Vesal Moeeni

Nutritional status and nutrition risk screening in hospitalized children in New Zealand

Children requiring hospitalization are at risk of malnutrition. This study aimed to define the nutritional status of paediatric inpatients in comparison with healthy children and to compare and contrast the feasibility and validity of three nutritional risk screening (NRS) tools in the hospitalized children.

Assessment of nutritional status and nutritional risk in hospitalized Iranian children.

Aims:  This study aimed to define the nutritional state of children admitted to a tertiary Iranian hospital and to evaluate nutritional risk score tools in these children.

The STRONGkids nutritional risk screening tool can be used by paediatric nurses to identify hospitalised children at risk

Hospitalised children have higher rates of undernutrition. Early detection of at‐risk patients could lead to prompt preventative or corrective interventions. Several nutritional risk screening tools are available for screening hospitalised children including the STRONGkids tool. This study was designed to assess the usefulness of STRONGkids when applied by nurses rather than a paediatrician.

Age-dependent variation of fecal calprotectin in cystic fibrosis and healthy children

BACKGROUND Fecal calprotectin may be used as a non-invasive method to assess the effect of novel therapies on the gut in cystic fibrosis (CF). METHOD Stools from CF patients and healthy controls (HC) (0-10years old) were prospectively collected for evaluation of temporal trends. RESULTS 130 CF samples (64 subjects) and 114 HC samples (101 subjects) were collected. Overall, fecal calprotectin levels were different in CF patients and HC from 0 to 10years (P=0.0002). Fecal calprotectin in CF was significantly lower than HC from 0 to 1years (P=0.03) and demonstrated an upward trajectory until 4years. From >4 to 10years calprotectin was consistently higher in CF patients compared with HC (P=0.007). CONCLUSIONS Fecal calprotectin levels in children with CF and HC were age-dependent and had distinct trajectories. Careful interpretation of calprotectin is required if used in drug trials for CF, particularly in children less than 4years old.

Nutritional Risk Screening Tools in Hospitalised Children

In clinical practice, the assessment of nutritional status in children can be problematic. More than one indicator is often required and may include a combination of anthropometric measurements, body compartment analysis and biochemical markers. The nutritional status of children at the time of admission to hospital can impact adversely on their hospital stay. Furthermore, children’s medical conditions may also impact upon their nutrition during a hospital stay. In recent years a number of Nutrition Risk Screening (NRS) tools have been developed and validated, with the goals of providing rapid assessment of children’s risk of nutritional change during a hospitalisation. This article reviews the current NRS tools, considers their benefits and shortcomings and evaluates the potential roles of these tools.

Re: Nutritional risk screening and its clinical significance in hospitalized children

on theapplication of a nutritional screening tool (STRONGkids) to assessthe nutritional status of hospitalized children in China. The recruit-ment of a large number of children (n ¼ 1325) in the study isimpressive and permits a number of key analyses. The authorswere able to demonstrate a close relationship between patients’Nutritional Risk Screening (NRS) scores and their anthropometricindexes, indicating that children who are currently malnourishedare at much greater risk for further nutritional deterioration. Thisstudy showed clearly that paediatric patients with higher riskscores had longer length of hospital stay. In addition, NRS riskwas clearly linked to health care costs.Recently, we have completed similar studies in two separatecountries: firstly in a developing country (Iran) and more recentlyin a developed country (New Zealand).

A Retrospective Comparison between the PNST and other Paediatric Nutritional Screening Tools

Background : Although it is widely acknowledged that hospitalized children are at greater risk of malnutrition, the available paediatric Nutritional Risk Screening (NRS) tools have not yet become universally used to identify those children at greater risk. Furthermore, the utility of one NRS tool over another remains unclear. Materials and Methods : The utility of a recently developed tool, the Paediatric Nutritional Screening Tool (PNST), was evaluated using data previously collected in the assessment of three other NRS tools in 281 children from Iran and New Zealand. The sensitivity and specificity of each tool was then assessed based on the WHO criteria for malnutrition. Results : The PNST recognized about half of the malnourished patients while the other three tools identified at least 85% of these children. The sensitivity of PNST for moderate (BMI-z < 2) and severe malnutrition (BMI-z <-3) was 37% and 46% respectively, while the sensitivity for other three NRS tools ranged from 82-100%. Conclusion : In this data set, the PNST tool did not perform as well as the three more established NRS tools. Further work is required to provide optimal tools for the identification of hospitalized children at risk of malnutrition.

Malnutrition screening tools need to be applied properly before they can be compared – Response to Letter to Editors by Gerasimidis et al.

prepared by the nurses before the protocol was revised was significantly lower than the theoretical one (mean SD, 33.83 4.58 mg vs. 40 mg; Student’s test, p < 0.001). When it came to the method of reconstitution, we observed that the amount of vancomycin was significantly different between water and saline, with or without stirring (Kruskal– Wallis test; p < 0.001), especially between water with stirring and saline without stirring [median (min-max): 34.5 mg (34.2–35.1) vs. 27.6 mg (25.5–33.0); Conover and Iman, p < 0.0001]. The drug transfer method and dilution process were also associated with a significant difference between the amounts of vancomycin (p = 0.043). After revising the protocol, there was still a significant difference between the observed and theoretical amounts (35.80 0.88 mg vs. 40 mg; p < 0.001). The relative standard deviation (Fig. 1) was significantly lower before we revised the protocol (2.5% vs. 13.0%; Fisher’s test, p < 0.001). Our main hypothesis is that the dosing variability of vancomycin syringes is mainly due to the solventused to reconstitute the solution and the nonsystematic practice of stirring to ensure that the powder is completely dissolved. Another way to reduce these risks and errors is to standardize and centralize preparation and reconstitution in the hospital pharmacy (1). The authors wish to thank the members of the NICU care team, University Hospital of Lille and Dr Damien Lannoy for their dedication and commitment to this study and the manufacturers, Safic Alcan and ACS Dobfar, for providing free vancomycin powder samples for our research.