A four-stage evaluation of the Paediatric Yorkhill Malnutrition Score in a tertiary paediatric hospital and a district general hospital.

Paediatric in-patients are at high risk of malnutrition but validated paediatric screening tools suitable for use by nursing staff are scarce. The present study aimed to assess the diagnostic accuracy of the new Paediatric Yorkhill Malnutrition Score (PYMS). During a pilot introduction in a tertiary referral hospital and a district general hospital, two research dietitians assessed the validity of the PYMS by comparing the nursing screening outcome with a full dietetic assessment, anthropometry and body composition measurements. An additional PYMS form was completed by the research dietitians to assess its inter-rater reliability with the nursing staff and for comparison with the Screening Tool for the Assessment of Malnutrition in Paediatrics (STAMP) and the Paediatric Subjective Global Nutritional Assessment (SGNA). Of the 247 children studied, the nurse-rated PYMS identified 59% of those rated at high risk by full dietetic assessment. Of those rated at high risk by the nursing PYMS, 47% were confirmed as high risk on full assessment. The PYMS showed moderate agreement with the full assessment (kappa = 0.46) and inter-rater reliability (kappa = 0.53) with the research dietitians. Children who screened as high risk for malnutrition had significantly lower lean mass index than those at moderate or low risk, but no difference in fat. When completed by the research dietitians, the PYMS showed similar sensitivity to the STAMP, but a higher positive predictive value. The SGNA had higher specificity than the PYMS but much lower sensitivity. The PYMS screening tool is an acceptable screening tool for identifying children at risk of malnutrition without producing unmanageable numbers of false-positive cases.

Nutritional support for children during critical illness: European Society of Pediatric and Neonatal Intensive Care (ESPNIC) metabolism, endocrine and nutrition section position statement and clinical recommendations.

BACKGROUND: Nutritional support is considered essential for the outcome of paediatric critical illness. There is a lack of methodologically sound trials to provide evidence-based guidelines leading to diverse practices in PICUs worldwide. Acknowledging these limitations, we aimed to summarize the available literature and provide practical guidance for the paediatric critical care clinicians around important clinical questions many of which are not covered by previous guidelines. OBJECTIVE: To provide an ESPNIC position statement and make clinical recommendations for the assessment and nutritional support in critically ill infants and children. DESIGN: The metabolism, endocrine and nutrition (MEN) section of the European Society of Pediatric and Neonatal Intensive Care (ESPNIC) generated 15 clinical questions regarding different aspects of nutrition in critically ill children. After a systematic literature search, the Scottish Intercollegiate Guidelines Network (SIGN) grading system was applied to assess the quality of the evidence, conducting meta-analyses where possible, to generate statements and clinical recommendations, which were then voted on electronically. Strong consensus (> 95% agreement) and consensus (> 75% agreement) on these statements and recommendations was measured through modified Delphi voting rounds. RESULTS: The final 15 clinical questions generated a total of 7261 abstracts, of which 142 publications were identified relevant to develop 32 recommendations. A strong consensus was reached in 21 (66%) and consensus was reached in 11 (34%) of the recommendations. Only 11 meta-analyses could be performed on 5 questions. CONCLUSIONS: We present a position statement and clinical practice recommendations. The general level of evidence of the available literature was low. We have summarised this and provided a practical guidance for the paediatric critical care clinicians around important clinical questions.

Development and validation of a novel paediatric weight estimation equation in multinational cohorts of sick children.

AIM: In sick children who are unable to be weighed estimation of weight is often required, but the routinely used equations lack accuracy and precision. This study aimed to develop a novel equation (Children's European Estimator of Weight-CEEW) using measurements of mid-upper arm circumference (MUAC) and other predictors in multinational groups of sick children in Europe. METHODS: Weight estimation equations were developed in 2086 children from the UK, Greece and the Netherlands, using a combination of demographics, MUAC and height measurements. The final CEEW equations were compared against the performance of the European Resuscitation Council (ERC), Advanced Paediatric Life Support (APLS) and the Cattermole equations. RESULTS: Two final CEEW equations were developed, incorporating measurements of age, gender and MUAC, with (CEEW1) or without (CEEW2) the inclusion of height. Both equations presented very high coefficients of determination (R2>96.5%), minimal mean prediction error and narrower limits of agreement than the comparator equations. 88% (CEEW1) and 77% (CEEW2) of weight estimates fell within 15% of measured body weight. These figures compared with less than 57%, 57% and 37% for the ERC, APLS and Cattermole equations respectively. CONCLUSION: The CEEW equations performed substantially better than other routinely used equations for weight estimation. An electronic application for mobile use is presented.

Performance of the novel Paediatric Yorkhill Malnutrition Score (PYMS) in hospital practice.

BACKGROUND & AIMS: Nutritional screening in paediatric inpatients is important. However, there is a lack of validated screening tools for this population. In this study the development of a nurse administered paediatric malnutrition screening tool is described and its performance evaluated. METHODS: The Paediatric Yorkhill Malnutrition Score (PYMS) rate BMI, weight loss, dietary intake and predicted effect of the current condition on nutritional status, with a score of 0-2 for each element. Patients with total score of 2 or more are referred for dietetic review. A four month pilot phase was conducted in three medical and one surgical wards of a tertiary hospital and the general paediatric ward of a district general hospital. Performance of the tool was assessed by auditing completion rates, yield, impact on dietetic workload, and by evaluating dietitians' feedback. RESULTS: 1571 patients (72% of admissions) were screened of whom 158 (10%) scored at high risk. Non-screened children were younger and had a shorter length of hospital stay. Of the 125 patients who scored at high risk, between the 2nd and 4th month of the pilot, 66 (53%) were assessed by a dietitian of whom 86% were judged to be at true risk of malnutrition and 50% of these were new to the dietetic service. Dietetic workload did not increase significantly during the pilot phase although the proportion of referrals from the acute receiving wards increased. Dietitians' feedback was positive, with recognition that PYMS identified patients at risk of malnutrition who may not have otherwise been referred. CONCLUSIONS: Nutrition screening by nurses using the new PYMS score is feasible for paediatric inpatients, identifies children at risk of malnutrition and uses available resources efficiently.