Nutritional risk screening in critically ill children using Screening Tool for the Assessment of Malnutrition in Pediatrics

Abstract

Objective To evaluate the incidences of nutritional risk and malnutrition of critically ill children using Screening Tool for the Assessment of Malnutrition in Pediatrics (STAMP),and to investigate the correlation between nutritional risk and clinical outcomes.Methods Altogether 506 children admitted to pediatric intensive care unit (PICU) of Shanghai Children's Medical Center from February to November 2013 were enrolled.The patients were divided into 3 groups based on STAMP scores,namely low risk group (score 0-1),medium risk group (score 2-3),and high risk group (score 4-9).Nutritional status was determined using Z-scores based on the World Health Organization child growth standards.Clinical outcomes were recorded and analyzed,including nosocomial infection,mechanical ventilation,number of dysfunction organs,incidence of multiple organ dysfunction syndrome (MODS),PICU stay,hospital stay,hospital fee,and 28-day mortality after discharge from PICU.Results According to STAMP scores,79 children (15.6％) were at low nutritional risk,167 (33.0％) at medium nutritional risk,and 260 (51.4％) at high nutritional risk.Upon admission,253 children (50.0％) were malnourished,including 225 (44.5％) with undernutrition and 28 (5.5％) with overweight.The prevalence of underweight,stunting,and wasting was 31.0％ (157/506),29.4％ (149/506),and 14.4％ (73/506),respectively.Children at high nutritional risk had higher incidence of mechanical ventilation,more organ dysfunction,higher incidence of MODS,longer length of PICU stay and length of hospital stay,higher hospital fee,and higher 28-day mortality than those at medium risk [45.8％ vs.31.7％,P=0.004; 1 (1,2) vs.1 (0,2),P=0.000; 45.8％ vs.26.3％,P=0.000; 8 (3,15) days vs.5 (2,9) days,P=0.000; 17 (9,29) days vs.12 (6,21) days,P＝0.001; 3.81 (1.67,8.53) ×104 yuan vs.2.09 (1.13,4.85) ×l04 yuan,P=0.000; 26.9％ vs.18.6％,P=0.047] and those at low risk [45.8％ vs.22.8％,P=0.000; 1 (1,2) vs.1 (0,1),P=0.000;45.8％vs.15.2％,P=0.000;8 (3,15) daysvs.6 (3,9) days,P=0.008; 17 (9,29) daysvs.11 (6,20) days,P=0.001; 3.81 (1.67,8.53) ×104yuanvs.1.57 (0.96,3.37) ×104yuan,P=0.000; 26.9％ vs.7.6％,P =0.000].Malnourished children had higher incidence of MODS and nosocomial infection compared with children at normal nutritional status (39.9％ vs.29.2％,x2 =6.368,P =0.012; 8.3％ vs.4.0％,x2 =4.158,P =0.041).Conclusions High nutritional risk and malnutrition are common among critically ill children.Patients at high nutritional risk are more likely to have worse clinical outcomes.STAMP is a valid tool for nutritional risk screening in critically ill children and early nutrition support is recommended. Key words: Critically ill children; Nutritional risk screening; Malnutrition