Hospital-acquired undernutrition and associated factors in children and adolescents admitted to a tertiary care hospital.

BACKGROUND: The present study aimed to verify the proportion and factors associated with hospital-acquired malnutrition in the paediatric unit of a tertiary care hospital. METHODS: A retrospective study was carried out in a tertiary care hospital in the state of Maranhão, Brazil. Demographic and clinical data on children and adolescents were collected from medical records and the data regarding weight, height and z-scores of anthropometric indicators were obtained from the World Health Organization (WHO) Anthro® and WHO Anthro Plus® applications. Those with weight-for-height z-score (< 5 years) and a body mass index (BMI)/age z-score (≥ 5 years) < -2 SD at admission were considered to be malnourished. Patients who presented a decrease of > 0.25 SD between the z-score of BMI-for-age (BMIZ) at admission and at discharge were classified as having hospital-acquired malnutrition. Weight loss was also evaluated and was considered significant when it was > 2% between the weight measured at admission and the one before discharge. Logistic regression analysis was performed to verify the factors associated with hospital-acquired malnutrition. RESULTS: The median age was 4.7 years and the length of stay was 21 days; 26.8% of patients had significant weight loss during hospitalisation and a greater proportion had hospital-acquired malnutrition (34.9%). Gastroenteropathies, neuropathies and malnutrition on admission were significantly associated with hospital-acquired malnutrition. CONCLUSIONS: The occurrence of hospital-acquired malnutrition is still a problem in paediatric patients. Thus, providing adequate nutritional support from admission is essential when aiming to avoid deterioration of the nutritional status of paediatric patients during hospitalisation.

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

BACKGROUND/OBJECTIVES: 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. SUBJECTS/METHODS: 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. RESULTS: 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). CONCLUSIONS: 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.