| Hospitalized neonates,due to their disease consumption,physiological and metabolic characteristics,are prone to have malnutrition.Short-term effects may include increased morbidity and mortality,longer length of stay and more expenses of hospitalization.Long-term effects may cause growth and development lag,nerve growth retardation,learning difficulties and increase the risk of adult obesity,type ? diabetes mellitus and cardiovascular disease in adulthood.If nutritional risk could be evaluated or screened for neonates,and then nutritional intervention and treatment could be performed early,it will help to improve the prognosis of disease,the neonatal the quality of life and reduce the incidence of neonatal malnutrition,the burden of family economic society.Though many nutritional risk screening tools in pediatric area are existence,most of them are not suitable for neonates due to the unique physiological characteristics of neonates.There are no reports that common nutritional risk screening tool of hospitalized children can be used to screen the neonatal nutritional risk so far.Screening tools related to neonatal nutritional risk are less and the validity of them has yet to be confirmed.Therefore,the lack of a simple and effective nutritional risk screening tool for neonates is commonly seen as a major limiting factor to improvement.It is necessary to develop a nutritional risk screening tool for neonates and test its validity to perform nutrition risk screening preliminarily and regular monitoring of nutritional status.ObjectivesThe purpose of this study is to develop a neonatal nutritional risk screening tool which can be used to identify the nutritional risk in hospitalized neonates simply and effectively.The sensitivity,specificity,validity and reliability of neonatal nutritional risk screening tool should be tested by clinical application.Through the characteristics of the growth and the nutrition status in different risk grade neonates,the rationality of nutritional risk grade classification and the relationship between newborns with different level nutritional risk and clinical outcome can be analyzed.Methods1.The neonatal nutritional risk factors and related literatures were analyzed by literature analysis and core group discussion method.It lay a theoretical foundation for the contents of each dimensions and indicators.2.An expert group of experienced neonatal clinical treatment,nutrition care and nursing was compiled to undertake a two-round Delphi process and form the dimension and indicator contents of the neonatal nutritional risk screening tool.AHP software yaahp10.3 was used to calculate the weight coefficients of each dimensions and indicators.3.Hospitalized neonates who recruited from May to July 2016 in neonatal diseases diagnoses and treatment center of Children's Hospital of Chongqing Medical University.The weight measurements were taken in every morning.The nutritional risk screening by our tool and the measurement of length and head circumference were performed in each participants during hospital stay weekly.Then the related data were recorded.Comparing the birth and discharge weight of each infants and then plotted on the Chinese neonatal birth weight curve to judge whether they had faltering growth or not.This was regarded as a standard for the sensitivity,specificity,and validity analysis of the nutritional risk screening tool.Scorer reliability was determined by calculating Kappa coefficient.According to the comparison of neonates' various characteristics in different risk grade,the rationality of nutritional risk grade classification could be analyzed.Results1.The calculation results of the Delphi method and AHP: The average coefficient of expert authority degree was 0.9.The expert enthusiasm coefficient of two rounds were 88% and 100% respectively.Dimensions and indicators of coordination coefficient in the second round were 0.443,0.486 respectively.The coordination coefficient of dimensions and indicators were between 0.4 ~ 0.5,P<0.01,which showed the experts' opinion tended to be consistent.According to the consistency check,CR values were all less than 0.1,which showed the satisfied consistency of judgment matrix.On that basis,the weight coefficients of each dimensions and indicators could be calculated.Indicator scores were determined by the weight coefficients.2.The determination of relevant instructions and scoring rules: The final tool included scale,instructions and scoring rules.The content of the scale header is the basic information,while the body is constituted by 4 dimensions(dimension ? birth situation,dimension ? weight change,dimension ? nutrition intake way and dimension ? common neonatal disease diagnosis)and 31 indicators.Nutritional risk score is calculated for sum scores of 4 dimensions.The score range of the tool is 0 ~ 15.The nutritional risk can be divided into three levels: total score ?8 for high risk,?4 and < 8 for medium risk,<4 for low risk.3.The results of sensitivity,specificity,reliability and validity: The sensitivity and specificity was 85.11% and 91.07%.The correlation coefficient of criterion validity(r = 0.530,P = 0.530)was calculated by correlation method.Then distinguish method was used to test criterion validity(Z = 9.732,P = 9.732),the difference was statistically significant.The test results of content validity between items ?~ ? and total score were positively correlated by Spearman correlation analysis,the correlation coefficient r was 0.672,0.321,0.735,0.560 respectively.Kappa value was 0.89.4.The comparison results of general condition,growth and development,nutritional intake,complications for newborns in different risk levels: values of the gestational age,birth weight,length,admission head circumference,admission albumin,total protein admission,discharge weight,discharge length and head circumference decreased with nutritional risk level increasing.The values of the length of stay,parenteral nutrition support rose with the increase of nutrition risk level.In the comparison of various complications during hospitalization,except hyperbilirubinemia,milk protein allergy and gastroesophageal reflux,the difference of the rest of disease morbidity had statistical significance.Conclusions1.The consultation panelists presented good cooperation,high of enthusiasm and authority degree in this study.The scores of expert evaluation fluctuated slightly,which showed good consistency and credibility.2.The results of sensitivity,specificity,positive predictive value and negative predictive value were high,which showed the ability of identification for high risk neonates.Good reliability and validity showed that the results screened by the tool were effective and reliable.It can be used as the early neonatal nutritional risk screening tool.3.The nutritional risk of the tool was divided into three levels: high risk,medium risk,and low risk.The differences in three nutritional risk level are obvious by the comparative analysis of all kinds of data.The nutrition risk classification was reasonable.The different nutrition risk classification had significance to the prediction of clinical outcomes with neonates. |
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