| Objective Because malnutrition can cause slow weight growth,aggravation of illness,and even affect children’s growth and development,and hospitalized children have higher nutritional risk because of disease factors,so as to identify the nutritional problems of hospitalized children as soon as possible and implement nutritional management,that is,to use child nutritional risk screening tools for hospitalized children,to carry out nutritional risk analysis,and to carry out child nutritional risk screening for medical staff.Cognition survey.Early nutritional assessment and individualized nutritional support programs for children with high nutritional risk can prevent the risk of adverse clinical outcomes due to further malnutrition,or enable children with existing nutritional risk to benefit from nutritional treatment.Medical staff with low awareness of children’s nutritional risk screening should be trained to improve their ability of clinical nutritional risk screening.At the same time,clinical nutritional support team should be set up to explore the model of children’s nutritional care,which can provide reference for standardizing children’s nutritional management.Methods(1)Using the Chinese version of Child Malnutrition Risk Score(CVPYMS),358 children hospitalized in the second pediatric ward of the First Affiliated Hospital of Guangxi Medical University from October to December 2018 were screened for nutritional risk.The scale has good reliability and validity.It includes five steps.According to the total score of steps,nutritional risk is divided into three levels: low risk,moderate risk and high risk.According to the level of nutritional risk screening and clinical characteristics of hospitalized children,the laboratory indicators,possible adverse outcomes,hospitalization days and average hospitalization days of hospitalized children with different nutritional risk levels were analyzed.Multivariate analysis and body mass index analysis were carried out for hospitalized children with high nutritional risk.(2)A self-designed questionnaire on children’s nutritional risk screening awareness was used to collect and distribute questionnaires to 457 medical staff from 28 secondary and higher medical institutions in Guangxi Zhuang Autonomous Region through the questionnaire star platform.The preliminary draft of the questionnaire was revised by five experts,pre-surveyed,and then revised.The reliability and validity of the questionnaire were good.The questionnaire consists of general information and nutritional risk perception,consisting of 24 questions.It aims to understand the attention of medical staff to clinical nutritional problems,the understanding of children’s nutritional risk screening,the views and attitudes of nutritional support,and the needs and willingness to acquire nutritional knowledge and training.Results(1)358 children were aged from 1 to 16 years,with an average age of(4.88 ±3.95)years.Among them,208 were males,with an average age of(4.42±3.88)years and 150 were females,with an average age of(5.54 ± 3.98)years.According to the score,the detection rate of low risk was 43.29%(155/358)and moderate risk was 12.85%(46/358).The detection rate of high risk was 43.85%(157/358).Among them,the detection rate of high risk was in the age distribution,the highest was over 10 years old,accounting for 55.10%(27/49).The detection rates of high risk were 53.52%(38/71),41.54%(81/195),36.67%(22/60)for digestive system diseases,41.54%(81/195)for respiratory system diseases,36.67%(22/60)for immune system diseases and 13.638 for non-parametric tests(p < 0.05).Aspects: Albumin of 132 children was lower than the lowest normal standard value,of which 27.74%(43/155)had low risk,41.30%(19/46)had moderate risk,44.58%(70/157)had high risk,and Z value of non-parametric test was-3.076(p < 0.05).Hemoglobin of 112 children was lower than the lowest normal standard value,of which 27.09%(42/155)had low risk,moderate risk 28.26%(13/46),high risk 32.48%(57/157),non-parametric test z-0.384,there was no significant difference(p > 0.05);the recovery and improvement rates of hospitalized children with different risk levels were tested by non-parametric test z-0.585,there was no significant difference(p > 0.05);hospitalization days and average hospitalization days of children with different risk levels were the highest(p > 0.05).The average hospitalization days were 1-35 days,the average hospitalization days were(7.30±5.61)days,followed by the moderate risk of 1-20 days,the average hospitalization days were(6.24±4.08)days,the low risk of 1-17 days,the average hospitalization days were(5.00±3.54)days,and the nonparametric test Z value was 18.929,the difference was statistically significant(p < 0.05).(2)In the survey of children’s nutritional risk screening awareness,women accounted for 97.16%(444/457),men accounted for 2.84%(13/457),of which 94.75% were nurses(433/457),5.25% were doctors(24/457),working for 1-5 years accounted for 30.85%(141/457),followed by more than 15 years accounted for 24.73%(113/457).Bachelor degree accounted for 51.86%(237/457).There were 276 tertiary medical institutions,181 secondary hospitals,371 pediatric departments,30 surgical departments,50 internal medicine departments and 6 ICUs.Among them,50.68%(188/371)were under 30 years old,39.89%(148/371)were under 5 years old and 61.46%(228/371)were under primary level.There was no significant difference in the age and title of medical staff(p > 0.05).42.01%(192/457)of the medical staff attached great importance to clinical nutrition;only 0.22%(1/457)of the medical staff did not attach importance to it;52.30%(239/457)of the cases in which children’s nutrition problems were exchanged with colleagues in their daily work were occasionally exchanged;90.15%(412/457)of the medical staff who often or occasionally asked questions about nutrition by children and their parents in their work.70.24%(321/457)of the medical staff were not familiar with the nutritional risk screening scale,59.30%(271/457)had general knowledge and 24.07%(110/457)had no knowledge at all.The awareness of nutritional risk screening scale was very low;76.47%(350/457)agreed with the view that nutritional support was beneficial to children;59.52%(272/457)read books by themselves,60.18%(275/457)explored at work,57.33%(262/457)exchanged colleagues,49.23%(225/457)participated in training and 35.23%(161/457)studied at school.1.64%(236/457)of the medical staff indicated that they were in great need of relevant training on child nutrition knowledge;only 3.50%(16/457)often had the opportunity to participate in training;training intention was negatively correlated with age,length of service and Title(p values were 0.001,0.001 and 0.007);40.57%(189/457)of the medical staff chose network training(regularly pushing training content,using fragmentation time)training methods.Conclusion(1)The detection rate of high risk in nutritional risk screening of hospitalized children is higher.Children with digestive system diseases are more likely to aggravate malnutrition because of their appetite,eating condition and digestion and absorption.Hospitalized children aged over 10 and 1-3 years need to pay more attention.The proportion of high nutritional risk hospitalized children whose albumin is lower than normal value is higher,which can lead to an increase in hospitalization days,on average.The length of hospitalization was extended.Hospitalized children need nutritional risk screening before further nutritional assessment to facilitate personalized nutritional intervention.(2)The current situation of child nutrition risk screening is not optimistic.The implementation rate of clinical nutrition assessment is low.The proportion of hospitalized children with nutrition-related problems is high.Medical staff are not familiar with nutrition risk screening tools,do not understand nutrition risk screening,deviate from nutrition viewpoint,and have few training opportunities to acquire nutrition-related knowledge.However,its high attention to children’s nutritional problems and strong willingness to train are beneficial support for the clinical implementation of children’s nutritional risk screening,so it is imperative to carry out further and extensive nutritional risk screening for hospitalized children.To strengthen the training of nutrition knowledge of medical staff,especially those who have worked for less than 5 years or more,the training methods can be flexible and diverse.At the same time,an interdisciplinary nutrition management team will be set up to further standardize the nutrition management of clinical children. |
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