Pediatric Nutrition Screening Research Articles

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.

Comparison of two pediatric nutrition screening tools in hospitalized children and their association with length of stay

Comparison of two pediatric nutrition screening tools in hospitalized children and their association with length of stay

Survey of nutrition screening practices in pediatric hospitals across the United States.

Nutrition screening on admission is critically important to systematically identify patients with undernutrition given the known relationship with deleterious clinical outcomes. Limited data exist regarding optimal processes and criteria for pediatric nutrition screening. Therefore, we sought to characterize nutrition screening practices in pediatric hospitals. A total of 365 inpatient pediatric hospitals in the United States were identified, eligible, and contacted. Eligible hospitals included general pediatric hospitals, adult hospitals with pediatric units, and specialty pediatric hospitals. One respondent at each eligible hospital was asked to complete a 33-question survey of admission nutrition screening practices. Of 268 survey respondents, 37% represented pediatric units in adult hospitals, 35% general pediatric hospitals, and 28% pediatric specialty or psychiatric hospitals. A total of 98.5% endorsed the existence of a screening process on admission. Anthropometrics (eg, body mass index z score, 84%) and nutrition status (eg, change in intake, 67%) were the most common screening criteria applied. A nutrition screening instrument was used in 37% of institutions, and only 31% of institutions reported using pediatric-specific screening instruments. Pediatric units within adult hospitals were 1.38 times more likely to use a screening instrument validated in any population. Barriers to nutrition screening included the lack of a standard screening procedure and insufficient staff to conduct screening. Fifty-four percent of respondents reported a desire to change their hospital's nutrition screening process. Most pediatric hospitals screen for nutrition risk on admission. However, methods and criteria varied widely across pediatric hospitals, highlighting the importance of standardized best practices.

Malnutrition care in hospitalized pediatric inpatients: comparison of perceptions and experiences across two pediatric academic health sciences centres.

Malnutrition affects up to one in three Canadian children admitted to hospital. Awareness among pediatric healthcare providers (HCPs) of the prevalence and impacts of hospitalized malnutrition is critical for optimal management. The purpose of this study was to determine perceptions of malnutrition among pediatric HCP across two major academic health sciences centres, and to determine how the use of a standardized pediatric nutritional screening tool at one institution affects responses. Between 2020 and 2022, 192 HCPs representing nursing, dietetics, medicine, and other allied health were surveyed across McMaster Children's Hospital and The Hospital for Sick Children. 38% of respondents from both centres perceived rates of malnutrition between approximately one in three patients. Perceptions of the need for nutritional screening, assessment, and management were similar between centres. All respondents identified the need for better communication of hospitalized malnutrition status to community providers at discharge, and resource limitations affecting nutritional management of pediatric inpatients. This study represents the largest and most diverse survey of inpatient pediatric HCPs to date. We demonstrate high rates of baseline knowledge of hospital malnutrition, ongoing resource challenges, and the need for a systematic approach to pediatric nutritional management.

Pediatric nutritional risk screening using strongkids in patients aged 5-17 years admitted at hospital infantil doctor Robert Reid Cabral, february-april 2021

Pediatric nutritional risk screening using strongkids in patients aged 5-17 years admitted at hospital infantil doctor Robert Reid Cabral, february-april 2021

Nutrition Screening in the Pediatric Intensive Care Unit: Evaluation of an Electronic Medical Record-Based Tool.

Hospitalized, critically ill children are at increased risk of developing malnutrition. While several pediatric nutrition screening tools exist, none have been validated in the pediatric intensive care units (PICU). The Children's Wisconsin Nutrition Screening Tool (CWNST) is a unique nutrition screening tool that includes the Pediatric Nutrition Screening Tool (PNST) and predictive elements from the electronic medical record and was found to be more sensitive than the PNST in acute care units. The aim of this study was to assess the performance of the tool in detecting possible malnutrition in critically ill children. The data analysis, including the results of the current nutrition screening, diagnosis, and nutrition status was performed on all patients admitted to PICUs at Children's Wisconsin in 2019. All 250 patients with ≥1 nutrition assessment by a dietitian were included. The screening elements that were predictive of malnutrition included parenteral nutrition, positive PNST, and BMI-for-age/weight-for-length z-score. The current screen had a sensitivity of 0.985, specificity of 0.06, positive predictive value (PPV) of 0.249, and negative predictive value of 0.929 compared to the PNST alone which had a sensitivity of 0.1, specificity of 0.981, PPV of 0.658, and NPV of 0.749. However, of the 250 included patients, 97.2% (243) had a positive nutrition screen. The CWNST can be easily applied through EMRs and predicts the nutrition risk in PICU patients but needs further improvement to improve specificity.

Families' perception of proposed nutrition screening on admission to pediatric hospitals: a qualitative analysis.

Nutrition screening is the first step in most acute care pediatric nutrition care pathways. However, there is a lack of understanding of patient and families' perception of nutrition screening in pediatric populations. The objective of this study was to explore the potential perceptions, feelings, and opinions of families if pediatric nutrition screening were to be completed during hospital admission. Nine members of the Family Advisory Council at the Alberta Children's Hospital participated in a focus group to discuss questions around nutrition screening practices, malnutrition, and the pediatric nutrition screening tool. Transcripts were analyzed using MAXQDA and thematic analysis using the Braun and Clarke methodology. Two major themes emerged: screening may raise sensitive emotions and understanding the purpose of nutrition screening and the questions. Participants agreed discussions around growth and nutrition are vital to comprehensive medical care; however, the timing and approach of nutrition screening can lead to anxiety and feelings of judgement. A lack of understanding of the purpose of screening, next steps, and benefit to the individual patient could limit acceptance of nutrition screening. The findings of this study can inform training and education of healthcare professionals involved in nutrition screening.

An Automated Pediatric Nutrition Screening Tool: Development and Evaluation

An Automated Pediatric Nutrition Screening Tool: Development and Evaluation

Comparison of Pediatric Nutrition Screening Tool (PNST) With the Pediatric Yorkhill Malnutrition Score (PYMS) in Hospitalized Turkish Children

This study aimed to compare the diagnostic accuracy of Pediatric Nutrition Screening Tool (PNST) and Pediatric Yorkhill Malnutrition Score (PYMS) in Turkish pediatric inpatients. A cross-sectional study was conducted on 996 inpatients aged 1 to 16 years. The prevalence of malnutrition was 31.8%. The PNST identified 28.7% (original cutoffs) and 62.6% (adjusted cutoffs) of patients as at risk, whereas PYMS categorized 44.3% as at high risk of malnutrition. The sensitivity of PNST with original cutoffs (52.1%) was lower than that of PYMS (85.2%) and PNST with adjusted cutoffs (83.3%), especially for acute malnutrition (67.6% vs 95.3% and 94.6%, respectively). Considering the importance of early identification and treatment of malnutrition, PYMS and PNST with adjusted cutoffs may be useful as a screening tool in this population.

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.

Development and Validation of a New Screening Tool with Non-Invasive Indicators for Assessment of Malnutrition Risk in Hospitalised Children.

There is no evidence of the most effective nutritional screening tool for hospitalized children. The present study aimed to develop a quick, simple, and valid screening tool for identifying malnutrition risk of hospital admission with non-invasive indicators. A cross-sectional study was conducted. Children`s nutritional baseline using a questionnaire, subjective malnutritional risk, and Subjective Global Nutritional Assessment were assessed on admission. Concurrent validity was assessed using American Society for Parenteral and Enteral Nutrition (ASPEN)and Academy of Nutrition and Dietetics assessment and Subjective Global Nutritional Assessment tool. A new screening tool Simple Pediatric Nutritional risk Screening tool (SPENS) was developed, and sensitivity, specificity and reliability were evaluated. A total of 180 children aged from 1 month to 18 years were included (142 in the development phase and 38 in the validation phase). SPENS consist of four variables and shows almost perfect agreement with subjective malnutritional risk assessment (κ = 0.837) with high sensitivity and specificity (93.3% and 91.3% respectively). Compared with Subjective Global Nutritional Assessment and ASPEN and Academy of Nutrition and Dietetics assessment, SPENS had sensitivity 92.9% and 86.7%, a specificity of 87.5% and 87.0%, and an overall agreement of 0.78 and 0.728, respectively. Due to the fast, simple, easy, and practical to use, screening the SPENS can be performed by nurses, physicians, and dieticians.

Validating Food Security Measurement in a Pediatric Nutrition Screening Tool (Nutristep®)

ABSTRACT The Nutrition Screening Tool for Every Preschooler (NutriSTEP®) is a 17-item nutrition-screening tool administered to parents. This study validated the food security question in the NutriSTEP® against the Household Food Security Survey (HFSS) and the Hunger Vital Sign. Parents (n = 55) of Head Start preschoolers answered an online survey that included the NutriSTEP®, the Hunger Vital Sign, and the HFSS. All of the tools identified over 40% of the participants experienced food insecurity. The food security question in the NutriSTEP® had 82.1% sensitivity and 94.1% specificity when compared against the HFSS reference standard. The NutriSTEP® adequately identified children with food insecurity.

Comparison of three different nutrition screening tools for pediatric inpatients

Early detection of children at risk of developing malnutrition during hospitalization prevents the development of complications. This study aims to determine the malnutrition risk of pediatric inpatients by using three different nutrition screening tools and to evaluate the reliability/sensitivity of the screening tools. This cross-sectional study included 176 children who were 1-16 years of age and were admitted to the pediatrics service of a second-line hospital. Body weight and height were used to evaluate the nutrition status of children. Age- and sex-specific z-score values for height for age (HFA), weight for age (WFA), and body mass index for age (BFA) were indicators of malnutrition. The Screening Tool for Risk of Impaired Nutritional Status and Growth (STRONGkids), Pediatric Yorkhill Malnutrition Score (PYMS), and Pediatric Nutrition Screening Tool (PNST) were used under the responsibility of pediatricians and dietitians to evaluate the risk of malnutrition in children. At admission, according to the HFA, BFA, and WFA SD scores (SDSs), the incidence of malnutrition in children was 8.5%, 14.8%, and 6.3%, respectively. Three screening tools determined that WFA SDSs were significantly higher in children without malnutrition risk than in those at risk of malnutrition (P<0.05). PYMS revealed a relatively higher sensitivity of 90.9% and 84.6% for WFA and BFA, respectively, and PNST revealed a relatively higher sensitivity of 88.9% for HFA. PYMS and PNST are suitable for use in malnutrition risk assessment in pediatric inpatients because of the screening tools' high sensitivity.

STRONGkids nutrition screening tool in pediatrics: An analysis of cutoff points in Brazil.

Studies have indicated the Screening Tool for Risk on Nutritional Status and Growth (STRONGkids) as a method of pediatric nutrition screening with good validity in the hospital setting. However, we need to analyze whether the cutoff values originally proposed are suitable for use in Brazil. A cross-sectional study was performed in patients admitted to the pediatric ward of a public hospital. STRONGkids was used to assess nutrition risk (low risk, 0 points; moderate risk, 1-3 points; and high risk, 4-5 points). The indexes weight/height or body mass index/age were used to indicate acute malnutrition, and length or height/age was used to indicate chronic malnutrition. Receiver operating characteristic curves were constructed and the areas under the curve were calculated, with respective 95% confidence intervals, to assess the ability of STRONGkids to predict malnutrition and longer hospital stay. The study included 599 patients, with a median age of 2.6 years. The frequency of nutrition risk (medium or high) was 83.6%. In comparison with anthropometric indexes, STRONGkids was the only scoring system with the discriminatory capacity to identify patients with longer hospital stays. The comparative analysis of the means of hospital stay according to STRONGkids showed that patients with a score equal to 3 behaved similarly to those classified as high nutrition risk (4-5 points). Considering the best cutoff point to predict prolonged hospitalization, STRONGkids used in Brazil should consider patients with 3 points as having high nutrition risk, as well those scoring 4 and 5.

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.

Clinical application of the modified pediatric nutritional risk screening tool

OBJECTIVE To study the clinical application of the modified nutritional risk screening tool and nutrition assessment in pediatric patients in China, and to provide a theoretical basis for establishing a standardized nutritional management process for pediatric patients. METHODS A retrospective analysis was performed for the nutritional risk screening and nutrition assessment data of 16 249 hospitalized children. According to the degree of nutritional risk, the children were divided into a high nutritional risk group with 588 children, a moderate nutritional risk group with 4 330 children, and a non-nutritional risk group with 11 331 children. Nutrition assessment results were compared between groups. The composition of nutritional risk screening scores and the impact of nutritional risk screening on the rate of nutrition support therapy were analyzed. RESULTS The incidence rate of nutritional risk was 30.27% (4 918/16 249), and the incidence rates of malnutrition and overnutrition were 27.37% (4 448/16 249) and 11.29% (1 834/16 249), respectively. Nutrition assessment results were significantly correlated with nutritional risk (≥ 5 years old:rs=0.313, P < 0.05; < 5 years old:rs=-0.304, P < 0.05). There was a significant difference in the composition of scoring items between the groups with different nutritional risks (P < 0.05). With the implementation of nutritional risk screening, there was a gradual increase in the rate of nutrition support therapy year by year (P < 0.05). CONCLUSIONS There is a high incidence rate of nutritional risk in hospitalized children. The use of the modified pediatric nutritional risk screening tool can promote the implementation of standardized nutritional management.

Effectiveness of the Pediatric Nutrition Screening Tool at Tallahassee Memorial Healthcare

Effectiveness of the Pediatric Nutrition Screening Tool at Tallahassee Memorial Healthcare

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.

Aplicação da triagem de risco nutricional em crianças e adolescentes hospitalizados com cardiopatia congênita

Introdução: A triagem nutricional em crianças é de extrema importância no ambiente hospitalar, pois é uma ferramenta simples e eficiente. Objetivo: Detectar o risco nutricional, a partir do método de triagem nutricional pediátrica Strong Kids, em crianças e adolescentes com cardiopatias congênitas. Método: Foram avaliados 81 crianças e adolescentes com cardiopatia congênita, até 48 horas de internação, no período de agosto de 2016 a maio de 2017. Dados foram coletados através de triagem nutricional pediátrica. A análise estatística se deu através do teste qui-quadrado, a fim de verificar o nível de significância, p &lt; 0,05. Resultados: Dentre os resultados obtidos, houve maior prevalência de crianças com cardiopatia congênita internadas do gênero feminino 60,49% (n=49). De acordo com a classificação das fases de vida, a predominância ocorreu na fase pré-escolar 46,91%, seguida de lactentes 27,16%, adolescentes 13,58% e escolar 12,35%. Não houve déficit nutricional para 74,07%. Segundo o teste qui-quadrado, observou-se relevância do médio risco nutricional. Conclusão: A triagem nutricional pediátrica é fundamental na prática clínica, e sua melhor forma de avaliação é a intervenção nutricional precoce. Isto implicará um tratamento nutricional adequado, em especial para crianças com cardiopatia congênita.

StrongKids for pediatric nutritional risk screening in Brazil: a validation study

To evaluate the validity and reproducibility of StrongKids as a pediatric nutritional screening tool in Brazil, which has no validated method for this purpose. A cross-sectional study was conducted with 641 patients admitted to the pediatric care unit of a public hospital from 2014 to 2018. The concurrent validity was assessed by evaluating the sensitivity, specificity, and the positive and negative predictive values of StrongKids in detecting acute, chronic, and overall malnutrition. Predictive validity was determined by calculating the same indices to identify longer than median hospital stay, need of enteral nutrition, 30-day hospital readmission, transfer to hospitals with more complex procedures, and death. StrongKids was reapplied to a subsample to evaluate the inter-rater reproducibility. Prevalence of low risk was 15.6%, moderate risk was 63.7%, and high nutritional risk was 20.7%. A positive test, corresponding to the moderate or high risk category, identified all those with acute malnutrition and showed sensitivity of 89.4% (95% CI: 76.9-96.4) and 94.0% (95% CI: 86.6-98.0) for the detection of chronic and overall malnutrition, respectively. Regarding its predictive capacity, 100% of the patients who needed enteral nutrition, who were transferred, died, or were readmitted to hospital within 30 days after discharge were considered in risk by StrongKids, and the sensitivity to identify those with prolonged hospital stays was 89.2 (95% CI: 84.6-92.7). The inter-rater agreement was excellent (PABAK: 0.87). StrongKids had satisfactory validity and reproducibility and successfully identified nutritional deficits and predict unfavorable health outcomes. Our results support the use of StrongKids as a pediatric nutritional risk screening method in Brazil.