Hastanede yatan pediatrik hastalarda yetersiz beslenme riskini etkileyen faktörler ve STRONGkids skorlaması uygulaması

Amaç: Çocuklarda tedaviye yanıtı etkileyen önemli bir faktör malnutrisyondur. Hastaneye yatışın ilk gününde malnutrisyon açısından gerekli önlemlerin alınması malnutrisyonu önleyecek ve morbiditeyi azaltacaktır. Bu amaçla hastane yatışında malnutrisyonun erken saptanmasını sağlayacak ip uçlarına ihtiyaç vardır. Bu çalışmada malnutrisyonu erken tesbit etmede ve değerlendirmede göz önünde bulundurulması gereken risk faktörlerini, vücut ölçümlerini ve skorlama sisteminin önemini göstermeyi amaçladık. Bu amaçla da basit, kullanışlı ve pratik bir skorlama olan STRONGkids skoru tercih edilerek malnutrisyonu gösterme başarısı araştırılmıştır.Yöntemler: Bu çalışma retrospektif bir kohort çalışmasıdır. Bu çalışmanın denekleri 0-18 yaşları arasında herhangi bir kronik hastalığı olmayan çocuklar iken, altta yatan kronik hastalıkları olan hastalar araştırmamızın dışında bırakılmıştır. Akut enfeksiyon nedeniyle hastaneye yatırılan pediyatrik hastalar çalışmaya alındı. Hastanede yatış süresi ve sıklığı, anne yaşı, doğum sayısı, doğum kilosu, emzirme süresi ve emzirmenin devamı, ek besin alımının geçiş süresi, hastaneye yatış ve taburculuk sırasında ölçülen ilgili ağırlıklar değerlendirildi. Gomez ve Waterlow kullanılarak yetersiz beslenme derecesi ve STRONGkids skoru kullanılarak yetersiz beslenme riski belirlenmiştir.Bulgular: Çalışmaya dahil edilen çocukların %61'i erkek, %39'u kadındı. Yaş ortalaması 34,67 (39,95) aydı. Çocukların %84,62'si 60 aydan küçük ve %15,38'i 60 ayın üzerindedir. Hastaların STRONGkids değerlendirmesi olguların %55,77'si için düşük, %31,41'i için ılımlı ve %12,82 yüksek risk grubu olarak değerlendirildi. Orta kol çevresi ile hastanede yatış süresi, emzirme süresi ve anne yaşı ilişkili bulunmuştur.Sonuç: Malnutrisyon riski, tek bir risk yerine çok yönlü risk faktörleri ile birlikte değerlendirilmelidir. Malnutrisyon tanımı ve sınıflandırılması kullanılan yönteme göre değişmektedir. Orta kol çevresi, hastaneye yatış süresini ve yetersiz beslenme düzeyini tahmin etmede STRONGkids skoru ile birlikte kullanılabilir.

Anahtar Kelimeler:

Çocuk, Malnutrisyon, STRONGkids, Gomez, Waterlow

Factors influencing malnutrition risk in hospitalized pediatric patients and the application of STRONGkids scoring

Aim: A significant factor affecting the response to treatment in children is malnutrition. To reduce its risk and morbidity, necessary precautions should be taken on the first day of hospitalization. It is highly essential to obtain clues that assist with the early detection of malnutrition at the time of hospitalization. In this study, we aimed to show the risk factors, body measurements and the importance of a scoring system in its early detection and evaluation. To this end, we examined the accuracy of the STRONGkids score, which is a simple, useful, and practical scoring system, in detecting the risk of malnutrition. Methods: Children between 0-18 years of age without any chronic diseases who were hospitalized due to acute infection were included in this retrospective cohort study. Those with chronic illnesses were left out of scope of our research. The duration and frequency of hospitalization, maternal age, number of births, birth weight, duration of breastfeeding and its continuation, transition period of supplemental nutrition intake, respective weights measured at the time of hospitalization and discharge were evaluated. By using Gomez and Waterlow, malnutrition degree and STRONGkids score were calculated and the risk of malnutrition was determined. Results: Among all, 61% of the children included in the study were males. While the mean age was 34.67 (39.95) months, 84.62% of the children’s age was less than or equal to 60 months and 15.38% were aged over 60 months. Based on the STRONGkids scores, 55.77%, 31.41% and 12.82% of the included cases were low, moderate, and high-risk in terms of malnutrition, respectively. The length of hospitalization, breastfeeding duration and maternal age were related with middle arm circumference.Conclusion: Malnutrition risk should be evaluated together with various risk factors rather than one. The definition and classification of malnutrition vary based on the method used. Middle arm circumference can be used together with STRONGKIDS score in estimating the duration of hospitalization and the level of malnutrition.

Keywords:

Child, Malnutrition, STRONGkids, Gomez, Waterlow,

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