Malnutrition in Hospitalized Children: A Responsibility and Opportunity for Pediatric Hospitalists

Abstract

Poor nutrition is an underrecognized cause of significant morbidity in hospitalized children. 1,2 In addition to presenting with poor nutrition at the time of admission, children often suffer worsening of their nutritional status during the course of a hospitalization, 3,4 often due to providers' underrecognition of ongoing poor intake (see Fig 1). Pediatric hospitalists can and should play a central role in recognizing and treating this common comorbid condition. In this article we highlight the important issue of malnutrition in hospitalized pediatric patients and propose a general approach to nutritional assessment and supplementation for the pediatric hospitalist. DEFINITION OF MALNUTRITION Malnutrition is defined as a state in which a deficiency (or excess) of energy, protein, and other nutrition causes measurable adverse effects on the body and on growth (in children), and may impact clinical outcome. 5 The term "nutritional deterioration" has been used to describe significant weight loss in hospitalized children, a precursor to acute malnutrition. Although the term malnutrition includes both overnutrition (obesity) and undernutrition, in this article we focus specifically on undernutrition. MALNUTRITION IN HOSPITALIZED CHILDREN: INCIDENCE AND OUTCOMES Recent studies in developed countries have estimated the prevalence of malnutrition in hospitalized children as 12% to 24%. 1,3,5,6 Despite many medical advances over the past 20 years, the prevalence of malnutrition among hospitalized children has not decreased. Malnutrition is known to have detrimental effects on clinical outcomes. 7 For example, in children with bronchiolitis in PICUs, poor nutritional status is significantly related to increased length of stay and duration of mechanical ventilation. 2 Malnourished children experience more complications, such as infections after surgery, than well-nourished children, also leading to increased length of stay. 8 Malnutrition also affects growth. Growth depends on a permanent increase in fat and lean body mass, which requires positive energy and nitrogen balance. 7 An increase in nutritional demands due to illness or injury competes with these specific needs of growth. Infancy and adolescence are especially high-risk periods when sustained undernutrition during illness may inhibit growth. Initially, children may show an absence of weight gain,

The Effect of Malnutrition on the Risk of Unplanned 7-Day Readmission in Pediatrics

“…This may have to do with a period of rapid growth seen in patients ,2 years old when malnutrition may be more detrimental. 5,7 The model also identified known risk factors for readmission, such as LOS, acute and/or emergent admission, comorbidities, and ED visits, with effect sizes comparable to those found in other studies. 32 The prevalence of malnutrition in 4.7% of the sample of patients in this study is lower than most reported estimates, [8][9][10] but such comparisons are difficult because of differences in how malnutrition may be assessed across different institutions.…”

“…6 Worldwide, the prevalence of pediatric malnutrition of hospitalized patients in developed countries has been estimated at 5% to 27%, depending on the criteria used. [7][8][9][10] On the other hand, there has been an abundance of reports over the last several years in regard to pediatric readmissions, their prevalence, causes, metrics, and preventability. [11][12][13][14][15] Malnutrition has not been specifically addressed as a factor in any of the reports.…”

Nutrition Risk in Hospitalized Pediatric Patients: Higher Complication Rate and Higher Costs Related to Malnutrition

“…Prevalence of malnutrition ranges from 6% to 41% in Europe, the USA, and Australia and from 8% to 26% in Spain . Malnutrition leads to an increase in infectious complications, length of hospital stay, and weight loss as well as nutrition support needs . Moreover, malnutrition is associated with higher hospital expenses .…”

“…Moreover, malnutrition is associated with higher hospital expenses . Early detection, especially on admission, leads to an appropriate assessment and a nutrition intervention in order to prevent further decline . Therefore, in recent years, many pediatric nutrition screening tools have been developed .…”

Administração de terapia nutricional em crianças gravemente doentes: fatores que prejudicam a oferta de nutrientes

“…Nos últimos anos, diversos estudos científicos demonstraram as repercussões da subnutrição hospitalar como co-responsável pela piora da morbidade/mortalidade, má cicatrização de feridas, maior tempo de permanência na ventilação mecânica, prolongamento do tempo de internação, menor rotatividade de leitos, principalmente na (UTI), e maior custo para o tratamento em todo o sistema de saúde (Sahu et al, 2016;Shaughnessy;Kirkland, 2016;Cao et al, 2014;Yeh et al, 2016;Ghorabi et al, 2016).…”