Verbum 30.2% of the hospitalized children they stud-
Gepubliceerd in Nutrition 2013;29:1356–1361.
Gepubliceerd in Acta Paediatrica 2013;102:e460-466.
THE STRONGKIDS NUTRITIONAL SCREENING
HOSPITAL-RELATED
IN
iedwere acutely malnourished on admission,
TOOL IN HOSPITALIZED CHILDREN:
CHILDREN: STILL AN OFTEN UNRECOGNIZED
which is comparable with the prevalence in
A VALIDATION STUDY.
AND UNDERTREATED PROBLEM.
Turkey 10 years ago. Recent studies, includ-
K. Huysentruyt, Ph. Alliet, L. Muyshont, R. Ros-
K. Huysentruyt, P. Alliet, L. Muyshont, T. Devre-
ing our own (2), lead us to the conclusion that
signol, T. Devreker, P. Bontems, J. Dejonckheere,
ker, P. Bontems, Y. Vandenplas.
the prevalence of under-nutrition in paediat-
Y. van Vandenplas, J. De Schepper.
Abstract
ric hospitals in Europe remains an important
Abstract
Aim: To evaluate the nutritional status of
issue.
Objective: The STRONGkids is a nutritional
hospitalized children in Belgian hospitals
Is it impossible to avoid the problem of hos-
screening tool for hospitalized children, which
and to analyse the impact of undernutrition
pital-related under-nutrition in children? One
was found to predict a negative weight for
on the degree of weight loss and duration of
explanation could be that hospitalized chil-
height (WFH) standard deviation score (SDS)
hospitalization.
dren represent a selective at-risk population.
and a prolonged hospital length of stay (LOS)
Methods: In each hospital (one tertiary and
Why is it that one previously healthy child
in a Dutch population of hospitalized children.
three secondary hospitals), 100 consecu-
gets hospitalized for pneumonia or gastroen-
This study aimed to test the ease of use and
tively hospitalized children were eligible for
teritis and another doesn’t? Another expla-
reproducibility of the STRONGkids, and to con-
inclusion. Of these, 379 were included for
nation could be that paediatricians are still
firm its concurrent and prospective validity in
analysis. Body weight, length and mid-upper
not convinced that under-nutrition is a major
a Belgian population of hospitalized children.
arm circumference were measured at admis-
problem that requires appropriate treatment
Methods: Reproducibility was tested in a co-
sion and body weight also at discharge.
as a condition in its own or that they under-
hort of 29 hospitalized children in a tertiary
Results: The median (range) age was 2.1
estimate the degree of under-nutrition, based
center and validity was tested in 368 chil-
(0.8–17) years. On admission, 29 (7.7%) chil-
on their clinical impressions. A strong argu-
dren (105 hospitalized in a tertiary and 263
dren were chronically malnourished and, de-
ment pointing to the lack of interest among
in three secondary hospitals) ages between
pending on the parameter, between 2.4% and
healthcare workers can be found in the fre-
0.08 and 16.95 y (median 2.2 y).
9.8% acutely undernourished, while 12.1%
quent absence of weight and height data in
Results: Substantial intrarater (ĸ = 0.66) and
had at least one subnormal parameter. Median
medical or nursing files, not only at admission,
interrater (ĸ = 0.61) reliabilities were found
(range) duration of hospitalization was four
but also at discharge, especially in case of
between observations. STRONGkids scores cor-
(1–64) days. Median (range) weight change
prolonged hospitalization. For example, only
related negatively with WFH SDS of the pa-
was 0.0% (15.6% – +13.9%). Weight loss of
27% of patients had both their weight and
tients (ρ = –0.23; P < 0.01; odds ratio [OR],
>2% was significantly (p < 0.05) more preva-
height recorded in the nutrition audit carried
2.47; 95% confidence interval [CI], 1.11–5.49;
lent in tertiary (20.0%) than in secondary
out by O’Connor et al. (3).
P < 0.05). It had a sensitivity and negative
(10.2%) hospitals. Median hospital duration
Raising awareness on the importance of
predictive value (NPV) of respectively 71.9%
was 50% longer for chronically malnourished
nutritional screening and assessment is a
and 94.8% to identify acutely undernour-
children (6.0 vs 4.0 days; p < 0.01). Only 36
shared responsibility. Firstly, there is a re-
UNDERNUTRITION
ished children. STRONGkids did not correlate
children received a nutritional intervention.
sponsibility for academic staff to teach nu-
with weight loss during hospitalization, but
Conclusion: Acute undernutrition and chronic
tritional screening skills to young doctors and
correlated with LOS (ρ = 0.25; OR 1.96; 95%
undernutrition remain frequent findings in
nurses. Secondly, national governments need
CI, 1.25–3.07; both P < 0.01) and the set-up
hospitalized children in Belgium. Children
to make a major effort to encourage hospitals
of a nutritional intervention during hospi-
with chronic undernutrition had a 50% longer
to make proper nutritional policy a higher pri-
talization (OR, 18.93; 95% CI, 4.48–80.00; P
hospital stay. Hospital-related undernutrition
ority. Funding should be provided to set up
< 0.01). The sensitivity and NPV to predict a
is an often unrecognized problem, because
paediatric nutritional support teams, whose
LOS ≥ 4 d were respectively 62.6% and 72%,
only one-third of the acutely malnourished
primary focus would be to carry out routine
and respectively 94.6% and 98.9% to predict
children received nutritional support.
screening and appropriate nutritional assess-
a nutritional intervention.
Keywords: Child, Hospital, Malnutrition, Nu-
ment in paediatric hospital units. In addition,
Conclusions: STRONGkids is an easy-to-use
tritional status, Undernutrition.
research on nutritional screening has so far
screening tool. Children classified as “low risk”
only focused on validating screening tools
have a 5% probability of being acutely mal-
for their ability to detect malnutrition and as-
nourished, with only a 1% probability of a nu-
Gepubliceerd in Acta Paediatrica 2013;102:e484-485.
sociated problems, but not enough on their
tritional intervention during hospitalization.
Letter to the editor.
ability to demonstrate improved outcome. We
Keywords: Child, Hospitalized, Malnutrition,
HOSPITAL-RELATED
IN
suspect that clinicians who focus on treating
Nutritional screening, Sensitivity, Specificity.
CHILDREN: WHY AREN’T THE NUMBERS FAL-
and preventing diseases will be more likely to
LING?
listen to these particular arguments. Current
Sir,
research should also focus on assessing the
The report by Oztürk et al. (1) mentions that
effect of a nutrition programme that includes
UNDER-NUTRITION
JESSALINEA 29