A simple nutrition screening tool to identify nutritional deterioration in long stay paediatric inpatients: The paediatric nutrition rescreening tool (PNRT).

BACKGROUND AND AIMS: Children with extended hospital stays are at risk of nutritional deterioration making regular nutrition screening throughout their admission an integral part of the nutrition care pathway. The purpose of this study was to design and validate a simple, quick and universal weekly rescreening tool to identify hospital acquired nutritional deterioration during a child's hospital stay. METHODS: A prospective, longitudinal sample of children aged 0-16 years admitted to a paediatric tertiary hospital with a length of stay ≥7 days were included in the study. Agreement between nutritional deterioration markers of reduction in weight (kg), body mass index (kg/m2), energy intake (kcal/day) and protein intake (g/day) over a 7-day period and two proposed rescreening questions was determined using sensitivity, specificity, area under the curve and positive and negative predictive values. RESULTS: Sixty-one children were included in the study with 224 full 7-day datasets. The sensitivity and specificity of the rescreening question 'Has the child had reduced nutritional intake in the last 7 days' for identifying children with a ≥25% reduction in energy intake over the previous 7-day period were 61.9% (95% CI 41.1-82.7) and 82.2% (95% CI 76.9-87.5) respectively. The sensitivity of 'Has the child lost weight or had poor weight gain' at detecting weight loss was 71.4% (95% CI 54.7-88.2) and specificity 87.8% (95% CI 83.1-92.5). CONCLUSION: The paediatric nutrition rescreening questions provide a valid and simple tool to detect nutritional deterioration in long stay paediatric patients and should be an integral part of the nutrition care process.

Nutritional Assessment and Status of Hospitalized Infants.

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.

Simple Nutrition Screening Tool for Pediatric Inpatients.

BACKGROUND: Pediatric nutrition risk screening tools are not routinely implemented throughout many hospitals, despite prevalence studies demonstrating malnutrition is common in hospitalized children. Existing tools lack the simplicity of those used to assess nutrition risk in the adult population. This study reports the accuracy of a new, quick, and simple pediatric nutrition screening tool (PNST) designed to be used for pediatric inpatients. MATERIALS AND METHODS: The pediatric Subjective Global Nutrition Assessment (SGNA) and anthropometric measures were used to develop and assess the validity of 4 simple nutrition screening questions comprising the PNST. Participants were pediatric inpatients in 2 tertiary pediatric hospitals and 1 regional hospital. RESULTS: Two affirmative answers to the PNST questions were found to maximize the specificity and sensitivity to the pediatric SGNA and body mass index (BMI) z scores for malnutrition in 295 patients. The PNST identified 37.6% of patients as being at nutrition risk, whereas the pediatric SGNA identified 34.2%. The sensitivity and specificity of the PNST compared with the pediatric SGNA were 77.8% and 82.1%, respectively. The sensitivity of the PNST at detecting patients with a BMI z score of less than -2 was 89.3%, and the specificity was 66.2%. Both the PNST and pediatric SGNA were relatively poor at detecting patients who were stunted or overweight, with the sensitivity and specificity being less than 69%. CONCLUSION: The PNST provides a sensitive, valid, and simpler alternative to existing pediatric nutrition screening tools such as Screening Tool for the Assessment of Malnutrition in Pediatrics (STAMP), Screening Tool Risk on Nutritional status and Growth (STRONGkids), and Paediatric Yorkhill Malnutrition Score (PYMS) to ensure the early detection of hospitalized children at nutrition risk.