Prevalence of Hospital Malnutrition at Admission and Outcomes in Pediatric Patients
DOI:
https://doi.org/10.6000/1929-4247.2017.06.03.2Keywords:
Undernutrition, Malnutrition, Hospitalized children, Hospital outcomes, Hospital costAbstract
Background: Hospitalized children are at risk of malnutrition and vulnerable for many adverse outcomes.
Objectives: This study aimed to determine the prevalence of hospital malnutrition in pediatric patients admitted at Chiang Mai University (CMU) hospital and evaluate correlation between malnutrition and outcomes including length of hospital stay (LOS), total hospital cost and mortality.
Methods and Study Design: A prospective cohort study was conducted at CMU hospital. Patients aged 1 month to 15 year-old who admitted to general pediatric wards were included. Demographic data, anthropometric assessments including weight, length/height and outcomes were collected. Malnutrition was classified by the WHO growth reference.
Results: A total of 217 patients with mean age 68.8 ± 53.8 month-old were analyzed. Majority of them were male (65.4%) while leading diagnosis were oncologic, infectious and congenital heart diseases. The prevalence of all malnutrition was 59.9%. According to the WHO classification, percentages of the patients who were stunted, wasted, both of stunted and wasted, and overweight were 29.9%, 9.2%, 17.1%, and 3.7%, respectively. Moreover, compared to previous study of this center in 1985, more than half of hospitalized children have still assessed as under-malnourished patients. For the hospital outcomes, wasting regardless of stunting had significantly longer LOS (8 vs 5 days, p = 0.001) and higher hospital expenditure (37,283.0 vs 23,630.0 Baht, p = 0.004) while mortality was not different.
Conclusions: The prevalence of malnutrition in hospitalized children is common and remains unchanged. Acute malnutrition significantly impact on total hospital cost and prolong LOS comparing with other groups.
References
World Health Organization. Global child malnutrition trends (1990-2104) [internet]. 2015 [cited 2016 November 27]. Available from: http;//apps.who.int/gho/data/view.wrapper. nutrition-1-1?lang=en.
Huysentruyt K, Alliet P, Muyshont L, Devreker T, Bontems P, Vandenplas Y. Hospital-related undernutrition in children: still an often unrecognized and undertreated problem. Acta Paediatr 2013(10); 102: e460-6. https://doi.org/10.1111/apa.12344
Huong PT, Lam NT, Thu NN, Quyen TC, Lien DT, Anh NQ, et al. Prevalence of malnutrition in patients admitted to a major urban tertiary care hospital in Hanoi, Vietnam. Asia Pac J Clin Nutr 2014; 23(3); 437-44.
Hecht C, Weber M, Grote V, Daskalou E, Dell’Era L, Flynn D, et al. Disease associated malnutrition correlates with length of hospital stay in children. Clin Nutr 2015; 34(1): 53-9. https://doi.org/10.1016/j.clnu.2014.01.003
Allard JP, Keller H, Jeejeebhoy KN, Laporte M, Duerksen DR, Gramlich L, et al. Malnutrition at hospital admission-contributors and effect on length of stay: a prospective cohort study from the Canadian Malnutrition Task Force. JPEN J Parenter Enteral Nutr 2016; 40(4): 487-97. https://doi.org/10.1177/0148607114567902
Joosten KF, Hulst JM. Prevalence of malnutrition in pediatric hospital patients. Curr Opin Pediatr 2008; 20(5): 590-6. https://doi.org/10.1097/MOP.0b013e32830c6ede
Corkins MR, Guenter P, DiMaria-Ghalili RA, Jensen GL, Malone A, Miller S, et al. Malnutrition diagnoses in hospitalized patients: United States, 2010. JPEN J Parenter Enteral Nutr 2014; 38(2): 186-95. https://doi.org/10.1177/0148607113512154
Cao J, Peng L, Li R, Chen Y, Li X, Mo B, et al. Nutritional risk screening and its clinical significance in hospitalized children. Clin Nutr 2014; 33(3): 432-6. https://doi.org/10.1016/j.clnu.2013.06.009
Garenne M, Maire B, Fontaine O, Briend A. Distributions of mortality risk attributable to low nutritional status in Niakhar, Senegal. J Nutr 2006; 136(11): 2893-900.
Brinksma A, Sanderman R, Roodbol PF, Sulkers E, Burgerhof JG, de Bont ES, et al. Malnutrition is associated with worse health-related quality of life in children with cancer. Support Care Cancer 2015; 23(10): 3043-52. https://doi.org/10.1007/s00520-015-2674-0
Tienboon P. Incidence and spectrum of malnutrition in pediatric wards. Thai J Pediatr 1985; 24: 20-6. [Thai]
Tienboon P. Nutritional status of pediatric patients; Maharaj Nakorn Chiang Mai Hospital. Thai J Paren Enter 1995; 6: 3-14.
Aurangzeb B, Whitten KE, Harisson B, Mitchell M, Kepreotes H, Sidler M, et al. Prevalence of malnutrition and risk of under-nutrition in hospitalized children. Clin Nutr 2012; 31(1): 35-40. https://doi.org/10.1016/j.clnu.2011.08.011
O’Connor J, Youde LS, Baur LA. Obesity and under-nutrition in a tertiary paediatric hospital. J Paediatr Child Health 2004; 40(5-6): 299-304. https://doi.org/10.1111/j.1440-1754.2004.00368.x
Moeeni V, Walls T, Day AS. Nutritional status and nutrition risk screening in hospitalized children in New Zealand. Acta Paediatr 2013; 102(9): e419-23.
Argostoni C, Fossali E, Calderini E, Edefonti A, Colombo C, Battezzati A, et al. Nutritional assessment and risk of malnutrition in hospitalized children in northern Italy. Acta Paediatr 2014; 103(9): e416-7. https://doi.org/10.1111/apa.12712
Sermet-Gaudelius I, Poisson-Salomon A, Colomb V, Brusset MC, Mosser F, Berrier F, et al. Simple pediatric nutritional risk score to identify children at risk of malnutrition. Am J Clin Nutr 2000; 72(1): 64-70.
Kac G, Camacho-Dias P, Silva-Coutihno D, Silveira-Lopes R, Vilas-Boas V, Pinheiro BV. Length of stay is associated with incidence of in-hospital malnutrition in a group of low-income Brazilian children. Salud Publica Mex 2000; 42:407-12. https://doi.org/10.1590/S0036-36342000000500006
De Moraes Silveira CR, De Mello ED, Antonacci Carvalho PR. Evolution of nutritional status of pediatric patients of a tertiary care general hospital in Brazil. Nutr Hosp 2008; 23(6): 599-606.
Sarni ROS, Carvalho MFCC, Monte CMG, Albuquerque ZP, Souza FIS. Anthropometric evaluation, risk factors for malnutrition, and nutritional therapy for children in teaching hospitals in Brazil. J Pediatr (Rio J) 2009; 85(3): 223-8. https://doi.org/10.1590/S0021-75572009000300007
Santafe Sanchez LR, Sanchez Rodriguez DA, Villegas Galarza AL, Gonzalez-Correa CH. Nutritional status among hospitalized children with mixed diagnoses at a referral teaching hospital in Manizales, Colombia. Nutr Hosp 2012; 27(5): 1451-9.
Tutar E, Boran P, Oktem S, Tokuc G, Caliskan B. Malnutrition in hospitalized pediatric patients: a comparison of the National Turkish and World Health Organization (WHO) Child Growth Standards. Marmara Med J 2012; 25:128-32.
Aekplakorn W, editor. The fourth Thai National Health Examination Survey (NHES) 2008-9. Bangkok: Ministry of Public Health. National Health Examination Survey Office (NHESO). [Thai]
Baxter JB, Al-Madhaki FI, Zlotkin SH. Prevalence of malnutrition at the time of admission among patients admitted to a Canadian tertiary-care paediatric hospital. Paediatr Child Health 2014; 19(8): 413-7. https://doi.org/10.1093/pch/19.8.413
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