicine , malnutrition , pediatrics , intensive care medicine , environmental health , risk assessment , malnutrition in children , computer security , computer science
Background Underrecognition of pediatric malnutrition may affect nutrition interventions and outcomes. Pediatric malnutrition uses more specific etiology‐based criteria but lacks clarity in implementation guidelines. Study goals were to identify malnutrition and risk among hospitalized patients, characterize malnutrition risk factors, and assess reliability of criteria against outcome measures. Materials and Methods All children 44 weeks postmenstrual age–18 years, admitted for 48 hours during a 16‐day period, were included (n = 528). Trained dietitians assessed patients in physical assessments (PA), growth, energy intake, increased nutrient losses (IL), altered absorption of nutrients (AA), hypermetabolism and inflammation, laboratory information, micronutrient deficiency, and functional status. Outcome data assessed were length of stay (LOS), intensive care unit (ICU) LOS, ventilation days, nutrition support, and dietitian intervention.Results Malnutrition prevalence upon admission was 19.7%. Weight/length or BMI/age z ‐score (ZS) had no effect on LOS. AA and IL upon admission were independently associated with malnutrition (both, P <.01). Wasting and hypermetabolism were independently associated with longer LOS ( P <.01). Other factors associated with longer LOS included IL and inflammation ( P < .05). Those with hypermetabolism had significant ZS improvements if followed by a dietitian ( P < .05). Wasting via PA was the only factor associated with longer ICU LOS ( P < .05). Conclusions Identification of risk factors (wasting, hypermetabolism, AA, IL) beyond anthropometrics to define malnutrition and risk is important in prioritizing care in a tertiary pediatric facility. Of great significance is the ability of dietitian‐based PA to predict LOS and need for intervention.