Nutritional Risk Screening And Nutrition Assessment In Hospitalized Children

Background:Malnutrition is a common clinical problem in children,can affect thechildren’s physical and mental development,reduce the bodyfunctions,especially in hospitalized children, the prevalence of malnutritionand nutritional risk rate is higher, can affect the prognosis of disease,hospitalization time, cost of hospitalization and nursing difficulty. So weshould pay attention to malnutrition in hospitalized children in the earlyidentification of nutritional risk screening, and evaluate the nutrition forproper nutrition intervention on risk in children. In recent decade, theinternational community has put forward a number of pediatric nutritionalrisk screening tools, such as，in2000，Sermet-Gaudelus proposed a simplepediatric nutritional risk score, in2007，Secker proposed Subjective GlobalNutritional Assessment, and Screening Tool for the Assessment ofMalnutrition in Pediatrics proposed in2008by McCarthy, and In2010,Paediatric Yorkhill Malnutrition Score proposed by Geradimidis et al.and Screening Tool for Risk of Impaired Nutritional Status and Growthproposed by Hulst et al, but there is no screening tools well accepted in theworld. Objective:Screening Tool for Risk of Impaired Nutritional Status andGrowth,called STRONGkids was applicated in419cases of hospitalizedchildren, to understand the nutritional risk and nutritional condition, carryout the statistical analysis on the tool score items, verify the practicabilityand feasibility of this tool.Objects and methods:1.Object: randomly selected419newly admitted patients ofchildren’s Hospital in Chongqing Medical University during February toDecember2012, and researched by physical measurement andquestionnaire; Our inclusion criteria: age>1month and an expected lengthof stay at last24hours. Exclusion criteria:age<1month;serious illness;refuse to participate.2.Research methods: used STRONGkids screening tool to evaluat thehospitalized children within24hours of admission, including physicalmeasurement and questionnaire survey. Specialized electronic baby scalewas used to measure weight for chidren below10Kg and mechanical heightand weight measurement instrument for children more than10Kg, accuratereading to10g and0.1Kg respectively. Height measured by mechanicalheight and weight measurement instrument or bed, accurate readings to0.1cm. Completed the questionnaire among the parents of hospitalized children, which contains children’s change of body weight nearly3monthsand nearly1weeks of diet.3.STRONGkids screening tool consists of4items:(1) subjectiveclinical assessment(1point);(2)high risk disease(2points);(3) nutrientintake(1point);(4) weight loss(1point). The total score of each item is therisk score:0point for the low risk;1-3points for the moderate risk;4-5points for the high risk.4malnutrition diagnostic criteria: in accordance with the newstandards recommended by WHO in2006, used standard statisticverification method (Z method) to evaluate the nutritional status of children.Evaluation indexes include the SD-score of weight-for-age, height-for-age,weight-for-height and BMI, if the score<-2,meet any of them can bedefined as malnutrition. SD-scores<-2for weight-for-height andheight-for-age were considered to indicate acute and chronic malnutritionrespectively.5.statistical analysis： used SPSS17.0statistical software andMicrosoft Office Excel to complete the data processing.Result:1.There were a total of419hospitalized children attending theinvestigation,77.6%were classified the risk of developing malnutrition bythe STRONGkids screening tool(67.5%with moderate risk,10%with highrisk). 2.The rate of acute and chronic malnutrition measured by the physicalmeasurement are respectively10.7%and12%,the total malnutrition rate is19.6%.3.The detection rate of malnutrition and nutritional risk was positivelycorrelated (r=0.222, p<0.01).4Compared to children with no nutritional risk,Children at nutritionalrisk had significantly lower SD score of HFA、WFA、WFH and BMI,ahigher prevalence of malnutrition, a higher risk of disease and operationrate, and a longer hospital stay.Conclusion:STRONG kids tool has the advantage of simplicity, fast and goodpatient compliance, the function of predicting the malnutrition, and can bepromoted for use for the nutritional screening of hospitalized children, butsome scoring projects such as "subjective clinical assessment" and thechange of nutrient intake and weight which are difficult to objectivelyquantify still need to be further improved.