Nutritional management in children with disease-related malnutrition : what’s the guideline?
Abstract
Background: Disease-related malnutrition (DRM) is one of the most common problems in pediatric patients. Both cancer and congenital heart diseases (CHD) are commonly associated with DRM. Altered nutrition utilization, reduced intake, malabsorption, and hypermetabolism are the main pathophysiology in DRM. Method: A systematic literature searching was performed through Pubmed and Google Scholar websites. Thirty-six articles were included into the study. Results: Malnutrition screening should be performed as soon as possible since early feeding can benefit the patients. One of the most commonly used tools is Screening Tool for Risk on Nutritional Status and Growth (STRONGkids), which was proven to be valid, reproducible, and applicable in pediatric patients with malnutrition. Following screening and assessment, nutrition support can ensue, preferably in the form of enteral nutrition, unless contraindicated. Nutrient-dense formula, also known as protein and energy-enriched formula, aims to aid infants to reach nutrition target rapidly and stimulate anabolism. This formula has been studied in various population, mostly infants with CHD and studies showed favorable outcomes with its administration, namely faster improvement, reduced diuretics use and oxygen supplementation, decreased length of hospital stay, and less antibiotic use. Nutrient-dense formula is also safe and well-tolerated. Conclusion: Proper screening and management should be performed with multidisciplinary approach to achieve the best outcome in children with DRM.Downloads
References
Zimmermann K, Ammann RA, Kuehni CE, De Geest S, Cignacco E. Malnutrition in pediatric patients with cancer at diagnosis and throughout therapy: A multicenter cohort study. Pediatr Blood Cancer. 2013;60:642-9.
Maehara M, Rah JH, Roshita A, Suryantan J, Rachmadewi A, Izwardy D. Patterns and risk factors of double burden of malnutrition among adolescent girls and boys in Indonesia. PLoS One. 2019;14:e0221273.
De Silva I, Sumarto S. Child Malnutrition in Indonesia: Can Education, Sanitation and Healthcare Augment the Role of Income? Journal of International Development. 2018;30:837-64.
Rachmi CN, Li M, Alison Baur L. Overweight and obesity in Indonesia: prevalence and risk factors-a literature review. Public Health. 2017;147:20-9.
Mehta NM, Corkins MR, Lyman B, Malone A, Goday PS, Carney LN, et al. Defining pediatric malnutrition: a paradigm shift toward etiology-related definitions. JPEN J Parenter Enteral Nutr. 2013;37:460-81.
Freijer K, van Puffelen E, Joosten KF, Hulst JM, Koopmanschap MA. The costs of disease related malnutrition in hospitalized children. Clin Nutr ESPEN. 2018;23:228-33.
Guenter P, Jensen G, Patel V, Miller S, Mogensen KM, Malone A, et al. Addressing Disease-Related Malnutrition in Hospitalized Patients: A Call for a National Goal. The Joint Commission Journal on Quality and Patient Safety. 2015;41:469-73.
Toole BJ, Toole LE, Kyle UG, Cabrera AG, Orellana RA, Coss-Bu JA. Perioperative nutritional support and malnutrition in infants and children with congenital heart disease. Congenit Heart Dis. 2014;9:15-25.
Hassan BA, Albanna EA, Morsy SM, Siam AG, Al Shafie MM, Elsaadany HF, et al. Nutritional Status in Children with Un-Operated Congenital Heart Disease: An Egyptian Center Experience. Front Pediatr. 2015;3:53.
Monteiro FPM, Araujo TLd, Lopes MVdO, Chaves DBR, Beltrão BA, Costa AGdS. Nutritional status of children with congenital heart disease. Rev Latino-Am Enfermagem. 2012;20:1024-32.
Arodiwe I, Chinawa J, Ujunwa F, Adiele D, Ukoha M, Obidike E. Nutritional status of congenital heart disease (CHD) patients: Burden and determinant of malnutrition at university of Nigeria teaching hospital Ituku - Ozalla, Enugu. Pak J Med Sci. 2015;31:1140-5.
Hubschman LE. Malnutrition in Congenital Heart Disease. ICAN: Infant, Child, & Adolescent Nutrition. 2013;5:170-6.
Brinksma A, Huizinga G, Sulkers E, Kamps W, Roodbol P, Tissing W. Malnutrition in childhood cancer patients: a review on its prevalence and possible causes. Crit Rev Oncol Hematol. 2012;83:249-75.
Loeffen EA, Brinksma A, Miedema KG, de Bock GH, Tissing WJ. Clinical implications of malnutrition in childhood cancer patients--infections and mortality. Support Care Cancer. 2015;23:143-50.
Brinksma A, Sanderman R, Roodbol PF, Sulkers E, Burgerhof JG, de Bont ES, et al. Malnutrition is associated with worse health-related quality of life in children with cancer. Support Care Cancer. 2015;23:3043-52.
Schiessel DL, Baracos VE. Barriers to cancer nutrition therapy: excess catabolism of muscle and adipose tissues induced by tumour products and chemotherapy. Proceedings of the Nutrition Society. 2018;77:394-402.
Martini S, Beghetti I, Annunziata M, Aceti A, Galletti S, Ragni L, et al. Enteral Nutrition in Term Infants with Congenital Heart Disease: Knowledge Gaps and Future Directions to Improve Clinical Practice. Nutrients. 2021;13.
Dos Santos CA, Ribeiro AQ, Rosa COB, de Araujo VE, Franceschini S. Nutritional risk in pediatrics by StrongKids: a systematic review. Eur J Clin Nutr. 2019;73:1441-9.
Klanjsek P, Pajnkihar M, Marcun Varda N, Povalej Brzan P. Screening and assessment tools for early detection of malnutrition in hospitalised children: a systematic review of validation studies. BMJ Open. 2019;9:e025444.
Murphy AJ, White M, Viani K, Mosby TT. Evaluation of the nutrition screening tool for childhood cancer (SCAN). Clin Nutr. 2016;35:219-24.
Joffe L, Ladas EJ. Nutrition during childhood cancer treatment: current understanding and a path for future research. The Lancet Child & Adolescent Health. 2020;4:465-75.
Sidiartha IGL, Wati DK, Subanada IB, Suwarba IGNM. High C-reactive protein/albumin ratio increased risk of acute malnutrition during hospitalization in pediatric patients. International journal of health sciences. 2020;4:32-8.
Radman M, Mack R, Barnoya J, Castaneda A, Rosales M, Azakie A, et al. The effect of preoperative nutritional status on postoperative outcomes in children undergoing surgery for congenital heart defects in San Francisco (UCSF) and Guatemala City (UNICAR). J Thorac Cardiovasc Surg. 2014;147:442-50.
Gu Y, Hu Y, Zhang H, Fu W, Yang Y, Latour JM. Implementation of an Evidence-Based Guideline of Enteral Nutrition for Infants With Congenital Heart Disease: A Controlled Before-and-After Study. Pediatr Crit Care Med. 2020;21:e369-e77.
St Pierre A, Khattra P, Johnson M, Cender L, Manzano S, Holsti L. Content validation of the infant malnutrition and feeding checklist for congenital heart disease: a tool to identify risk of malnutrition and feeding difficulties in infants with congenital heart disease. J Pediatr Nurs. 2010;25:367-74.
Argent AC, Balachandran R, Vaidyanathan B, Khan A, Kumar RK. Management of undernutrition and failure to thrive in children with congenital heart disease in low- and middle-income countries. Cardiol Young. 2017;27:S22-S30.
Wong JJ, Cheifetz IM, Ong C, Nakao M, Lee JH. Nutrition Support for Children Undergoing Congenital Heart Surgeries: A Narrative Review. World J Pediatr Congenit Heart Surg. 2015;6:443-54.
Ackerman D, Laszlo M, Provisor A, Yu A. Nutrition Management for the Head and Neck Cancer Patient. Cancer Treat Res. 2018;174:187-208.
Viani K. Parenteral and enteral nutrition for pediatric oncology in low- and middle-income countries. Indian J Cancer. 2015;52:182-4.
Obeid OA, Hachem DH, Ayoub JJ. Refeeding and metabolic syndromes: two sides of the same coin. Nutr Diabetes. 2014;4:e120.
Zhang H, Gu Y, Mi Y, Jin Y, Fu W, Latour JM. High-energy nutrition in paediatric cardiac critical care patients: a randomized controlled trial. Nurs Crit Care. 2019;24:97-102.
Cui Y, Li L, Hu C, Shi H, Li J, Gupta RK, et al. Effects and Tolerance of Protein and Energy-Enriched Formula in Infants Following Congenital Heart Surgery: A Randomized Controlled Trial. JPEN J Parenter Enteral Nutr. 2018;42:196-204.
Clarke SE, Evans S, Macdonald A, Davies P, Booth IW. Randomized comparison of a nutrient-dense formula with an energy-supplemented formula for infants with faltering growth. J Hum Nutr Diet. 2007;20:329-39.
Eveleens RD, Dungen DK, Verbruggen S, Hulst JM, Joosten KFM. Weight improvement with the use of protein and energy enriched nutritional formula in infants with a prolonged PICU stay. J Hum Nutr Diet. 2019;32:3-10.
Scheeffer VA, Ricachinevsky CP, Freitas AT, Salamon F, Rodrigues FFN, Brondani TG, et al. Tolerability and Effects of the Use of Energy-Enriched Infant Formula After Congenital Heart Surgery: A Randomized Controlled Trial. JPEN J Parenter Enteral Nutr. 2020;44:348-54.
Marino LV, Meyer R, Cooke ML. Cost comparison between powdered versus energy dense infant formula for undernourished children in a hospital setting. e-SPEN Journal. 2013;8:e145-e9.
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