Assessment Of Malnutrition In Paediatrics Research Articles

The malnutrition screening tool STRONGKIDS performed better than other screening tools for children hospitalised in Egypt.

To compare the accuracy of three different screening tools, namely, the Paediatric Yorkhill Malnutrition Score (PYMS), Screening Tool for the Assessment of Malnutrition in Paediatrics (STAMP), and Screening Tool for Risk on Nutritional Status and Growth (STRONGKIDS), in assessing malnutrition risk in hospitalised children. A cross-sectional study was conducted on 300 children aged 6 months to 15 years at Alexandria University Children's Hospital, Egypt. The sensitivity and specificity of each tool were calculated to detect acute and chronic malnutrition, and an agreement test was conducted between the nutritional screening tools. The patients were classified into different nutritional risk groups, and their classification was compared with anthropometric measures and clinical variables, such as the length of hospital stay (LOS). The prevalence of stunting and wasting on admission was found to be 3% and 6.6%, respectively. Children categorised as high-risk on admission had a longer LOS than those at low risk. The agreement test between the STAMP score and STRONGKIDS score on admission showed the most significant agreement, and STRONGKIDS had the best accuracy in detecting acute and chronic malnutrition. The comparison of the three screening tools revealed that STRONGKIDS exhibited the best accuracy in detecting acute and chronic malnutrition.

Evaluation of malnutrition and screening tools in hospitalized children

Detecting malnutrition and its related risk factors are crucial, in hospitalized children. Anthropometric z scores are used to assess malnutrition. Screening tools also aim to detect the presence of malnutrition and the developing risk of malnutrition in hospitalized children to determine who may benefit from nutritional support. Therefore, the aims of the study are to detect malnutrition and its related demographic and clinical risk factors in hospitalized children and determining the sensitivity of Screening Tool for the Assessment of Malnutrition in Pediatrics (STAMP) and Pediatric Yorkhill Malnutrition Score (PYMS) screening tools. A total of 130 hospitalized children aged between 0 and 18 years were included in to study. A survey including demographic and clinical characteristics, STAMP and PYMS were applied to parents of the children. Patients were classified into nutritional risk groups through screening tools. Anthropometric measurements (body weight, length/height, and middle upper arm circumference (MUAC) of the children were taken. Body mass index-for-age and height-for-age z scores were calculated to assess acute and chronic malnutrition prevalence. MUAC-for-age z scores were calculated as well. To detect independent risk factors for acute and chronic malnutrition multivariable logistic regression models were constructed. A total of 14.6% of hospitalized children had acute malnutrition, 21.5% of children had chronic malnutrition and 27.7% of them had low MUAC standard deviation score (SDS) (less than-2). The independent risk factors for acute malnutrition were younger maternal age at birth and long length of stay (p<0.05). The independent risk factors for chronic malnutrition were being female, younger maternal age at birth, longer illness duration and having urological or allergy and immunological diseases (p<0.05). However, MUAC for age SDS groups were not related to any demographic and clinical factors, in children of all ages (p>0.05). Regarding the screening tools, PYMS displayed 100% sensitivity against acute malnutrition. While PYMS displayed better sensitivity to identify acute malnutrition than STAMP, STAMP was more sensitive than PYMS to detect chronic malnutrition and low MUAC SDS. Low MUAC for age SDS was not related to any demographic and clinical factors, in hospitalized children of all ages, unlike acute and chronic malnutrition, in this study. Pediatric screening tools mainly PYMS did not have high sensitivity to detect chronic malnutrition and low MUAC SDS, in hospitalized children. Therefore, the tools have to be used along with z scores of anthropometric parameters.

Influence of malnutrition and body composition on the gross motor function of children with cerebral palsy in Kano, Nigeria: a cross-sectional study

BackgroundMalnutrition is common among children with cerebral palsy (CWCP); however, its impact on gross motor function (GMF) is not adequately reported. The study evaluated the influence of malnutrition and body composition on GMF.MethodsIn the cross-sectional survey, CWCP were recruited using purposive sampling from three selected secondary and tertiary hospitals in Kano, Nigeria. Sociodemographic variables were recorded on a data capture form. Anthropometric variables were measured using standard procedures. Percent (%) body fat, malnutrition, and GMF were assessed using skinfold thickness, screening tool for the assessment of malnutrition in pediatrics, and GMF classification system (GMFCS), respectively. The data was analyzed with one-way ANOVA, chi-square, and logistic regression using SPSS version 20 at p < 0.05.ResultsThe 146 CWCP have mean age of 4.70 ± 2.46 years. About 95 (65.1%) are malnourished. Those with GMFCS V had lower %body fat and higher malnutrition than children with GMFCS II and I, respectively (p < 0.05). Malnutrition has no significant influence on GMF (B = 0.984, OR = 2.676; 95% CI = 0.965–7.423, p > 0.05). %body fat (B = −0.192, OR = 0.826; 95% CI = 0.687–0.992, p < 0.05), type of CP (OR = 12.106; 95% CI = 3.771–38.866, p < 0.005), child’s position in the family (OR = 1.639; 95% CI = 1.162–2.312, p < 0.05), and mothers’ education (B = −2.815, OR = 0.060; 95% CI = 0.012–0.309, p < 0.005) all predicted GMF.ConclusionsMajority of the CWCP in this study are malnourished. But malnutrition did not however significantly predict GMF, meaning that though malnutrition could impair children’s physical growth and motor development, it however did not have significant influence on their motor function. Hence, CWCP undergoing rehabilitation may not likely experience significant decrease in their motor function due to inadequate nutrition. Decrease in body fat, type of CP, low level of mothers’ education, and child occupying 4th or more position in the family have negative influence on GMF. It was recommended that physiotherapists should routinely assess for malnutrition in CWCP. Prompt nutritional intervention may prevent considerable lose of body fat and augment the gains of physical rehabilitation by providing appropriate nutrition to support muscle growth and the supply of adequate energy for participation in physical exercise. Adequate caregiver education is important for ensuring satisfactory nutrition for CWCP.

Comparação de quatro ferramentas diferentes de triagem de risco nutricional em crianças hospitalizadas

ABSTRACT Objective: Early detection of malnutrition risk in hospitalized children can improve health outcomes and quality of life; however, the number of studies where the pediatric screening tool is appropriate for Turkish children is limited. Therefore, this article aims to determine the prevalence of malnutrition risk in pediatric patients evaluated with Screening Tool for Risk on Nutritional Status and Growth, Screening Tool for the Assessment of Malnutrition in Pediatrics, Pediatric Yorkhill Malnutrition Score, and Simple Pediatric Nutrition Screening Tool with original and adjusted cutoffs and to evaluate which pediatric screening tool is appropriate for Turkish children. Methods: In this cross-sectional study, four published nutritional risk screening tools (Screening Tool for Risk on Nutritional Status and Growth, Screening Tool for the Assessment of Malnutrition in Pediatrics, Pediatric Yorkhill Malnutrition Score, Pediatric Nutrition Screening Tool) were applied to pediatric inpatients (n=604) aged 1 month to 17 years, admitted to a pediatric ward for at least 24 hours. Results: Pediatric Nutrition Screening Tool with adjusted cutoffs had the greatest recognition rate (94.2%) of acute malnutrition. Having a high nutritional risk by Pediatric Yorkhill Malnutrition Score was associated with an increased risk of acute (OR: 6.57 for Screening Tool for Risk on Nutritional Status and Growth, 5.84 for Screening Tool for the Assessment of Malnutrition in Pediatrics, and 20.35 for Pediatric Yorkhill Malnutrition Score) and chronic malnutrition (OR: 1.27 for Screening Tool for Risk on Nutritional Status and Growth, 3.28 for Screening Tool for the Assessment of Malnutrition in Pediatrics, and 1.72 for Pediatric Yorkhill Malnutrition Score). Classifying the at-risk category by the Pediatric Nutrition Screening Tool was related to raised odds of malnutrition (OR: 2.64 for original and 5.24 for adjusted cutoffs). This positive association was also observed for acute (OR: 4.07 for original cutoffs, and 28.01 for adjusted cutoffs) and chronic malnutrition (OR: 1.14 for original cutoffs, and 1.67 for adjusted cutoffs). Conclusion: Pediatric Nutrition Screening Tool with adjusted cutoffs and Pediatric Yorkhill Malnutrition Score have higher diagnostic accuracy than other screening tools in assessing the nutritional status of hospitalized Turkish children and detecting children, particularly with acute malnutrition.

Adaptation in Spanish and validation in Mexico of the Screening Tool for the Assessment of Malnutrition in Paediatrics (STAMP

Background: pediatric malnutrition is one of the main causes of complications in hospitalized children. Nutritional screening at admission is essential. The Screening Tool for the Assessment of Malnutrition in Paediatrics (STAMP) is a simple, reproducible and easy-to-interpret tool, but it is not validated in Mexico. The objective of the study was to validate and adapt the STAMP nutritional screening tool to the Mexican population. Methods: the validation was carried out in two phases: firstly, the translation and cultural adaptation was carried out; and secondly, a cross-sectional study was performed comparing the STAMP tool with a complete nutritional assessment (CNA). A pediatrician specialized in nutrition performed the CNA with the evaluation of anthropometric, clinical and dietary parameters; later, two nutritionists carried out the same evaluation with the STAMP tool. Finally, the patients were graded as low risk and moderate or severe malnutrition risk. Results: of the 300 patients included in the study, 160 were boys (53.3 %) and 140 were girls (46.7 %), with a mean age of 9.44 ± 5.73 years. The assessments made by with the STAMP tool had a 100 % concordance. Compared with CNA, a kappa index of 0.480 (p < 0.01) was obtained. The STAMP test showed a sensitivity of 92 %, a specificity of 75 %, positive predictive value (PPV) of 45 %, negative predictive value (NPV) of 97 %, RVN of 3,68, and RVN of 0,10. Conclusions: the STAMP screening tool has the necessary elements to objectively assess the risk of malnutrition in Mexican children and is a highly sensitive and specific test. test.

Value of Nutritional Screening Tools Versus Anthropometric Measurements in Evaluating Nutritional Status of Children in a Low/Middle-Income Country.

Pediatric patients in low-income countries are at a high risk of malnutrition. Numerous screening tools have been developed to detect the risk of malnutrition, including the Subjective Global Nutritional Assessment (SGNA), Pediatric Yorkhill Malnutrition Score (PYMS), Screening Tool for the Assessment of Malnutrition in Pediatrics (STAMP), and Screening Tool for Risk of Nutritional Status and Growth (STRONGkids). However, anthropometry remains the main tool for assessing malnutrition. We aimed to identify the value of four nutritional screening tools versus anthropometry for evaluating the nutritional status of children. We conducted a cross-sectional study of 1,000 children aged 1-12 years who visited the outpatient clinic of Cairo University Pediatric Hospital. Each participant was evaluated using anthropometric measurements (weight, length/height, and weight for length/height) as well as the PYMS, STAMP, STRONGkids, and SGNA screening tools. The sensitivities and specificities of these four tools were assessed using anthropometry as the gold standard. Of the patients, 1.7% were underweight, 10.2% were wasted, and 35% were stunted. STRONGkids demonstrated the highest sensitivity (79.4%) and a high specificity (80.2%) for detecting malnutrition compared with weight for height, followed by STAMP, which demonstrated lower sensitivity (73.5%) but higher specificity (81.4%). PYMS demonstrated the lowest sensitivity (66.7%) and the highest specificity (93.5%), whereas SAGA demonstrated higher sensitivity (77.5%) and lower specificity (85.4%) than PYMS. The use of nutritional screening tools to evaluate the nutritional status of children is valuable and recommended as a simple and rapid method for identifying the risk of malnutrition in pediatric patients.

Nutritional rehabilitation of malnourished children: are nutritional supplements a must?

Objective Malnutrition threatens children worldwide. The objective of the current study was to highlight the role of nutritional screening, evaluate the effectiveness of nutritional intervention program, and whether nutritional supplements have surplus benefit. Patients and methods Screening Tool for the Assessment of Malnutrition in Pediatrics (STAMP) was used to screen 3640 clinically stable 2–5 years old children recruited from the outpatient clinics, Children’s Hospital, Ain Shams University. A total of 100 patients at high risk of malnutrition were enrolled. Full nutritional assessment was done and according to the distribution of the calories in the daily meal plan, the patients were randomly divided into two groups each comprised 50 patients. Group A received tailored nutritional dietary rehabilitation plan including dietary supplements, while Group B received only dietary advice. Anthropometric measurements, laboratory tests, as well as STAMP scoring were reassessed after the nutritional rehabilitation programs. Results Nutritional screening revealed that 5.14% were at high risk of malnutrition. Both studied groups showed significant improvement in caloric intake and all anthropometric measurements upon nutritional rehabilitation, except for the height z scores. Patients who received nutritional supplements showed significantly better changes regarding weight, BMI, caloric intake, and hemoglobin. Regarding STAMP categories during follow up, Group A had only 6% of the patients still in the high-risk category and 76% were at low risk compared to 14% high risk and only 54% were at low risk in Group B. Conclusions Nutritional screening in pediatric outpatient facilities can lead to implementing prompt nutritional rehabilitation, which can reflect on the patients’ overall health. Tailored nutritional plan can accomplish good response in terms of improvement of caloric intake, anthropometric measurements and laboratory parameters. Adding a nutritional supplement to the dietary plan during nutritional rehabilitation isn’t a must but it ensures superior goal achievement.

Adapting the Screening Tool for the Assessment of Malnutrition in Pediatrics to the Electronic Health Record.

Nutrition screening is a crucial process for allocating nutrition care, particularly in acute care settings. Screening is meant to prioritize care for those patients at highest nutritional risk, ensuring timely assessment and intervention for improved patient outcomes. Without proper screening and intervention, patients are at risk for malnutrition-related complications and extended hospitalizations. Effective nutrition screening is concise, clear, and objective and enables the appropriate utilization of registered dietitian nutritionist (RDN) resources.

ALL-066 Safety and Efficacy of Turmeric in Children With Acute Lymphoblastic Leukemia

Gut microbiota may have a role in regulating the progress of cancer. Curcumin and its metabolites may have various effects on cancer treatments by eliminating intestinal microflora dysbiosis. To assess the safety and efficacy of curcumin in children with acute lymphoblastic leukemia (ALL) and determine whether gut microbiota can be used to predict therapy-related complications. Single-center, open-label prospective randomized controlled clinical trial. Pediatric Hematology Oncology Department, Ain Shams University Hospitals, Cairo, Egypt. All patients underwent detailed clinical assessment and anthropometric measurement. Nutritional assessment was performed using the Screening Tool for the Assessment of Malnutrition in Pediatrics (STAMP), and nutrition risk were assigned based on 3 parameters: nutrition implication of the patient's medical diagnoses, recent nutrition intake, and anthropometrics. Complete blood count, total protein, and albumin were gathered. Fecal samples were collected to detect microbiota quantity. A block-randomization scheme was generated by computer software; patients were randomized between curcumin plus the nutritional standard of care (SOC) and the nutritional SOC only, which consisted of a nutrition program through supplementation of a high-caloric, high-protein diet, tailored according to patients' age and sex for both groups. Curcumin 500 mg was supplemented per oral capsule twice daily for 1 month starting at week 1 of the maintenance phase of chemotherapy. Patients were followed up with once weekly during the curcumin supplementation to monitor compliance and adverse events. All assessments were performed at ALL diagnosis, at week 1 of maintenance phase of chemotherapy, and after 1 month of intervention. Thirty pediatric patients with confirmed ALL were recruited from day 0 of presentation and followed over a 12-month period. The majority of patients were under 10 years of age and presented mainly with fever at time of diagnosis. Their initial nutritional assessment showed STAMP scores of mainly 3 and 4. The curcumin showed a safety profile and was tolerated by most patients. The effects of curcumin on microbiota were studied through assessment of the proportions of Lactobacillus and Bifidobacterium in fecal samples, and the results are in the statistical analysis phase. This interim analysis showed a promising role of curcumin as a nutritional supplement in children with ALL.

Agreement between nutritional risk screening tools and anthropometry in hospitalized pediatric patients.

The use of malnutrition screening tools has been recommended to identify the risk of malnutrition among hospitalized children. The aim of this study was to evaluate the association between the Screening Tool for Risk on Nutritional Status and Growth (STRONGkids), the Screening Tool for the Assessment of Malnutrition in Pediatrics (STAMP), and anthropometric nutritional parameters to identify malnutrition in hospitalized children. Data recorded in the nutrition sector for 672 pediatric patients hospitalized between 2019 and 2020 were used to complete the STRONGkids and STAMP tools. To test for associations, the chi-square test or Fisher-Freeman-Halton Exact Test were employed, accepting a p-value <0.05 as the threshold for significance. To determine agreement, the Kappa coefficient was applied. Patients with a mean age of 5 years and 7 months were classified as at high nutritional risk by STRONGkids and STAMP in 10.1% (n=68) and 24.3% (n=163) of cases, respectively. A significant association (p<0.05) was identified between all parameters studied for both tools. For STRONGkids, the chi-square test were as follows: BMI/Age, 69.707; Height/Age, 37.730; Weight/Age, 72.202; and Weight/Height, 60.595, whereas for STAMP, they were BMI/Age, 79.620; Height/Age, 75.246; Weight/Age, 91.034; and Weight/Height, 57.227. When compared, the two tools showed significant moderate agreement (κ=0.448; p<0.001). STAMP classified a higher percentage of patients as being at high nutritional risk when compared with STRONGkids, and both tools had a significant association when compared with anthropometric parameters. Screening tools are easy to apply and can be used to identify the risk of malnutrition in this population.

Возможности реализации скрининговых методов оценки нутритивного риска у детей с неврологической патологией

Objective. Comparative evaluation and study of the effectiveness of using different nutritional risk screening tools in children with neurological pathology. Patients and methods. This study included 105 children with neurological pathology (epilepsy, cerebral palsy, congenital anomalies of the nervous system), among whom were 50 (47.6%) boys and 55 (52.4%) girls aged 1 to 17 years (7.8 ± 4.9 years). Anthropometric indices were assessed and questionnaires using nutritional risk screening tools were conducted, followed by calculation of their sensitivity and specificity. STRONGkids (Screening Tool Risk on Nutritional Status and Growth), PYMS (Pediatric Yorkhill Malnutrition Score), and STAMP (Screening Tool for the Assessment of Malnutrition in Paediatrics) were used. Results. Assessment of anthropometric indices (weight-for-height, BMI-for-age, and height-for-age Z-scores) indicated malnutrition in 5 to 15 children (4.8-14.3%), depending on the evaluation criteria. According to the screening results, all patients were classified as high and medium risk of malnutrition, and 94 (89.5%) children required nutritional care according to STRONGkids, 38 (36.2%) children – according to PYMS, and 104 (99%) children – according to STAMP. The most sensitive screening tool was STAMP with a sensitivity score of 89.5% as compared with STRONGkids and PYMS (21.1% and 31.6%, respectively). Conclusion. The results of this work demonstrate the advantages of the STAMP tool in assessing the nutritional status of children with neurological pathology, given its higher efficacy in this group of patients, and the need for further research to develop practical recommendations. Key words: children, nutrient deficiency, nutritional risk screening tools

Association between Nutritional Status of a Child Using Screening Tool for Assessment of Malnutrition in Paediatrics and Clinical Outcomes in Inpatients at a Tertiary Care Hospital Setting in Eastern Nepal

Introduction: Malnutrition in children has health and physical consequences resulting in delayed physical growth and motor development, behavioral and social problems as well as susceptibility to contracting diseases.The Screening Tool for Assessment of Malnutrition in Pediatrics (STAMP) is a specially constructed tool that uses anthropometric measurements, body composition, and patient's clinical status to predict the risk of malnutrition for inpatients at admission. There is no agreement on the ideal screening tool or scales for detecting and determining the level of malnutrition in pediatric inpatients. Various studies in the pediatric population have analyzed the association of malnutrition during hospitalization with patient outcomes, but few have analyzed whether the STAMP tool in particular could be used to predict length of hospital stay and disease severity in these patients. Objectives: We studied the use of STAMP screening tools to assess the risk of malnutrition in inpatients by including a nutritional screening in the admission process and analyze the association between the risk of malnutrition and patient outcomes (length of hospital stay and severity of disease). Methodology: We conducted a prospective single-center study between May to July 2021 at a tertiary care hospital. All patients admitted to the pediatric ward aged 1 month to 15 years with a length of stay of at least 24 hours were included into the study. Data were collected about clinical, anthropometric and demographic variables for each patient including STAMP grading, length of hospital stay and severity of disease. Results: Our study suggests comparable demographic and other patient-related variables in the three categories (mild, moderate and severe) of STAMP grading (p-value &gt;0.05). STAMP grading was not significantly associated with both length of hospital stay and severity of disease. Conclusion: The use of STAMP as a malnutrition screening tool for pediatric inpatients is not significantly associated with length of stay or severity of disease.

Validation of screening tool for the assessment of malnutrition in pediatrics - stamp in a Brazilian hospitalized children population

Rationale: Guidelines recommend the use of malnutrition screening tools to identify risk of malnutrition among the hospitalized children. The aim of this study was evaluating the reliability of Screening Tool for the Assessment of Malnutrition in Pediatrics (STAMP) to determine malnutrition risk of pediatric patients.

Evaluation of the screening tool for the assessment of malnutrition in pediatrics (stamp) among hospitalized children (1 month to 18 years old) in a private tertiary hospital in metro Manila, Philippines

Rationale: Early detection of malnutrition in hospitalized children is of high clinical importance, hence, the need to have a validated pediatric nutrition screening tool. STAMP1 is a quick, easy to use tool, requiring minimal training to implement but needs further evaluation and validation in the Filipino population.

Malnutrition in Hospitalised Children-An Evaluation of the Efficacy of Two Nutritional Screening Tools.

Nutritional risk screening (NRS) is not yet established in many clinical settings. This study aimed to evaluate the efficacy of two NRS tools; the Paediatric Yorkhill Malnutrition Score (PYMS) and the Screening Tool for the Assessment of Malnutrition in Paediatrics (STAMP), compared to the global dietitians’ clinical judgment. The goal of this study was also to estimate the prevalence of nutritional risk in Greek paediatric patients. Overall, 1506 children, 1–16 years, from paediatric and surgical wards of two Greek hospitals were included. NRS was performed using PYMS and STAMP based either on World Health Organization (WHOGC) or Hellenic growth charts (HGC). The first 907 children were also referred to dietitians who categorized children in low, medium and high nutritional risk according to their global clinical judgment. PYMS, either based on WHOGC or HGC, showed better agreement with dietitians’ feedback (kPYMS_WHO = 0.47; 95%CI: 0.41–0.52, kPYMS_HGC = 0.48; 95%CI: 0.43–0.53) compared to STAMP (kSTAMP_WHO = 0.28; 95%CI: 0.23–0.33, kSTAMP_HGC = 0.26; 95%CI: 0.21–0.32). PYMS also showed the best diagnostic accuracy compared to STAMP in paediatrics and surgical wards separately. Moreover, the PYMS showed similar sensitivity to the STAMP (WHOGC: 82% vs. 84.4%), but a higher positive predictive value (WHOGC: 58.2 vs. 38.7). Using PYMS, high and medium malnutrition risk was observed at 14.9%, and 13.1% of children, respectively. Almost 28% of hospitalised children were at nutritional risk. Children in hospitals should be screened with effective and feasible NRS tools such as PYMS.

Validation of 3-Minute Nutrition Screening-Paediatric (Paediatric 3-MinNS) for Hospitalized Children

Nutrition screening in pediatric hospitals is not a common practice in many countries. This study validated the 3-Minute Nutrition Screening-Paediatric (Paediatric 3-MinNS) with Screening Tool for the Assessment of Malnutrition in Paediatrics (STAMP), anthropometric measures, biochemical parameters, and dietary assessment. This cross-sectional study included 165 patients aged 2 to 12 years admitted as pediatric patients to the University Malaya Medical Centre. The tool identified 26.1% of patients as being at high risk of malnutrition. The findings suggest that Paediatric 3-MinNS offers a valid and reliable screening tool for early recognition of children at risk of malnutrition.

Nutrition risk profile of 62 408 inpatients based on electronic health records in a tertiary children's hospital

ObjectivesThis study aimed to evaluate the nutrition risk profile of hospitalized children with electronic health record–based nutrition risk screening. Additionally, this study analyzed the association between high nutrition risk and clinical outcomes. MethodsChildren discharged from Shanghai Children's Medical Center between 2017 and 2018 were enrolled and nutritionally screened. Nutrition risk scores using the Screening Tool for Assessment of Malnutrition in Pediatrics (STAMP), length of stay (LOS), and costs of hospitalization were recorded. Enrolled patients were categorized into two groups: the low and medium nutrition risk (LMNR) group, with scores ranging from 0 to 3, and the high nutrition risk (HNR) group, with scores ≥4. ResultsOut of 62 408 subjects, 17.4% were at HNR. Patients with congenital heart diseases (83.9%), hematology-oncology diseases (26.0%) and gastroenterological diseases (21.4%) were affected most. Infants had the highest HNR rates (35.5%) of any age group. Surgical patients (20.7%) had a higher rate of HNR than non-surgical patients (9.5%). The HNR group had longer LOS (10.0 d versus 3.0 d, P < 0.001), higher total hospital costs (53 680.1 Chinese yuan [CNY] versus 8810.1 CNY, P < 0.001), and higher costs of antibiotics (441.0 CNY versus 0.0 CNY, P < 0.001) compared to the LMNR group. As STAMP score values increased, growing LOS and costs of hospitalization, medications, and antibiotics were observed. ConclusionsA high prevalence of HNR was found in patients of Shanghai Children's Medical Center. Surgeries, specific disease, and infancy were important HNR risk factors. HNR scores using STAMP might predict prolonged LOS and higher medical costs.

Nutrition Evaluation Screening Tool: An Easy to Use Screening Tool for Hospitalised Children.

PurposeNutrition screening is vital to ensure patients are appropriately managed in hospital. In paediatrics there is currently no universally accepted nutrition screening tool. The Nutrition Evaluation Screening Tool (NEST) was developed as an easy to use and practical screening tool for hospitalised children. We aim to evaluate compliance of the NEST and assess agreement of the NEST with the already validated nutrition screening tools, Screening Tool for Risk on Nutritional Status and Growth (STRONGkids), Screening Tool for the Assessment of Malnutrition in Paediatrics (STAMP) and the Subjective Global Nutritional Assessment (SGNA) tool.MethodsRetrospective review of 102 patient episodes at the Evelina London Children's Hospital. Electronic records were used to assess NEST compliance and to complete the nutrition tools for each patient episode. Cohen's kappa was used to determine the level of agreement between each nutrition tool.ResultsThere was moderate agreement between the NEST and the two screening tools, STRONGkids (κ=0.472) and STAMP (κ=0.416) for patients on initial screening at admission. 87.2% of patient episodes were NEST compliant within 24 hours of admission to hospital.ConclusionThe moderate agreement between these two already validated screening tools enhances the NEST's validity as a paediatric screening tool. The NEST had the strongest correlation with the SGNA tool compared to other screening tools. The NEST is user friendly screening tool for hospitalised children.

Use of standardized body composition measurements and malnutrition screening tools to detect malnutrition risk and predict clinical outcomes in children with chronic conditions

Better tools are needed to diagnose and identify children at risk of clinical malnutrition. We aimed to compare body composition (BC) and malnutrition screening tools (MSTs) for detecting malnutrition on admission; and examine their ability to predict adverse clinical outcomes [increased length of stay (LOS) and complications] in complex pediatric patients. This was a prospective study in children 5-18 y old admitted to a tertiary pediatric hospital (n=152). MSTs [Pediatric Yorkhill Malnutrition Score (PYMS), Screening Tool for the Assessment of Malnutrition in Pediatrics (STAMP), and Screening Tool for Risk of Impaired Nutritional Status and Growth (STRONGkids)] were completed on admission. Weight, height, and BC [fat mass (FM) and lean mass (LM) by DXA] were measured (n=118). Anthropometry/BC and MSTs were compared with each other and with clinical outcomes. Subjects were significantly shorter with low LM compared to reference data. Depending on the diagnostic criteria used, 3%-17% were classified as malnourished. Agreement between BC/anthropometric parameters and MSTs was poor. STAMP and STRONGkids identified children with low weight, LM, and height. PYMS, and to a lesser degree STRONGkids, identified children with increased LOS, as did LM compared with weight or height. Patients with complications had lower mean±SD LM SD scores (-1.38±1.03 compared with -0.74±1.40, P<0.05). In multivariable models, PYMS high risk and low LM were independent predictors of increased LOS (OR: 3.76; 95% CI: 1.36, 10.35 and OR: 3.69; 95% CI: 1.24, 10.98, respectively). BMI did not predict increased LOS or complications. LM appears better than weight and height for predicting adverse clinical outcomes in this population. BMI was a poor diagnostic parameter. MSTs performed differently in associations to BC/anthropometry and clinical outcomes. PYMS and LM provided complementary information regarding LOS. Studies on specific patient populations may further clarify the use of these tools and measurements.

Screening Tool for the Assessment of Malnutrition in Pediatrics (STAMP) in the Electronic Health Record: A Validation Study.

The impact of malnutrition on pediatric patients in the acute care setting is significant. Hospitalized patients with malnutrition have been shown to have poor clinical outcomes. Nutrition screening is the first critical step in identifying and treating malnutrition. Although several pediatric nutrition screening tools exist, none incorporate both electronic health record (EHR) compatibility and the recommended indicators of pediatric malnutrition, a gap recently identified in a systematic review by the Academy of Nutrition and Dietetics. The aim of this study was to prove the validity of a new version of Screening Tool for the Assessment of Malnutrition in Pediatrics (STAMP), EHR-STAMP, modified for incorporation into the EHR and inclusion of updated pediatric malnutrition indicators. An interprofessional team modified the existing STAMP for integration into the EHR. Audits were performed by the research dietitian to assess accuracy and provide feedback for continuous improvement of the tool design. A total of 3553 pediatric inpatients were studied from August 2017 to May 2019. Accuracy, sensitivity, and specificity improved with each modification to the EHR-STAMP. The final version of the EHR-STAMP found 85% accuracy, 89% sensitivity, and 97% specificity, with a positive predictive value of 60% and a negative predictive value of 94%. The EHR-STAMP is a highly reliable tool in the screening of nutrition risk for pediatric hospitalized patients. The tool is easy to use, EHR compatible, and incorporates the current indicators recommended for assessing pediatric malnutrition.