Abstract
Background: Disease-related malnutrition (DRM) is one of the most common problems in pediatric patients. Both cancer and congenital heart diseases (CHD) are commonly associated with DRM. Altered nutrition utilization, reduced intake, malabsorption, and hypermetabolism are the main pathophysiology in DRM.
 Method: A systematic literature searching was performed through Pubmed and Google Scholar websites. Thirty-six articles were included into the study.
 Results: Malnutrition screening should be performed as soon as possible since early feeding can benefit the patients. One of the most commonly used tools is Screening Tool for Risk on Nutritional Status and Growth (STRONGkids), which was proven to be valid, reproducible, and applicable in pediatric patients with malnutrition. Following screening and assessment, nutrition support can ensue, preferably in the form of enteral nutrition, unless contraindicated. Nutrient-dense formula, also known as protein and energy-enriched formula, aims to aid infants to reach nutrition target rapidly and stimulate anabolism. This formula has been studied in various population, mostly infants with CHD and studies showed favorable outcomes with its administration, namely faster improvement, reduced diuretics use and oxygen supplementation, decreased length of hospital stay, and less antibiotic use. Nutrient-dense formula is also safe and well-tolerated.
 Conclusion: Proper screening and management should be performed with multidisciplinary approach to achieve the best outcome in children with DRM.
Highlights
Malnutrition, one of the most common problems encountered in pediatric patients, is defined as a condition of excess or lack of protein, energy, or other nutrients which affects the function and structure of the body.[1]
Acute malnutrition is often associated with burns, infectious diseases, and trauma as chronic malnutrition is associated with chronic diseases, such as chronic pulmonary disorders, malignancies, and cystic fibrosis
Aside from screening tool, there are several key points which indicate high risk for malnutrition should be noted in pediatric patients with cancer
Summary
Malnutrition, one of the most common problems encountered in pediatric patients, is defined as a condition of excess or lack of protein, energy, or other nutrients which affects the function and structure of the body.[1]. Disease-related malnutrition is identified in 651% of hospitalized pediatric patients. DRM is mostly associated with infectious disease, gastrointestinal disorders, endocrine disorders, metabolic disorders, as well as neuropsychiatric disorders. This condition might predispose the pediatric patients to poor outcomes, such as disrupted wound healing process, higher infection rates, longer length of stay (LOS), poor quality of life, and higher risk of surgical and medical complications. As for the stakeholders, this can lead to increased costs which affects the country’s economic status.[6] As this DRM can increase the pediatric patients’ morbidity and mortality rates, a proper screening and management algorithm is necessary. This review aims to discuss the guidelines for nutritional management in children with DRM
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