Pediatric Malnutrition Research Articles

P1123 Baseline characteristics and nutrition in patients with moderately to severely active Inflammatory Bowel Disease: Results from the phase 3 UNITI Jr and UNIFI Jr trials

Abstract Background Few clinical trials investigating the efficacy of pediatric inflammatory bowel disease (IBD) treatments evaluate nutritional parameters and diet history of participants (pts) at enrollment. The pathophysiology of IBD may be influenced by nutritional factors. Moreover, IBD may impact nutrient absorption, loss, and contribute to a hypermetabolic state.1 Exclusive enteral nutrition (EEN) is an effective induction therapy, and along with CD-diet therapies may improve disease-related symptoms.2 Here we characterized the nutritional parameters (vitamin D, methylmalonic acid [MMA], iron) and growth status of pts in two phase 3 pediatric IBD studies and nutritional therapy usage in CD. Methods Pts enrolled in two ongoing phase 3 trials evaluating the efficacy and safety of ustekinumab (UST) in pts 2 to <18 years with moderately to severely active CD (UNITI Jr) or UC (UNIFI Jr) and a history of inadequate response to corticosteroids, immunomodulators and/or biologics (BIO-IR). Pts receiving EEN had to have a stable regimen for ≥2 weeks prior to Week I-0 in UNITI Jr. In UNIFI Jr, pts previously receiving >80% of their daily caloric needs via EEN had to stop or bring down the percentage of nutritional therapy ≥4 weeks prior to Week I-0. Baseline demographic data included height, weight, body mass index (BMI), nutritional parameters, disease characteristics, and nutritional history use (UNITI Jr only). Results Baseline demographics for UNITI Jr (n=101) and UNIFI Jr (n=102) are presented (Table). According to clinical guidelines,3 some pts in both UNITI Jr and UNIFI Jr exhibited mild malnourishment at enrollment (median BMI Z score [range]: -0.46 [-1.7, 4.1] and -0.18 [-1.7, 2.7], respectively). The majority of pts in UNITI Jr and UNIFI Jr were receiving disease-related medications at baseline (69.3% and 89.2%, respectively). BIO-IR pts represented 52.5% and 36.3% of the population in UNITI Jr and UNIFI Jr, respectively. Low vitamin D and elevated MMA were reported in both trials. In UNITI Jr, 61.4% of pts previously received EEN and 50% had followed the CD exclusion diet. Conclusion The cross-sectional data presented here offers insight into EEN usage and nutritional status of treatment refractory pediatric IBD pts in the UST pediatric IBD clinical studies. These data suggest that despite being at increased risk, a small portion of pts met the criteria for mild malnutrition and vitamin D deficiencies, suggesting appropriate use of international treatment guidelines for pediatric CD and UC. References 1)Mitrev N, Huang H, Hannah B, et al. Review of exclusive enteral therapy in adult Crohn’s disease. BMJ Open Gastro. 2021; 8: e000745. 2)van Rheenen PF, Aloi M, Assa A, et al. The medical management of paediatric Crohn’s disease: an ECCO-ESPGHAN guideline update. J Crohns Colitis. 2021: 171-94. 3)Becker PJ, Carney LN, Corkins MR, et al. Consensus statement of the Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition: indicators recommended for the identification and documentation of pediatric malnutrition (undernutrition). Nutr Clin Pract. 2015; 30(1): 147-61.

Comparison of nutritional screening tools in pediatric oncology patients receiving chemotherapy treatment

BackgroundMalnutrition in pediatric oncology patients is a complex and multifactorial process, and the most appropriate screening tool to determine the risk of malnutrition is not clear. The study aimed to compare the Screening Tool for Risk on Nutritional Status and Growth (StrongKids), Pediatric Yorkhill Malnutrition Score (PYMS), Screening Tool for the Assessment of Malnutrition in Pediatrics (STAMP), which are commonly used in the general pediatric population, with the Nutrition Screening Tool for Childhood Cancer (SCAN), which was specifically validated for pediatric cancer, in determining the risk of malnutrition. MethodsThis cross-sectional study included 92 children aged 2–18 years who were admitted to the hematology-oncology unit and were receiving chemotherapy. The prevalence of nutritional risk was determined using the SCAN, StrongKids, PYMS, STAMP, and anthropometric assessments were performed. Sensitivity and specificity values, and the degree of agreement between screening tools were calculated. ResultThe SCAN identified nutritional risk in 69.6 % of the children. According to StrongKids, PYMS and STAMP, the high nutritional risk in children was 43.5 %, 56.5 % and 64.1 %, respectively. The sensitivity of STAMP (81.2 %) was higher than that of StrongKids (60.9 %) and PYMS (79.7 %). The specificity of StrongKids, PYMS and STAMP was 96.4 %, 96.4 %, and 75.0 %, respectively. There was substantial agreement between SCAN and PYMS. ConclusionPYMS has the best specificity and sensitivity in identifying patients at risk of malnutrition as determined by SCAN. Implications for practiceIn addition to anthropometric measurements, population-specific or highly sensitive nutritional screening tools should be used to determine the risk of malnutrition.

Nutrition-Focused Quality Improvement Programs in Pediatric Care.

Nutrition is fundamental to a child's growth and development. However, nutritional health is often compromised by acute and chronic conditions and treatments that can commonly result in malnutrition. Malnutrition encompasses undernutrition and overnutrition and may be exacerbated by food insecurity. Recent health policy efforts in the United States (US) include those focused on quality measurement and social determinants of health (SDOH) to reduce risks for malnutrition and food insecurity. Nutrition-focused quality improvement programs (QIPs) have emerged as a successful model for benchmarking current nutrition care in adult patients and creating pathways for establishing best practices for timely malnutrition screening, intervention, and appropriate follow-up and care coordination. However, less is known about opportunities for nutrition-focused QIPs in hospital pediatric malnutrition care. This Perspective helps fill the gap by discussing the problem of pediatric malnutrition and current US quality frameworks and child nutrition programs related to malnutrition and food insecurity. In addition, this Perspective summarizes how nutrition-focused QIPs can impact malnutrition, including how QIPs can link hospital care with patient discharge planning and outpatient interventions. Finally, the Perspective outlines specific opportunities for the implementation of pediatric nutrition-focused QIPs to reduce office visits and/or inpatient readmissions through appropriate nutrition screening, assessment, and interventions.

Exploring the Relationship of Paediatric Nutritional Status with Diarrhoeal Disease in Children Below Two Years of Age.

Background and objective: Paediatric malnutrition has a synergistic relationship with diarrhoea. In children under two years of age, diarrhoea occurs in more than half of malnutrition cases and is associated with increased duration of illness, increased length of hospital stays, increased morbidity, and mortality. A well-established relationship exists between diarrhoeal and various standalone forms of malnutrition, but their association with coexisting forms of malnutrition (CFM) has not yet been investigated. Thus, this study assessed the association of CFM with diarrhoea among Pakistani children using datasets retrieved from Demographic Health & Survey and UNICEF. Study design: A pooled analysis of datasets of Pakistan Demographic & Health Surveys (PDHS) and Multiple Indicator Cluster Surveys (MICS) from the year 2010 to 2018 was conducted. Methods: Data of 70,723 children aged below two years were analysed after excluding those with incomplete anthropometry and outliers. Findings: Of the total study population, this study reported the presence of either diarrhoea or malnutrition or both in over half of Pakistani children aged between 0 and 23.9 months. Both standalone forms of undernutrition and coexisting forms of undernutrition were significantly associated with increased odds of diarrhoea by 1.07 (1.02 to 1.12) and 1.21 (1.16 to 1.27) times. The practice of breastfeeding, secondary/higher level of maternal education, and improvement in socioeconomic status reduced the risk of diarrhoea, while the children aged between 6 and 23.9 months residing in urban areas showed a high risk of diarrhoea. Conclusions: The presence of any type of undernutrition, i.e., standalone and/or coexisting forms were associated with increased risk of diarrhoeal diseases in children. An improvement in socioeconomic status, adherence to the continuation of breastfeeding, and maternal education are keys to reducing the burden of diarrhoea among children.

The impact of a pediatric malnutrition telehealth clinic on anthropometric measurements in children aged 6-59 months in rural Guatemala.

Guatemala, a country with high rates of pediatric malnutrition, has significant challenges including food and potable water insecurity and a lack of health care providers. This study examined the impact of telehealth clinic attendance on pediatric malnutrition scores. A sample of 42 Guatemalan children aged 6-59 months with malnutrition were recruited to participate in eight clinic events, including two in-person and six telehealth clinics. Six telehealth clinics were held at 4- to 6-week intervals, bookended by an initial and concluding in-person event. Nonparametric tests were used to analyze changes between baseline and last visit z-scores for height, weight for length, mid-upper arm circumference (MUAC), and body mass index (BMI) and to examine the relationship between the number of telehealth visits and z-score measurements at baseline and last visit. The number of children with severe malnutrition at baseline by weight for length, BMI, and MUAC decreased by the last visit. A decrease occurred in the number of children with stunted height. Changes in z-scores for height, weight for length, BMI, and MUAC between study onset and last visit did not reach statistical significance. Statistically significant relationships existed between clinic attendance and baseline and last visit weight for height/length z-scores and baseline MUAC z-scores. Positive improvements in nutritional status occurred, especially among children with severe malnutrition. Children with severe malnutrition had significantly better telehealth attendance. Studies with larger sample sizes are needed. Study results indicate that telehealth may be a tool to battle global pediatric malnutrition.

The impact of a pediatric malnutrition telehealth clinic on anthropometric measurements in children aged 6-59 months in rural Guatemala.

The impact of a pediatric malnutrition telehealth clinic on anthropometric measurements in children aged 6-59 months in rural Guatemala.

Evaluating the Effectiveness of an Online Course on Pediatric Malnutrition for Syrian Health Professionals: Qualitative Delphi Study.

There is a shortage of competent health professionals in managing malnutrition. Online education may be a practical and flexible approach to address this gap. This study aimed to identify essential competencies and assess the effectiveness of an online course on pediatric malnutrition in improving the knowledge of pediatricians and health professionals. A focus group (n=5) and Delphi technique (n=21 health professionals) were used to identify 68 essential competencies. An online course consisting of 4 educational modules in Microsoft PowerPoint (Microsoft Corp) slide form with visual aids (photos and videos) was designed and published on the Syrian Virtual University platform website using an asynchronous e-learning system. The course covered definition, classification, epidemiology, anthropometrics, treatment, and consequences. Participants (n=10) completed a pretest of 40 multiple-choice questions, accessed the course, completed a posttest after a specified period, and filled out a questionnaire to measure their attitude and assess their satisfaction. A total of 68 essential competencies were identified, categorized into 3 domains: knowledge (24 competencies), skills (29 competencies), and attitudes (15 competencies). These competencies were further classified based on their focus area: etiology (10 competencies), assessment and diagnosis (21 competencies), and management (37 competencies). Further, 10 volunteers, consisting of 5 pediatricians and 5 health professionals, participated in this study over a 2-week period. A statistically significant increase in knowledge was observed among participants following completion of the online course (pretest mean 24.2, SD 6.1, and posttest mean 35.2, SD 3.3; P<.001). Pediatricians demonstrated higher pre- and posttest scores compared to other health care professionals (all P values were <.05). Prior malnutrition training within the past year positively impacted pretest scores (P=.03). Participants highly rated the course (mean satisfaction score >3.0 on a 5-point Likert scale), with 60% (6/10) favoring a blended learning approach. In total, 68 essential competencies are required for pediatricians to manage children who are malnourished. The online course effectively improved knowledge acquisition among health care professionals, with high participant satisfaction and approval of the e-learning environment.

The Validity of the Original and the Saudi-Modified Screening Tools for the Assessment of Malnutrition in Pediatrics: A Cross-Sectional Study.

Background: Screening for malnutrition among hospitalized children is essential, and the Screening Tool for the Assessment of Malnutrition in Pediatrics (STAMP) is a validated tool for this purpose. The study aimed to modify STAMP for a Saudi context and assess the sensitivity and specificity of both the original and modified tools. Method: A cross-sectional study was conducted among 307 hospitalized children, where both the original and Saudi-modified STAMP were applied. Anthropometric measurements were also recorded, and statistical analysis using SPSS and validity parameters was used to assess the tools' validity. Results: The Saudi-modified STAMP identified a higher percentage of children at high risk of malnutrition compared to the original STAMP (91.6% vs. 62.9%). The sensitivity, specificity, positive predictive value, negative predictive value, accuracy, and agreement of the Saudi-modified STAMP compared to the original were 94.3%, 13.2%, 64.8%, 57.7%, 0.654, and 0.089, respectively. Conclusions: The Saudi-modified STAMP showed excellent sensitivity and varied negative predictive value, indicating its potential effectiveness in screening for the risk of malnutrition among hospitalized children compared to the original STAMP.

Patterns of use of malnutrition risk screening in pediatric populations: A survey of current practice among pediatric hospitals in North America.

Information on the use of validated malnutrition risk screening tools in pediatric facilities to guide malnutrition identification, diagnosis, and treatment is scarce. Therefore, a survey of pediatric healthcare facilities and practitioners to ascertain malnutrition risk screening practices in North America was conducted. A pediatric nutrition screening practices survey was developed and sent to members of the American Society for Parenteral and Enteral Nutrition, the Council for Pediatric Nutrition Professionals and the Academy of Nutrition and Dietetics Pediatric Nutrition Practice Group. Respondents represented 113 pediatric hospitals in the United States and six in Canada, of which 94 were inpatient and 59 were outpatient. Nutrition risk screening was completed in 90% inpatient settings, and 63% used a validated screening tool. Nurses performed most malnutrition risk screens in the inpatient setting. Nutrition risk screening was reported in 51% of outpatient settings, with a validated screening tool being used in 53%. Measured anthropometrics were used in 78% of inpatient settings, whereas 45% used verbally reported anthropometrics. Measured anthropometrics were used in 97% outpatient settings. Nutrition risk screening was completed in the electronic health record in 80% inpatient settings and 81% outpatient settings. Electronic health record positive screen generated an automatic referral in 80% of inpatient and 45% of outpatient settings. In this sample of pediatric healthcare organizations, the results demonstrate variation in pediatric malnutrition risk screening in North America. These inconsistencies justify the need to standardize pediatric malnutrition risk screening using validated pediatric tools and allocate resources to perform screening.

Utility of mid-upper arm circumference in pediatric malnutrition: An Australasian Society of Parenteral and Enteral Nutrition consensus statement using the Delphi method.

Mid-upper arm circumference (MUAC) is a simple anthropometric tool used to screen for childhood undernutrition in humanitarian settings or low-income and middle-income countries. However, there is conflicting evidence and a lack of consensus with regard to its diagnostic use in clinical settings or population groups beyond this context. In 2023, a project officer was appointed by the Australasian Society of Parenteral and Enteral Nutrition (AuSPEN) to lead the development of a consensus review into the use of MUAC in the pediatric clinical setting. An AuSPEN appointed multidisciplinary group of informed clinicians used the Delphi method to critically appraise the evidence and develop a series of consensus statements. Delphi surveys were anonymous and distributed electronically. Members were asked to rate their level of agreement with each consensus statement using a 5-point Likert scale. A priori definition of consensus was established as ≥80% responses "agree" or "strongly agree." Three Delphi rounds were required to reach consensus. A total of 18 consensus statements, including rationale, were developed across the topics 'assessment and diagnosis', 'screening and monitoring' and 'clinical settings'. An evidence-based, region-specific consensus approach to the use of MUAC in pediatric malnutrition is a valuable tool for clinicians. MUAC is a straightforward, non-invasive and cost-effective tool, and may provide an advantage over traditional anthropometric tools in some clinical settings. There are limitations to the utility of MUAC and this consensus paper provides an empirical summary of advantages and limitations as they apply to the screening, assessment, diagnosis, and monitoring of pediatric malnutrition.

The validity of the original and Saudi-modified screening tools for the assessment of malnutrition in pediatrics (STAMP): A cross-sectional study

The validity of the original and Saudi-modified screening tools for the assessment of malnutrition in pediatrics (STAMP): A cross-sectional study

Measurement of mid-upper arm circumference to screen for childhood malnutrition: General applicability and use in special populations.

Since the development of consensus-recommended indicators for pediatric malnutrition in 2014, screening and diagnosis of pediatric malnutrition have improved, but the indicators are not always used; malnutrition continues to be underdiagnosed in some community and healthcare settings. In particular, mid-upper arm circumference (MUAC) is underused as a screening indicator for pediatric malnutrition, despite its unique advantages and usefulness in several clinical situations. In December 2022, a scientific roundtable was held to bring together several experts in pediatric malnutrition. One of the goals of the scientific roundtable was to discuss the clinical use of anthropometric measures as screening tools for pediatric malnutrition status, with a focus on the use of MUAC. This article arose from that event and is intended as an educational tool to aid clinicians in implementing MUAC measurements. In addition to describing the use of MUAC as a screening tool, the article discusses several clinical situations in which MUAC is especially useful. Additionally, the article reviews practical aspects of measuring and interpreting MUAC values, provides links to additional educational resources, and briefly reviews areas in which further research is needed regarding the use of MUAC for screening of nutrition status in children.

Differential performance regarding the relationship of C3-epi-25(OH)D3 levels and %C3-epi-25(OH)D3 with common pediatric diseases: a case control study

BackgroundRecently, the C3-epimer of 25-hydroxyvitamin D [C3-epi-25(OH)D] has become a topic of interest among 25-hydroxyvitamin D [25(OH)D] metabolites. Although it can lead to an overestimation of vitamin D storage, its relationship with disease occurrence remains controversial, possibly related to the great extent of tracking of 25(OH)D by C3-epi-25(OH)D over time. This study aimed to investigate the differential performance of C3-epi-25(OH)D3 and its percentage [%C3-epi-25(OH)D3] with respect to 20 common paediatric diseases.MethodsThis study involved 805 healthy children and adolescents and 2962 patients with common paediatric diseases. We investigated sex, age, and seasonal differences in C3-epi-25(OH)D3 and %C3-epi-25(OH)D3 levels; their variations on 20 common paediatric diseases; and their degree of correlation with 25(OH)D3 levels and various diseases.ResultsAmong the healthy underage participants, C3-epi-25(OH)D3 and %C3-epi-25(OH)D3 changed similarly, with no sex differences. Moreover, their levels were higher in the infant period than in the other periods (t = 5.329–5.833, t = 4.640–5.711, all Padj < 0.001), and in spring and summer than in autumn and winter (t = 3.495–6.061, t = 3.495–5.658, all Padj < 0.01). Under healthy and disease conditions, C3-epi-25(OH)D3 was positively correlated with 25(OH)D3 (ρ = 0.318 ~ 0.678, all P < 0.017), whereas %C3-epi-25(OH)D3 was not, except in patients with nephrotic syndrome (ρ=-0.393, P = 0.001). Before and after adjusting for 25(OH)D3, the relationship of C3-epi-25(OH)D3 with the diseases was notably different. However, it was almost consistent for %C3-epi-25(OH)D3. Our results indicated that %C3-epi-25(OH)D3 was associated with short stature, nephrotic syndrome, lymphocytic leukaemia, rickets, paediatric malnutrition, and hypovitaminosis D (OR = 0.80 ~ 1.21, all P < 0.05).ConclusionsThe %C3-epi-25(OH)D3 can correct the properties of C3-epi-25(OH)D3 to better track 25(OH)D3 and may be more suitable for exploring its pathological relevance. Further detailed studies of each disease should be conducted.

Predictive Validity of the Academy of Nutrition and Dietetics/American Society for Parental Nutrition Indicators to Diagnose Malnutrition and the Screening Tool for Risk on Nutritional Status and Growth among Hospitalized Children Relative to Medical Outcomes

ObjectiveTo evaluate predictive validity of the Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition Indicators to diagnose pediatric malnutrition (AAIMp) and the Screening Tool for Risk on Nutritional Status and Growth (STRONGkids) in regard to pediatric patient outcomes in US hospitals. Study designA prospective cohort study (Clinical Trial Registry: NCT03928548) was completed from August 2019 through January 2023 with 27 pediatric hospitals or units from 18 US states and Washington DC. ResultsThree hundred and forty-five children were enrolled in the cohort (n=188 in the AAIMp validation subgroup). There were no significant differences in the incidence of emergency department (ED) visits and hospital readmissions, hospital length of stay (LOS), or healthcare resource utilization for children diagnosed with mild, moderate, or severe malnutrition using the AAIMp tool compared with children with no malnutrition diagnosis. The STRONGkids tool significantly predicted more ED visits and hospital readmissions for children at moderate and high malnutrition risk (moderate risk - incidence rate ratio [IRR] 1.65, 95% confidence interval [CI]: 1.09, 2.49, p = 0.018; high risk - IRR 1.64, 95% CI: 1.05, 2.56, p = 0.028) and longer LOS (43.8% longer LOS, 95% CI: 5.2%, 96.6%, p = 0.023) for children at high risk compared with children at low risk after adjusting for patient characteristics. ConclusionsMalnutrition risk based on the STRONGkids tool predicted poor medical outcomes in hospitalized US children; the same relationship was not observed for a malnutrition diagnosis based on the AAIMp tool.

Development and Validation of a Pediatric Hospital-Acquired Malnutrition (PHaM) Risk Score to Predict Nutritional Deterioration in Hospitalized Pediatric Patients: A Secondary Analysis Based on a Multicenter Prospective Cohort Study.

(1) Background: Hospital-acquired malnutrition in pediatric patients leads to adverse outcomes. This study aimed to develop and validate a pediatric hospital-acquired malnutrition (PHaM) risk score to predict nutritional deterioration. (2) Methods: This was a derivative retrospective cohort study for developing a PHaM risk score. The study included data from children aged 1 month-18 years admitted to pediatric wards in four tertiary care hospitals for at least 72 h between December 2018 and May 2019. Data on pediatric patients' characteristics, medical history, nutritional status, gastrointestinal symptoms, and outcomes were used for tool development. Logistic regression identified risk factors for nutritional deterioration, defined as a decline in BMI z-score ≥ 0.25 SD and/or ≥2% weight loss. A PHaM risk score was developed based on these factors and validated with an independent prospective cohort from July 2020 to March 2021. (3) Results: The study used a derivative cohort of 444 patients and a validation cohort of 373 patients. Logistic regression identified gastrointestinal symptoms, disease severity, fever, lower respiratory tract infection, and reduced food intake as predictors. The PHaM risk score (maximum 9 points) showed good discrimination and calibration (AUC 0.852, 95% CI: 0.814-0.891). Using a cut-off at 2.5 points, the scale had 63.0% sensitivity, 88.6% specificity, 76.1% positive predictive value, and 80.6% negative predictive value (NPV) when applied to the derivative cohort. The accuracy improved on the validation cohort, with 91.9% sensitivity and 93.0% NPV. (4) Conclusions: This PHaM risk score is a novel and probably effective tool for predicting nutritional deterioration in hospitalized pediatric patients, and its implementation in clinical practice could enhance nutritional care and optimize outcomes.

Exploring the Influence of Concurrent Nutritional Therapy on Children with Spinal Muscular Atrophy Receiving Nusinersen Treatment.

Background This study examines spinal muscular atrophy (SMA), a neuromuscular disease associated with malnutrition. Our goals are to assess how effectively screening tools can detect malnutrition and evaluate the impact of nutritional interventions on neurological outcomes, particularly motor functions. Methods Thirty-seven genetically diagnosed SMA patients (types 1, 2, and 3) under nusinersen therapy were included in the study. The nutritional status of these patients was assessed by using anthropometric measurements, including height for age (HFA), weight for height (WFH), and body mass index (BMI) before and after the study. Additionally, the risk of malnutrition was determined using screening tools, namely the Pediatric Yorkhill Malnutrition Score (PYMS) and the Screening Tool for the Assessment of Malnutrition in Pediatrics (STAMP). Nutritional counseling followed the European Society for Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) guidelines and considered the patients' dietary history, including content and administration method. Motor functions were assessed by validated tests: the Children's Hospital of Philadelphia Infant Test of Neuromuscular Disorders (CHOP-INTEND) and the Hammersmith Functional Motor Scale-Expanded (HFMSE). Result The study showed an improvement in HFA, by a change from -0.95 to -0.65 (p = 0.015). Conversely, BMI scores decreased from 0.08 to -0.54 (p = 0.015), while WFH and MUAC showed no significant alterations (p = 0.135, p = 0.307). Following nutritional interventions, HFMSE demonstrated a median increase from 29.5 to 30.5 (p = 0.023). Patients identified as being at high risk for malnutrition based on PYMS and STAMP belonged to the moderate-to-severe malnutrition group (BMI Z-score ≤ -2, p = 0.001). Conclusions Use of screening tools in SMA patients is highly beneficial for the early detection of malnutrition. Future research should highlight the importance of combining nutritional management with nusinersen therapy to potentially alter the disease trajectory, especially in motor and neurological functions.

Nutrition Screening for 2-5 Years Old Children by Screening Tool for the Assessment of Malnutrition in Paediatrics in Outpatient Setting

Abstract Introduction and Aim of the work Malnutrition is the primary causative factor of pediatric mortality and repeated hospitalization. The aim of this study is to highlight the role of nutrition screening in identifying those at risk of malnutrition who may benefit from nutritional interventions and test whether the nutritional supplements are essential during nutritional rehabilitation. Patients and methods Screening for malnutrition of 3640 children at the outpatient clinic of Ain Shams Pediatric hospital by Screening Tool for the Assessment of Malnutrition in Paediatrics (STAMP) followed by assessing 100 patients at high risk of malnutrition by anthropometric measurements, then BMI and z scores were computed. Oral nutritional supplement was advised in the rehabilitation program only in group A. Nutritional response testing was performed by reassessment at three and six months. Results The prevalence of underweight, stunting and wasting were 5.9%, 15.6%, and 9.4% respectively. As per STAMP, 14.7% were found to be nutritionally at low risk, 7.3% at intermediate risk, and 5.1% at high risk compared to 72.83% without risk for malnutrition. STAMP showed a significant increase in patients at low risk and decrease in patients at high risk through follow up in both groups with better percentages in group A which coincides with improvement in anthropometric indices. Conclusion STAMP is a sensitive, quick, and easy to use nutritional screening tool with a crucial role in identifying nutrition risk at outpatient services which can lead to implementing prompt nutritional rehabilitation. Tailored nutritional plans can accomplish good response and adding a nutritional supplement to the dietary plan ensures earlier goal achievement.

Nutrition-Focused Physical Exam in assessing nutritional status of children with neurological impairment

BackgroundAccurate and reliable anthropometric measurements in children with neurological impairments who are not able or not suitable for conventional anthropometric measuring techniques can be challenging and potentially leading to misinterpretation of their nutritional status. Nutrition-Focused Physical Exam (NFPE) is proven useful in providing supportive evidence to malnutrition. This study investigated the use of NFPE to identify malnutrition among children with Down syndrome (DS) and cerebral palsy (CP), in comparison to AND/ASPEN Pediatric Malnutrition Identification Criteria as the reference method. MethodsA cross-sectional study was conducted to recruit 31 children with DS and 20 children with CP aged between 4 and 15 years old. Nutrition-focused physical findings (fat loss, muscle wasting, abnormality observations on hair, eyes, oral cavity, skin, and nails), weight, height, mid upper arm circumference, and dietary intake were collected. The malnutrition status of children was determined using NFPE and AND/ASPEN criteria, respectively. Weighted Kappa agreement and diagnostic values were analyzed between these two criteria. Chi-square test examined the association between oral cavity abnormalities and the nutritional status identified by the AND/ASPEN criteria and NFPE. A p-value of <0.05 was considered statistically significant. ResultsFindings reported a significant and fair agreement between the two criterions for children with DS (k = 0.367, p = 0.018). NFPE offers a sensitivity of 81.3 % and a specificity of 60.0 % for children with DS when compared with the AND/ASPEN criteria as the reference method. Similarly, for children with CP, NFPE recorded a significant and moderate agreement (k = 0.503, p < 0.001) with AND/ASPEN criteria where NFPE offers a sensitivity of 90.9 % and a specificity of 22.2 %. Children with oral cavity abnormality were significantly associated with malnutrition defined by NFPE. ConclusionsNFPE serves as a supplementary assessment method to identify malnutrition in children with DS with altered body composition and CP with neuromuscular impairment.

Pediatric Malnutrition and Natural Dietary Supplementary Food to Overcome it: A Review

Abstract: Malnutrition is described by the World Health Organization (WHO) as a person's energy and/or nutrient consumption being insufficient, excessive, or out of proportion. Health officials in India are quite concerned about malnutrition in children under five. Recent research revealed a significant frequency of undernutrition among children under the age of five. It is estimated that malnutrition affects roughly 2/3 of India's population under the age of five and that 5-8% of those children are severely malnourished. It could be argued that it is one of the most prevalent issues affecting children's health in the nation. Mothers' nutritional health, breastfeeding habits, women's education, and cleanliness are all factors that contribute to malnutrition. The use of dietary supplements is widespread, and they are a class of ingestible goods that can be distinguished from common meals and medications. Over the past few decades, the demand for phytonutrients has increased, and individuals are now using them to meet their nutritional needs. This review enlightens and explores the prevalence of undernutrition, its causes, and the necessary countermeasures, treatments for malnutrition among children under the age of five in India and nutritional diversification of food and other benefits which make it a better choice to use in our daily diet to combat pediatric malnutrition.

The first translation on pediatrics: Er Ke Cuo Yao

Er Ke Cuo Yao(The Pediatric Summary) is the first monograph on pediatrics of Western medicine translated and introduced in the late Qing Dynasty. It occupies an important position in the history of the development of modern pediatrics and modern Western medicine in China. Edited by American missionary Mary Hannah Fulton and translated by Chinese Western medicine scholar Yin Duanmo, the book consists of 2 volumes and 14 books, including general discussion of pediatrics, diagnosis of pediatric diseases, and discussion on teething, throat diseases, gastrointestinal diseases, worms, liver diseases, abdominal epimesis, and new infectious diseases, etc. covering the diagnosis, treatment, maintenance and other knowledge of Western medical pediatrics. The source of Er Ke Cuo Yao is not yet available, but it may be a synthesis of various materials, and the translation uses paraphrasing, transliteration, and traditional Chinese medicine terminology, and the language is easy to understand. Er Ke Cuo Yao reflects the level of development of pediatrics in Western medicine in the early modern period, makes up for the lack of pediatrics knowledge of traditional Chinese medicine, and plays an active role in the diagnosis and treatment of common pediatric diseases, epidemiological diseases, surgical diseases, and malnutrition prevention.