Malnutrisi rumah sakit dan asuhan nutrisi pediatrik di Rumah Sakit Hasan Sadikin Bandung

https://doi.org/10.22146/ijcn.43090

Tisnasari Hafsah(1*), Titis Prawitasari(2), Julistio Tryoga Budhiawan Djais(3)

(1) Rumah Sakit Umum Pusat Dr. Hasan Sadikin/ Fakultas Kedokteran Universitas Padjadjaran
(2) Rumah Sakit Umum Pusat Nasional Dr. Cipto Mangunkusumo/ Fakultas Kedokteran Universitas Indonesia
(3) Rumah Sakit Umum Pusat Dr. Hasan Sadikin/ Fakultas Kedokteran Universitas Padjadjaran
(*) Corresponding Author

Abstract


Hospital malnutrition and pediatric nutrition care in Hasan Sadikin Hospital Bandung

Background: Malnutrition during hospitalization delays the recovery of children with acute or chronic illnesses. The Pediatric Nutrition Care (PNC) can improve nutritional support and reduce the prevalence of hospital malnutrition.

Objectives: This study was done to find evidence of hospital malnutrition and to evaluate the nutrition care in the pediatric ward of Dr. Hasan Sadikin Hospital, Bandung. 

Methods: We evaluated malnutrition by comparing body weight change between the first day of admission and at hospital discharge to the length of hospitalization. Screening for malnutrition risk was done using modified Pediatric Yorkhill Malnutrition Screening (mPYMS). Score≥2 was determined as high risk. The PNC process was evaluated by a focused group discussion with PNC-associated pediatric ward personnel.

Results: From February-March 2016, 760 patients were admitted to the pediatric ward, of which 111(14.6%) were included in the study. An mPYMS score of ≥2 was found in 69(62.2%) of the patients. During hospitalization, body weight decreased in 23(20.7%) patients, 10(9.0%) of whom were defined as hospital malnutrition. Among these, seven had an mPYMS score≥2. PNC was performed in patients with an mPYMS score≥2 by dietitians who also provided a standardized nutrition care process following American Dietetic Association recommendation. However, a dedicated multidisciplinary PNC team was absent and the nutrition and metabolic disease division was consulted only in a few cases. Performing consistent monitoring and evaluation of PNC was also found to be difficult. 

Conclusions: Hospital malnutrition may be prevalent among pediatric patients in Dr. Hasan Sadikin Hospital, Bandung. Improving PNC services may reduce this prevalence.


Keywords


care; pediatric; nutrition; hospital; malnutrition

Full Text:

PDF


References

  1. Barker LA, Gout BS, Crowe TC. Hospital malnutrition: prevalence, identification and impact on patients and the healthcare system. Int J Environ Res Pub Health. 2011;8(2):514-27. doi: 10.3390/ijerph8020514
  2. Meilyana M, Djais JTB, Garna H. Status gizi berdasarkan subjective global assessment sebagai faktor yang mempengaruhi lama perawatan pasien rawat inap anak. Sari Pediatri. 2010;12(3):162-7. doi: 10.14238/sp12.3.2010.162-7
  3. Joosten KFM, Hulst JM. Malnutrition in pediatric hospital patients: current issues. Nutrition. 2011;27(2):133-7. doi: 10.1016/j.nut.2010.06.001
  4. Mehta NM, Corkins MR, Lyman B, Malone A, Goday PS, Monczka JL, et al. Defining Pediatric malnutrition: a paradigm shift toward etiology-related definitions. J Parenter Enteral Nutr. 2013;37(4):460-81. doi: 10.1177/0148607113479972
  5. Morley JE, Thomas DR, G Wilson MG. Cachexia: pathophysiology and clinical relevance. Am J Clin Nutr. 2006;83(4):735-43. doi: 10.1093/ajcn/83.4.735
  6. Delgado AF, Okay TS, Leone C, Nichols B, Negro GMD, Vaz FAC. Hospital malnutrition and inflammatory response in critically ill children and adolescents admitted to a tertiary intensive care unit. Clinics. 2008;63(3):357-62. doi: 10.1590/s1807-59322008000300012
  7. Kac G, Camacho-Dias P, Silva-Coutinho D, Silveira-Lopes R, Marins VV-BA, Pinheiro ABV. Length of stay is associated with incidence of in-hospital malnutrition in a group of low-income Brazilian children. Salud Publica Mex 2000;42(5):407-12. doi: 10.1590/s0036-36342000000500006
  8. Marino LV, Goddard E, Workman L. Determining the prevalence of malnutrition in hospitalized paediatric patients. S Afr Med J 2006;96:993-5. doi:
  9. Joosten KFM, Hulst JM. Prevalence of malnutrition in pediatric hospital patients. Curr Opin in Ped. 2008;20(5):590-6. doi: 10.1097/MOP.0b013e32830c6ede
  10. Wonoputri N, Djais JTB, Rosalina I. Validity of nutritional screening tools for hospitalized children. Journal of Nutrition and Metabolism. 2014;143649:1-6. doi: 10.1155/2014/143649
  11. Nesa NNM, Sidiartha GL, Prawirohartono EP, Suandi KG. Accuracy of modified simple pediatric nutritional risk score to detect in-hospital malnutrition. Paediatr Indones. 2010;50:305-9. doi: 10.14238/pi50.5.2010.305-9
  12. Juliaty A. Malnutrisi rumah sakit pada bangsal anak Rumah Sakit DR. Wahidin Sudirohusodo Makassar. Sari Pediatri. 2013;15(2):65-8. doi: 10.14238/sp15.2.2013.65-8
  13. Sermet-Gaudelus I, Poisson-Salomon AS, Colomb V, Brusset MC, Mosser F, Berrier F, et al. Simple pediatric nutritional risk score to identify children at risk of malnutrition. Am J Clin Nutr. 2000;72(1):64-70. doi: 10.1093/ajcn/72.1.64
  14. Moeeni V, Day AS. Nutritional risk screening tools in hospitalised children. International Journal of Child Health and Nutrition 2012;1:39-43. doi: 10.6000/1929-4247.2012.01.01.05
  15. Agostoni C, Axelson I, Colomb V, Goulet O, Koletzko B, Michaelsen KF, et al. The need for nutrition support teams in pediatric units: a commentary by the ESPGHAN Committee on Nutrition. J Pediatr Gastroenterol Nutr. 2005 Jul;41(1):8-11. doi: 10.1097/01.mpg.0000163735.92142.87
  16. Departemen Kesehatan Republik Indonesia. Skrining malnutrisi pada anak yang dirawat di rumah Sakit. Jakarta: Depkes RI; 2007.
  17. Unit Kerja Koordinasi Nutrisi dan Penyakit Metabolik. Asuhan nutrisi pediatrik. Rekomendasi Ikatan Dokter Anak Indonesia. Jakarta; UKK NPM IDAI: 2011.
  18. Sugiyono. Memahami penelitian kualitatif. Cetakan kesembilan. Bandung: Penerbit Alfabeta; 2014.
  19. Creswell JW. Research design. Pendekatan kualitatif, kuantitatif, dan mixed. edisi ketiga, cetakan keempat. Yogyakarta: Penerbit Pustaka Pelajar; 2014.
  20. Butterworth C. The skeleton in the hospital closet. Nutrition Today 1974;9(2):4-8.
  21. Sidiartha IGL. Insidens malnutrisi pada anak balita yang menjalani rawat inap di Rumah Sakit Umum Pusat Sanglah Denpasar. Sari Pediatri. 2008;9(6):381-5. doi: 10.14238/sp9.6.2008.381-85
  22. Rocha GA, Rocha EJM, Martins CV. The effects of hospitalization on the nutritional status of children. J Pediatr. 2006;82(1):70-4. doi: 10.2223/JPED.1440
  23. Pichler J, Hill SM, Shaw V, Lucas A. Prevalence of undernutrition during hospitalisation in a children’s hospital: what happens during admission?. Eur J of Clin Nutr. 2014;68(6):730-5. doi: 10.1038/ejcn.2014.21
  24. Campanozzi A, Russo M, Catucci A, Rutigliano I, Canestrino G, Romondia A, et al. Hospital-acquired malnutrition in children with mild clinical conditions. Nutrition. 2009;25(5):540-7. doi: 10.1016/j.nut.2008.11.026
  25. Oztürk Y, Büyükgebiz B, Arslan N, Ellidokuz H. Effects of hospital stay on nutritional anthropometric data in Turkish children. J Trop Pediatr. 2003;49(3):189-90. doi: 10.1093/tropej/49.3.189
  26. Attia S, Versloot CJ, Voskuijl W, van Vliet SJ, Di Giovanni V, Zhang L, et al. Mortality in children with complicated severe acute malnutrition is related to intestinal and systemic inflammation: an observational cohort study. Am J Clin Nutr. 2016;104(5):1441-9. doi: 10.3945/ajcn.116.130518
  27. Hulst JM, Zwart H, Hop WC, Joosten KF. Dutch national survey to test the STRONGkids nutritional risk screening tool in hospitalized children. Clin Nutr. 2010;29(1):106-11. doi: 10.1016/j.clnu.2009.07.006
  28. Gerasimidis K, Keane O, Macleod I, Flynn DM, Wright CM. A four-stage evaluation of the Paediatric Yorkhill Malnutrition Score in a tertiary paediatric hospital and a district general hospital. Br J Nutr. 2010;104(5):751-6. doi: 10.1017/S0007114510001121
  29. Gerasimidis K, Macleod I, Maclean A, Buchanan E, McGrogan P, McAuley M, et al. Performance of the novel Paediatric Yorkhill Malnutrition Score (PYMS) in hospital practice. Clin Nutr. 2011;30(4):430-5. doi: 10.1016/j.clnu.2011.01.015
  30. Spagnuolo MI, Liguoro I, Chiatto F, Mambretti D, Guarino A. Application of a score system to evaluate the risk of malnutrition in a multiple hospital setting. Ital J Pediatr. 2013;39:81. doi: 10.1186/1824-7288-39-81
  31. White M, Lawson K, Ramsey R, Dennis N, Hutchinson Z, Soh XY, et al. Simple nutrition screening tool for pediatric inpatients. J Parenter Enteral Nutr 2016;40(3):392-8. doi: 10.1177/0148607114544321
  32. Teixeira AF, Viana KD.  Nutritional screening in hospitalized pediatric patients: a systematic review. J Pediatr (Rio J). 2016;92(4):343-52. doi: 10.1016/j.jped.2015.08.011
  33. Karagiozoglou-Lampoudi T, Daskalou E, Lampoudis D, Apostolou A, Agakidis C. Computer-based malnutrition risk calculation may enhance the ability to identify pediatric patients at malnutrition-related risk for unfavorable outcome. J Parenter Enteral Nutr 2015;39(4):418-25. doi: 10.1177/0148607114529161
  34. 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(5):1301-10. doi: 10.3945/ajcn.115.110700
  35. Gallagher-Allred CR, Voss AC, Finn SC, McCamish MA. Malnutrition and clinical outcomes: the case for medical nutrition therapy. J Am Diet Assoc. 1996;96(4):361-6. doi: 10.1016/s0002-8223(96)00099-5
  36. Somanchi M, Tao X, Mullin GE. The facilitated early enteral and dietary management effectiveness trial in hospitalized patients with malnutrition. J Parenter Enteral Nutr. 2011;35(2):209-16. doi: 10.1177/0148607110392234
  37. Starke J, Schneide H, Alteheld B, Stehle P, Meier R. Short-term individual nutritional care as part of routine clinical setting improves outcome and quality of life in malnourished medical patients. Clin Nutr. 2011;30(2):194-201. doi: 10.1016/j.clnu.2010.07.021
  38. Elia M, Normand C, Norman K, Laviano A. A systematic review of the cost and cost effectiveness of using standard oral nutritional supplements in the hospital setting. Clin Nutr 2016;35(2):370-80. doi: 10.1016/j.clnu.2015.05.010
  39. ASPEN Board of Directors and the Clinical Guidelines Task Force. Guidelines for the use of parenteral and enteral nutrition in adult and pediatric patients. J Parenter Eneral Nutr 2002;26(1 Supp): 1SA-138SA.
  40. Writing Group of the Nutrition Care Process/Standardized Language Committee. Nutrition care process and model part I: the 2008 update. J Am Diet Assoc. 2008;108(7):1113-7. doi: 10.1016/j.jada.2008.04.027
  41. Writing Group of the Nutrition Care Process/Standardized Language Committee. Nutrition care process part II: using the International Dietetics and Nutrition Terminology to document the nutrition care process. J Am Diet Assoc. 2008;108(8):1287-93. doi: 10.1016/j.jada.2008.06.368
  42. ESPGHAN. Organisational aspects of hospital PN. J Pediatr Gastroenterol Nutr. 2005;41:S63-9. doi: 10.1097/01.mpg.0000181850.46994.b2
  43. Tappenden KA, Quatrara B, Parkhurst ML, Malone AM, Fanjiang G, Ziegler TR. Critical role of nutrition in improving quality of care: an interdisciplinary call to action to address adult hospital malnutrition. J Parenter Enteral Nutr. 2013;37(4):482-97. doi: 10.1177/0148607113484066
  44. Guenter P, Jensen G, Patel V, Miller S, Mogensen KM, DiMaria-Ghalili RA, et al. Addressing disease-related malnutrition in hospitalized patients: a call for a national goal. Jt Comm J Qual Patient Saf. 2015;41(10):469-73. doi: 10.1016/s1553-7250(15)41061-x



DOI: https://doi.org/10.22146/ijcn.43090

Article Metrics

Abstract views : 565 | views : 500

Refbacks

  • There are currently no refbacks.




Copyright (c) 2019 Jurnal Gizi Klinik Indonesia

Creative Commons License
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.

Jurnal Gizi Klinik Indonesia (JGKI) Indexed by:
 
 Google Scholar 

  free
web stats View My Stats