| Background and Objectives: Undernutrition is common in hospitalized children.Currently,there is no consensus on the ideal screening tool to determine on admission those children who are at risk for developing undernutrition and will benefit from nutritional support.Furthermore,these nutritional screening tools which were developed in foreign countries are not suitable for Chinese children.The objective of this study was to develop,validate and apply a pediatric nutritional screening score to detect undernutrition risk upon hospital admission.Methods and Study Design: The study had a four-section prospective design.Firstly,a novel pediatric nutritional screening score(PNSS)was developed between May 2011 and May 2012.Secondly,body composition(BC)was measured in 96 pediatric patients older than 3 years by dietitians for validation.Thirdly,criterion validity,reproducibility,practicality and predictive validity of the PNSS were evaluated during July 2012 and December 2012.Finally,the prevalence of undernutrition risk from nine hospitals was investigated and clinical outcomes of nutritional support in children at malnutrition risk identified by PNSS was examined during June 2013 and December 2014.Children were eligible to participate if they were one month to 17 y of age with an expected hospital stay > 24 h.Exclusion criteria included preterm infants during the first 24 months of life and patients in intensive care units.Results: PNSS consisted of three elements: disease with malnutrition risks,changes in food intake,and anthropometric measurements,with a score of 0–2 for each element.The optimal cut-off score to identify patients at risk of undernutrition was 2.Among 847 participants,risk of undernutrition was detected in 217 patients(25.6%;95% CI = 23%–29%)by the complete dietetic assessment and in 361(42.6%;95% CI = 39%–46%)by PNSS(≥ 2).The agreement between the two methods was moderate(κ = 0.435,95% CI = 0.373–0.498).Sensitivity,specificity,positive predictive and negative predictive value of PNSS were 82%(95% CI = 76%–87%),71%(95% CI = 67%–74%),49%(95% CI = 44%–54%)and 92%(95% CI = 89%–94%),respectively.Inter-rater agreement had a κ value of 0.596(95% CI = 0.529–0.664,P < 0.001).The mean time spending for completing the PNSS in the whole population of 2,632 was(10.6±1.1)min.The prevalence of undernutrition risk in children from nine hospitals(n=4987)was 51.2%.The children with oncologic,GI,respiratory and cardiac disease were most likely to have high undernutrition risk(87.4%,54.9%,52.7% and 52.8%).Nutritional support during hospitalization was given to 47.1% of children with undernutrition risk.The prevalence of undernutrition risk in children from nine hospitals was 11.3%.Among the children with PNSS of ≥2,the complication rate was similar between children with or without nutritional support.Without nutritional intervention,the at-risk group was associated with significantly longer length of hospital stay,greater weight loss,and higher complication rates compared to the not-at-risk group.Conclusions: PNSS is the first pediatric nutritional screening tool developed for hospitalized children in China.Furthermore,this study was validated in a large population of hospitalized children.It provides a simple,quick and reliable scoring system for the detection of undernutrition and undernutrition risk upon hospital admission. |
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