Hastanede Yatan Çocuklarda Malnütrisyon Gelişme Durumunun Değerlendirilmesi

Year 2020, Volume: 7 Issue: 1, 15 - 22, 08.04.2020

Hatice Pars Hasibe Kazancı Gülperi Söylemez Bayram

https://doi.org/10.31125/hunhemsire.715032

Cited By: 4

Abstract

Amaç: Çalışmanın amacı hastanede yatan çocuklarda malnütrisyon gelişme durumunu ve malnütrisyon gelişmesini etkileyen faktörleri belirlemektir.
Gereç ve Yöntem: Tanımlayıcı-kesitsel olan bu çalışmada 80 hastanın nütrisyonel durumu Waterlow ve Gomez malnütrisyon sınıflama sistemi uygulanarak değerlendirilmiştir. Fiziksel ölçümler hastaneye yatış ve taburculuk sırasında, yaşa göre ağırlık (YGA), yaşa göre boy (YGB), boya göre ağırlık (BGA) ve beden kitle indeksi (BKİ) z- skorları ile hesaplanmıştır.
Bulgular: Çocukların %25’inin yatış sırasında z-skor indeksi -2’nin altında iken, taburculuk sırasında bu oran %31.2 olarak belirlenmiştir. Yapılan ölçümler sonucunda Gomez malnütrisyon sınıflama sistemine göre yatış sırasında çocukların %17.5’inde (%10 orta malnütrisyon; %7.5 ciddi malnütrisyon), taburculukta ise % 25.1’inde orta ve ciddi malnütrisyon tespit edilmiştir. Waterlow sınıflama sistemine göre ise yatış sırasında çocukların %20’sinde, taburculuk sırasında ise %28.8.’inde akut malnütrisyon saptanmıştır. BGA, YGA ve BKİ standart sapma skorlarında %3’lük azalma olan çocuklarda hastanede yatış süresinin daha uzun olduğu
belirlenmiştir (p<0.05). Hastaneye yatış sırasında enfeksiyon varlığı, hastanede yatış süresi ve ailenin gelir durumu çocukta malnütrisyon görülme durumunu etkilemektedir (p<0.05).
Sonuç: Hastaneye başvuru ve yatış sürecinde malnütrisyon önemli bir sorun olmaya devam etmektedir. Malnütrisyonun erken tanı ve tedavisinin sağlanması için hastanede yatan tüm çocukların nütrisyonel durumunun değerlendirilmesi oldukça önemlidir.

Keywords

Beslenme durumu, hastanede yatan çocuk, tarama araçları, malnutrisyon

Evaluation of Malnutrition Development in Hospitalized Children

Abstract

Aim: The aim of this study was to determine the development of malnutrition and the factors affecting it in hospitalized children.
Material and Methods: In this descriptive, cross-sectional study, nutritional status of 80 patients were evaluated using Waterlow and Gomez malnutrition classifications systems. Physical measurements were calculated by z-scores of weight-forlength/ height (WFL/H), weight for age (WFA), height-for-age (HFA) and body mass index–for–age (BMI) at hospital admission and at discharge.
Results: While 25% of the children had a z-score index below -2 at hospital admission, this rate was 31.2% during discharge. According to Gomez malnutrition classification system, moderate and severe malnutrition was detected in 17.5% of children (10% moderate malnutrition, 7.5% severe malnutrition) at hospital admission and 25.1% of children at discharge. According to the Waterlow classification system, acute malnutrition was found in 20% of children at hospital admission and 28.8% during discharge. The length of hospital stay was found to be longer in children with a 3% reduction in WFL/H, WFA and BMI standard deviation scores (p <0.05).
Conclusion: Malnutrition remains a major problem at admission and hospitalization process. All hospitalized children should be evaluated in terms of nutritional status in order to provide early diagnosis and treatment of malnutrition.

Keywords

Hospitalized children, malnutrition, nutritional status, screening tools

References

• 1. Cao J, Peng L, Li R, et al. Nutritional risk screening and its clinical significance in hospitalized children. Clin Nutr. 2014;33:432-6.
• 2. Hartman C, Shamir R, Hecht C, Koletzko B. Malnutrition screening tools for hospitalized children. Curr Opin Clin Nutr Metab Care. 2012;15:303-9.
• 3. Durakbaşa ÇU, Fettahoğlu S, Bayar A, Mutus M, Okur H. The prevalence of malnutrition and effectiveness of STRONGkids tool in the identification of malnutrition risks among pediatric surgical patients. Balkan Med J. 2014;31:313-21.
• 4. Ozturk Y, Buyukgebiz B, Arslan N, Ellidokuz H. Effects of hospital stay on nutritional anthropometric data in Turkish children. J Trop Pediatr. 2003;49:189-90. 5. Dogan Y, Erkan T, Yalvaç S, et al. Nutritional status of patients hospitalized in pediatric clinic. Turk J Gastroenterol. 2005;16:212-6.
• 6. Beser OF, Cokugras FC, Erkan T, et al. Evaluation of malnutrition development risk in hospitalized children. Nutrition. 2018;48:40-7.
• 7. Joosten KF, Hulst JM. Malnutrition in pediatric hospital patients: Current issues. Nutrition. 2011;27:133-7.
• 8. Huysentruyt K, Alliet P, Muyshont L, et al. The STRONG-kids nutritional screening tool in hospitalized children: A validation study. Nutrition. 2013;29:1356-61.
• 9. Campanozzi A, Russo M, Catucci A, et al. Hospital-acquired malnutrition in children with mild clinical conditions. Nutrition. 2009;25:540-7.
• 10. Hulst JM, Zwart H, Hop WC, Joosten KF. Dutch national survey to test the STRONG (kids) nutritional risk screening tool in hospitalized children. Clin Nutr. 2010;29:106-11
• 11. Young H, Borrel A, Holland D, Salama P. Public nutrition in complex emergencies. Lancet. 2004;364:1899-1909.
• 12. Marino LV, Goddard E, Workman L. Determining the prevalence of malnutrition in hospitalized paediatric patients. S Afr Med J. 2006;96:993-5.
• 13. Green JC. Existence, causes and consequences of disease-related malnutrition in the hospital and the community, and clinical and financial benefits of nutritional intervention. Clinical Nutrition. 1999;18:3-28.
• 14. Joosten KFM, Hulst JM. Prevalence of malnutrition in pediatric hospital patients. Curr Opin Pediatr. 2008;2:590-6.
• 15. Kondrup J, Allison SP, Elia M, Vellas B, Plauth M. Educational and Clinical Practice Committee, European Society of Parenteral and Enteral Nutrition (ESPEN). ESPEN Guidelines for Nutrition Screening 2002. Clin Nutr. 2003;22:415-21.
• 16. Corkins MR, Griggs KC, Groh-Wargo S; American Society for Parenteral and Enteral Nutrition Board of Directors; American Society for Parenteral and Enteral Nutrition. Standards for nutrition support: pediatric hospitalized patients. Nutr Clin Pract. 2013;28:263-6.
• 17. Agostoni C, Axelson I, Colomb V, et al. The need for nutrition support teams in pediatric units: a commentary by the ESPGHAN committee on nutrition. J Pediatr Gastroenterol Nutr. 2005;41:8-11.
• 18. Mehta NM, Corkins MR, Lyman B, et al. Defining pediatric malnutrition: a paradigm shift toward etiology-related definitions. J Parenter Enteral Nutr. 2013;37:460-81.
• 19. Hendrikse WH, Reilly JJ, Weaver LT. Malnutrition in a children’s hospital. Clin Nutr. 1997;13:16.
• 20. Tolkacheva N, Broese M, Groenoui V, Boer A, Tilburg T. The impact of informal care- giving networks on adult children’s care-giver burden. Ageing & Society. 2011;31:34-51.
• 21. Hecht C, Weber M, Grote V, et al.Disease associated malnutrition correlates with length of hospital stay in children. Clin Nutr. 2015;34:53-9.
• 22. World Health Organisation. Physical status: The use and interpretation of anthropometry. Report of a WHO Expert Committee. TRS No. 854. Geneva, Swizerland: World Health Organization; 1995. (Erişim Tarihi 28 Kasım 2019). Erişim adresi: https://www.who.int/childgrowth/publications/physical_status/en/
• 23. Gomez SF, Ramos GR, Frenk S, et al. Mortality in second and third degree malnutrition. J Trop Pediatr. 1956;2:77-87.
• 24. Waterlow JL. Classification and definition of protein-calorie malnutrition. Br Med J. 1972;3:566-99.
• 25. Malnutrition Advisory Group (MAG): A Standing Committee of the British Association for Parenteral and Enteral Nutrition (BAPEN). The 'MUST' Explanatory Booklet. A Guide to the 'Malnutrition Universal Screening Tool' ('MUST') for Adults: BAPEN; 2003. (Erişim Tarihi 28 Kasım 2019). Erişim adresi: https://www.bapen.org.uk/pdfs/must/must_explan.pdf.
• 26. Geylani Güleç S, Polat S, Yağar G, Hatipoğlu N, Urgancı N. Hastanede yatan 3 yaş altı çocuklarda malnütrisyon durumunun değerlendirilmesi. Ş.E.E.A.H. Tıp Bülteni. 2011;45:124-9.
• 27. Mevlitoğlu Ş. Hastanede yatan çocuklarda malnütrisyon oranının ve nütrisyonel risk skorlamasının belirlenmesi. Akdeniz Üniversitesi Tıp Fakültesi. Çocuk Sağlığı ve Hastalıkları Anabilim Dalı, Uzmanlık Tezi. 2015.
• 28. Marteletti O, Caldari D, Guimber D, et al. Malnutrition screening in hospitalized children: influence of the hospital unit on its management. Arch Pediatr. 2005;12:1226-31.
• 29. Moy R, Smallman S, Booth I: Malnutrition in a UK children’s hospital. J Hum Nutr Diet. 1990;3:93-100.
• 30. Pawellek I, Dokoupil K, Koletzko B. Prevalence of malnutrition in paediatric hospital patients. Clin Nutr. 2008;27:72-6.
• 31. Joosten KF, Zwart H, Hop WC, et al. National malnutrition screening days in hospitalized children in the Netherlands. Arch Dis Child. 2010;95:141-5.
• 32. Sermet-Gaudelus I, Poisson-Salomon AS, Colomb V, et al. Simple pediatric nutritional risk score to identify children at risk of malnutrition. Am J Clin Nutr. 2000;72:64–70.
• 33. Wonoputri N, Djais JT, Rosalina I. Validity of nutritional screening tools for hospitalized children. J Nutr Metab. 2014;1-6
• 34. Medoff-Cooper B, Irving SY, Marino BS, et al. Weight change in infants with a functionally univentricular heart: from surgical intervention to hospital discharge. Cardiol Young. 2011;21:136-44.
• 35. Elia M, Sratton RJ. Considerations for screening tool selection and role of predictive and concurrent validity. Curr Opin Clin Nutr Metab Care. 2011;14:425-33.
• 36. Rocha GA, Rocha EJ, Martins CV. The effects of hospitalization on the nutritional status of children. J Pediatr (Rio J). 2006;82:70-4.
• 37. Sylvestre LC, Fonseca KP, Stinghen AE, Pereira AM, Meneses RP, Pecoits-Filho R. The malnutrition and inflammation axis in pediatric patients with chronic kidney disease. Pediatr Nephrol. 2007;22:864-73.
• 38. Chourdakis M, Hecht C, Gerasimidis K, Joosten KF, Karagiozoglou -Lampoudi T, Koetse HA, et al. Malnutrition risk in hospitalized children: use of 3 screening tools in a large European population. Am J Clin Nutr. 2016;103:1301–10.
• 39. Spagnuolo MI, Liguoro I, Chiatto F, Mambreetti D, Guarino S. Application of a score system to evaluate the risk of malnutrition in a multiple hospital setting. Italian Journal of Pediatrics. 2013;39:81-7.
• 40. Jefferies D, Johnson M, Ravens J. Nurturing and nourishing: the nurses’ role in nutritional care. Journal of Clinical Nursing. 2011;20:317-30.