Proposal for An Algorithm for Screening for Undernutrition in Hospitalized Children

Abstract

The prevalence of disease-related undernutrition in hospitalized children has not decreased significantly in the last decades in Europe. A recent large multicentric European study reported a percentage of underweight children ranging across countries from 4.0% to 9.3%. Nutritional screening has been put forward as a strategy to detect and prevent undernutrition in hospitalized children. It allows timely implementation of adequate nutritional support and prevents further nutritional deterioration of hospitalized children. In this article, a hands-on practical guideline for the implementation of a nutritional care program in hospitalized children is provided. The difference between nutritional status (anthropometry with or without additional technical investigations) at admission and nutritional risk (the risk of the need for a nutritional intervention or the risk for nutritional deterioration during hospital stay) is the focus of this article. Based on the quality control circle principle of Deming, a nutritional care algorithm, with detailed instructions specific for the pediatric population was developed and implementation in daily practice is proposed. Further research is required to prove the applicability and the merit of this algorithm. It can, however, serve as a basis to provide European or even wider guidelines.

Canadian Nationwide Survey on Pediatric Malnutrition Management in Tertiary Hospitals

“…Recent studies reported that disease-related malnutrition (DAM), which can be defined as malnutrition in the context of acute and/or chronic disease, is highly prevalent in hospitalized children in North America [ 1 , 2 , 3 ]. Nine percent of the children had a body mass index (BMI) or weight for height (WFH) below −2 SD on admission [ 1 , 2 ], which is in close agreement with figures reported in Europe [ 4 ]. The use of WFH < −2 SD or BMI < −2 SD (or WFA < −2 SD for infants) as indicators of malnutrition stems from recommendations made by the World Health Organization to screen for children with malnutrition.…”

Pediatric screening tools for malnutrition: an update

“…Nutritional screening is considered a key part of the hospital nutrition care process and pediatric nutritional care algorithm [37]. A number of recent studies have focused on the organizational aspect of nutritional screening, focusing on auditing local or national practices [38,39 & ,40], describing barriers hindering optimal nutrition care [39 & ,40,41], and propositions to simplify or improve current practices [38,39 & ,42].…”

Prevalence of Malnutrition in Pediatric Hospitals in Developed and In-Transition Countries: The Impact of Hospital Practices

“…Independently of the income setting, malnutrition is multifactorial. Whereas malnutrition in low-income countries is often, but not solely, attributable to limited access to food and/or medical care, it is often triggered by disease in in-transition countries [5,6]. Of importance, the report of the Global Burden of Disease Study 2013 revealed that protein-energy malnutrition accounted globally for 9.8/100.000 age-standardized deaths in the largest 50 countries for child and adolescent populations.…”