| Objective:Malnutrition is a nutrient status refers to the energy, protein and other nutrients deficiency or excess. Nutrition closely related to disease, Improve the nutritional status plays an important role in rehabilitation of the disease. But children who are admitted to the hospital developing malnutrition, especially children disease. High percentages of both acute and are at a high risk of with an underlying chronic malnutrition have been reported in different countries, whether in developed or developing countries, are very common. Malnutrition affects not only children’s growth, reduce the body function, but also can increase the nutrition related complications and mortality. However, in clinical treatment, diagnosis of malnutrition is usually ignored and not to be treated. Nutritional status during hospitalization even showed a progressive deterioration trend. The disease state of hospitalized children with nutrient consumption and malnutrition is worrying. Although with clinicians pay more attentions and researchs on nutrition in recent years, also widely recognized correlation between nutrition and disease and the impact of malnutrition on disease prognosis. But some individual hospitals still do not pay attention to admissions of children with weight and height measurements, especially those who are critically ill in bed, and this phenomenon is not a minority. Nutritional risk screening is the first step, is a screening method for potential nutritional dysfunction risk, combined with their own nutritional status and clinical disease causes metabolic stress and other factors. Some European countries have developed a variety of screening and assessment tools to screen nutritional risk and assess nutritional status of children, However currently the decision criteria of nutrition risk screening and evaluation method each are not identical, there is no system, standard, unified plan, cause there are still a lot of malnutrition cases were missed diagnosis, miss the timing of the early intervention. The problem is the doctores lack of nutritional knowledge and consciousness, and lack of effective nutritional screening, assessment and intervention. Hope through this study can not only reflect the nutritional status of children in our hospital but also assess the feasibility of nutritional risk screening tool selected in our clinical work applications. Therefore, it is necessary for medical workers to hospitalized children with nutritional risk screening, exact nutrition assessment and nutritional surveillance, so that can timely find the nutritional problems and take reasonable nutrition support and intervention measures, save the disease brings to the body of poor prognosis. Ultimately through screening and assessment in order to better guide the nutrition intervention and treatment have clinical application. Methods:Nutritional risk screening tool (STRONGkids) on 651 cases of hospitalized children with nutritional risk screening. Our inclusion criteria were, age from 1 month to 5 years, and through the physical measurements to assess children’s nutritional status within 48h; Exclusion criteria: (1) admission for more than 48h, less than 1 month of age or greater than 5-year-old children; (2) within the past three months had received enteral (or) and parenteral nutrition in children. Study protocol was approved by the ethics committee of hospital, parents of children have signed informed consent. At the same time record their name, gender, actual age, disease diagnosis, chief complaint and other general information recorded on admission. Within 48 hours after admission to measure physical indicators of children, including the length (less than 3 years old) or height (3 years), body weight and body mass discharge measured by the person responsible. Choose simple dress under fasting weighing measurement. Length or height accurate to 0.1cm, accurate body weight to 0.01kg, were measured twice the average. Then do the nutrition risk screening by the tool of strongkisrthis nutritional risk screening questionnaire consisted of 4 items and each item was allocated a score of 1-2 points with a maximum total score of 5 points;(1) Subjective clinical assessment (1 point):Is the patient in a poor nutritional status judged by subjective clinical assessment (diminished subcutaneous fat and/or muscle mass and/or hollow face)? (2) High risk disease (2 points):Is there an underlying illness with a risk of malnutrition or expected major surgery (includes:Anorexia nervosa, burns, bronchopulmonary dysplasia (2 years), celiac disease, cystic fibrosis, premature delivery (best corrected age of 6 months), chronic heart disease, infectious disease, colitis, cancer, chronic liver disease, chronic kidney disease, pancreatitis, short bowel syndrome, muscle diseases, metabolic diseases, trauma, mental disorders /retardation, the expected major surgery, or the need for major surgery)?(3) Nutritional intake and losses (1 point):Are one of the following items present? Excessive diarrhoea (>5 per day) and/or vomiting (>3 times/day) the last few days? Reduced food intake during the last few days before admission (not including fasting for an elective procedure or surgery)? Pre-existing dietetically advised nutritional intervention? Inability to consume adequate intake because of pain? (4) Weight loss or poor weight gain? (1 point) Is there weight loss or no weight gain (infants<1 year) during the last few weeks/months? The first two were evaluated by a pediatrician, the latter discussed by their parents or guardian. The question is not clear, the answer will be considered as "no." According to the aforementioned score,4-5 score as high risk, medium risk score of 1-3,0 points for a low-risk. According WHO2006 the reference standard of physical development of children and adolescents, the application of Z score value by evaluating the height for age (HAZ), weight for height (WHZ) and weight-for-age (WAZ) to determine the nutritional status of children. A SD score of <-2 for WFH was used to indicate acute malnutrition, and an SD score of<-2 for HFA was used to indicate chronic malnutrition. Overall malnutrition rate was defined as the presence of acute and/or chronic malnutrition. Finally, using SPSS 18.0 statistical software for statistical analysis of the results and draw relevant conclusions. Results:Of 651 cases of hospitalized children, male 441, female 210 people,1 month to 1 year of 337 people,223 people aged 1 to 3,91 people aged 1 to 3.7.07% are highly nutritional risk,80.95% of the risk of moderate nutrition,11.98% low nutrition risk exists. Malnutrition rate is:22.58%, moderate malnutrition in 111 cases (17.05%); Severe malnutrition in 36 cases (5.53%). The First three high risk disease is Congenital heart disease, chronic liver disease, chronic kidney disease (CKD) (X2-21.43, P< 0.01); According to the result of nutrition evaluation concluded with congenital heart disease, chronic kidney disease occurred severe malnutrition is far higher than other diseases (x2=16.53, P< 0.05). Highly nutritional risk hospital stay relatively low nutritional risk in children with children are more likely to have weight loss (P< 0.05), the length of hospital stay longer than the low nutritional risk in children (all P< 0.01). Z-score value as the standard, evaluation and Comparison STRONGkids nutrition risk screening methods derived area under ROC curve was 0.783, which STRONGkids nutritional risk screening tool for malnutrition screening was significant (P= 0.00), with increased nutritional risk screening score, the greater the likelihood of malnutrition, CI(0.692,0.883). At the same time according to the ROC curve obtained when screening total score is 2,the sensitivity was 0.833, specificity was 0.473, the misdiagnosis rate was 0.527; and the screening total score is 3,the sensitivity was 0.456, specificity was 0.890, the misdiagnosis rate was 0.110. Meanwhile study concluded that moderate nutritional risk mainly in children 1-3 years old (P<0.05). Children with a high degree of nutritional risk weight for age, height for age, weight for height Z scores were lower than low, moderate nutritional risk children (all P<0.05). Highly nutritional risk hospital stay relatively low nutritional risk in children with children are more likely to have weight loss (P< 0.05), the length of hospital stay longer than the low nutritional risk in children (all P < 0.01). After excluded some factors such as the age, sex and disease that may impact children’s weight loss and length of hospital stay, duration of hospitalization of children with different nutritional risk was statistically significant (F= 11.57, P <0.05).Conclusions1. A ccording to the experimental results we find that the high incidence of hospitalized children with malnutrition, children with diseases consume nutrition and malnutrition is widespread, mainly that of a low level of nutrition clinician attention in children after hospitalization, result in weight loose. The different nutritional risk can lead to different clinical outcomes, poor nutritional status not only makes the illness delayed healing during hospitalization, but also prolonged hospitalization.2. STRONGkids nutritional risk screening tool used in this experiment has been verified through the multi-center study, it operation easier, practical and good patient compliance. STRONGkids nutritional risk screening tool for malnutrition screening was significant, with increased nutritional risk screening score, the greater the likelihood of malnutrition. At the same time the total score of three for a standard can reduce misdiagnosis, judgment nutritional status more accurately, and to guide clinical better, avoid excessive intervention.3. The First three highest risk disease is Congenital heart disease, chronic liver disease, chronic kidney disease; According to the result of nutrition evaluation congenital heart disease, chronic kidney disease occurred severe malnutrition is far higher than other diseases. At the same time from our study we found that children with come common diseases such as the respiratory diseases and digestive diseases more prone to malnutrition.4. High malnutrition risk mainly in infants less than 1 year, moderate nutritional risk mainly in children 1-3 years old, The younger the child the greater the likelihood of malnutrition.5. Different nutritional risk leads to different clinical outcomes. Highly nutritional risk hospital stay relatively low nutritional risk in children are more likely to have weight loss, the length of hospital stay longer than the low nutritional risk in children. Ultimately affect the rehabilitation of the disease and increase the financial burden on families of children.6. The study has its deficiencies, first, in our hospital, the most children are common respiratory infections and intestinal infectious, disease spectrum for analysis and utilization is not ideal. Second, STRONGkids nutritional risk screening tool in clinical applications subjective assessment needs professionals to assess, which increases the difficulty of clinical practice; Therefore, the screening process in the future we need to cultivate more professional doctor, reduce errors, improve the types of diseases and disease severity score. For widely use STRONGkids nutritional risk screening tool not only need a wider range, multi-center study but also need develop more comprehensive, standardized and child nutrition risk screening and evaluation methods that suitable for China’s national conditions and clinical applications, Better contribute to pediatric clinical. |
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