Current status of nutritional support for hospitalized children: a nationwide hospital-based survey in South Korea

Abstract

BACKGROUND/OBJECTIVESThe prevalence of malnutrition among hospitalized children ranges between 12% and 24%. Although the consequences of hospital malnutrition are enormous, it is often unrecognized and untreated. The aim of this study was to identify the current status of in-hospital nutrition support for children in South Korea by carrying out a nationwide hospital-based survey.SUBJECTS/METHODSOut of 345 general and tertiary hospitals in South Korea, a total of 53 institutes with pediatric gastroenterologists and more than 10 pediatric inpatients were selected. A questionnaire was developed by the nutrition committee of the Korean Society of Pediatric Gastroenterology, Hepatology and Nutrition. The questionnaires were sent to pediatric gastroenterologists in each hospital. Survey was performed by e-mails.RESULTSForty hospitals (75.5%) responded to the survey; 23 of them were tertiary hospitals, and 17 of them were general hospitals. Only 21 hospitals (52.5%) had all the required nutritional support personnel (including pediatrician, nutritionist, pharmacist, and nurse) assigned to pediatric patients. Routine nutritional screening was performed in 22 (55.0%) hospitals on admission, which was lower than that in adult patients (65.8%). Nutritional screening tools varied among hospitals; 33 of 40 (82.5%) hospitals used their own screening tools. The most frequently used nutritional assessment parameters were weight, height, hemoglobin, and serum albumin levels. In our nationwide hospital-based survey, the most frequently reported main barriers of nutritional support in hospitals were lack of manpower and excessive workload, followed by insufficient knowledge and experience.CONCLUSIONSAlthough this nationwide hospital-based survey targeted general and tertiary hospitals with pediatric gastroenterologists, manpower and medical resources for nutritional support were still insufficient for hospitalized children, and nutritional screening was not routinely performed in many hospitals. More attention to hospital malnutrition and additional national policies for nutritional support in hospitals are required to ensure appropriate nutritional management of hospitalized pediatric patients.

Canadian Nationwide Survey on Pediatric Malnutrition Management in Tertiary Hospitals

“…A survey among Belgian pediatricians showed that only a small minority of the centers was using validated nutritional screening tools, while more than half of the respondents did indicate they performed some kind of nutritional screening [ 7 ]. Similar findings were reported in a South Korean survey [ 8 ]. While some favor the advantage of validated screening tools that are able to filter out patients at risk of nutritional deterioration during hospitalization and favor their simplicity [ 11 ], others give preference to axiological methods as they find them more pragmatic [ 5 , 12 ].…”

“…Although there are recommendations available from the WHO and Academy of Nutrition and Dietetics/ASPEN, literature on North American practices of assessment and management protocols for pediatric DAM is lacking. Furthermore, available survey literature from other continents mainly focuses on what happens during hospitalization [ 6 , 7 , 8 ]. Therefore, we aimed to survey all tertiary pediatric hospitals in Canada to address all pillars of DAM care in hospitalized children: prevention, screening and assessment, treatment as well as post-hospitalization follow-up.…”

Pediatric screening tools for malnutrition: an update

“…A nationwide survey sent out to all members of the Korean Society of Pediatric Gastroenterology, Hepatology and Nutrition working in pediatric inpatient care revealed that only 52.5% of 40 participating hospitals had a nutrition support team [40]. Nutritional screening practices were less commonly performed for pediatric (55% of the centers) than adult patients (65.8% of the centers).…”

“…Most pediatric centers used a locally developed screening tool, although two centers implemented a validated screening tool (PNRS and STRONGkids). The survey identified a lack of time and manpower, inexperience, low financial reimbursement for nutrition care, and unavailable resources as the main barriers for nutritional support [40]. The same main barriers were named in a multicenter international survey among 693 pediatric gastrointestinal doctors and dieticians: low staff awareness on nutrition, lack of time and lack of local guidelines for nutrition screening, but also the absence of local guidelines or policy to screen [41].…”

Prevalence of Malnutrition in Pediatric Hospitals in Developed and In-Transition Countries: The Impact of Hospital Practices

“…Recently, De Longueville et al [ 80 ] reported that, when compared to an in-house developed software (Evalnut) that not only evaluates risk of malnutrition but it also provides advice for its management, dieticians were the most aware of the importance of nutritional assessment and management during the hospitalization period. Last, a South Korean nationwide hospital-based survey [ 81 ] revealed that only half of the surveyed tertiary- and general-care hospitals had the required nutritional support staff, and that their knowledge was insufficient leading to a failing identification upon admission.…”