利用STAMP对恶性肿瘤儿童进行营养风险评估及临床结局相关性分析

目的 利用儿科营养不良评估筛查工具(STAMP)筛查恶性肿瘤儿童的营养风险,探讨营养风险与临床结局之间相关性.方法 采用STAMP对146例肿瘤患儿进行营养风险筛查,并分析营养风险与肿瘤治疗结局的关联性.结果 66例(45.2％)存在高度营养风险,77例(52.8％)存在中度营养风险,3例(2.0％)存在低度(无)营养...     

营养风险筛查对重症肺炎儿童不良临床结局的评估

目的采用儿科营养不良评估筛查工具(STAMP)调查重症肺炎儿童营养风险发生情况,分析营养风险与不良临床结局的关系。方法选择216例重症肺炎患儿为研究对象,根据STAMP评分分为高度营养风险组(HR组,n=98)、中度营养风险组(MR组,n=65)和低度营养风险组(LR组,n=53)。空腹抽血检测胰岛素样生长因子-1(IGF-1)、脂联素、瘦素、非酯化脂肪酸(NEFA)、白蛋白、转铁蛋白、前白蛋白、视黄醇结合蛋白(RBP)水平,记录不良临床结局。结果 HR组的血清IGF-1、瘦素、脂联素、前白蛋白、RBP水平低于LR组和MR组(P0.05),而血清NEFA水平高于LR组和MR组(P0.05)。HR组中入住ICU患儿的比例高于LR组和MR组(P0.05);HR组机械通气时间长于LR组和MR组(P0.05);HR组住院时间长于LR组和MR组(P0.05),并发症发生率高于LR和MR组(P0.05)。结论营养风险筛查对评估重症肺炎儿童临床结局有重要价值,高度营养风险患儿有更多的不良临床结局,应尽早给予合理的营养支持。     

危重患儿营养评估及营养风险筛查工具的临床应用

目的调查住院危重患儿的营养状况,探讨营养风险筛查工具在危重患儿营养风险评估中的价值。方法收集2017年11月至2018年4月入住儿童重症监护病房的211例危重患儿的临床资料,对患儿入院、出院时的营养状况进行评估,运用STRONGkids和PYMS两种营养风险筛查工具进行营养风险筛查。结果 211例患儿中,入院时营养不良检出68例（32.2%）,其中中、重度营养不良各检出34例。通过STRONGkids和PYMS分别筛查出154例（73.0%）、165例（78.2%）存在中度或高度营养风险。以年龄别体重Z评分法为金标准,对两种营养风险筛查工具的效能进行评价,显示STRONGkids的ROC曲线下面积为0.822,PYMS为0.759,两者用于筛查营养不良均有统计学意义（P < 0.05）,但两者临床效能比较差异无统计学意义（P > 0.05）。STRONGkids和PYMS筛查营养不良的最佳界值点均为3分,其灵敏度分别为92.1%、76.2%。入院时中、高营养风险患儿临床预后较低营养风险患儿差（分别P=0.014、0.001）。入院时重度营养不良患儿的预后较营养正常患儿差（P=0.0009）。结论危重患儿营养不良及营养风险检出率较高;患儿营养状态和营养风险与预后相关。STRONGkids和PYMS对危重患儿营养风险筛查均有临床应用价值,临床效能类似,但STRONGkids灵敏度更高。     

临床营养风险筛查在儿科中的应用

营养不良是社会中普遍存在的问题,尤其是在发展中国家。住院儿童的营养不良则更为普遍,且往往会伴随严重的后果,例如会使患儿的感染率和病死率增加,使其住院时间延长,从而导致额外的医疗费用。随着营养筛查工具的发展,其在成人的营养问题方面起了越来越大的作用。近几年某些营养筛查工具渐渐在儿科展开应用,但是依然缺乏公认的营养风险筛查工具。该文的目的为比较几种在儿科中常用的营养风险筛查工具在临床中的应用及存在的不足。     

儿科住院患者营养状况及营养风险调查

目的探讨使用儿科营养不良筛查方法(STAMP)评估患儿营养状况并进行营养风险筛查。方法采用STAMP调查住院患儿营养状况,以STAMP评分≥4分为高营养风险标准。结果 1 506例住院儿童中高营养风险患儿占26.56%,营养不良(不足)的检出率为19.12%,生长迟缓检出率为10.16%。各科室间儿童生长迟缓检出率的差异有统计学意义(P<0.05),其中儿内科生长迟缓检出率最高。仅有10.09%的患者接受营养支持,其中肠外营养(PN)支持率为7.84%,肠内营养(EN)支持率为2.92%,PN:EN为2.68:1。对有高营养风险住院患儿进行干预和管理后,高营养风险检出率从入院时的26.56%下降至出院时的21.71%,差异有统计学意义(P<0.05)。结论 STAMP评分法评估住院儿童的营养风险,能比较客观地反映患儿可能发生营养不良的风险;通过营养风险管理可改善患儿的营养状况。     

住院患儿营养风险筛查工具介绍

住院患儿营养不良发生率高,并与不良临床结局相关。对住院患儿及时进行营养风险筛查,继而对有营养风险的患儿进行合理营养支持治疗,是改善患儿营养状况及相关临床结局的最佳途径。目前国际上有五种住院患儿营养风险筛查工具可用来确定住院患儿营养风险。营养风险筛查是住院儿童规范化诊疗的必要部分,但迄今为止,尚没有一种工具被全世界范围广泛接受。进一步对现有工具进行比较研究并提供数据,将有助于建立国际统一标准的住院患儿营养风险筛查工具。     

ICU患儿营养风险筛查

ICU患儿的病情较重,进展迅速,因此恰当的营养支持对于ICU患儿病情的恢复是有利的.ICU患儿需要根据其本身的营养状况以及潜在的营养风险来制定恰当的营养支持计划.营养风险筛查不仅可以评估患儿的营养状况,更能预测其潜在的营养风险,从而指导患儿的营养支持治疗计划的制定,最终改善预后.寻找出适用于ICU患儿的全面、简便、快捷、易行的营养风险筛查工具,实施恰当的营养风险筛查对ICU患儿的生长发育以及疾病的预后均具有重要意义.     

706例外科住院患儿营养风险筛查及其临床意义

目的：探讨外科住院患儿的营养风险及其与临床结局的相关性,为临床营养管理提供科学依据。方法：应用营养状况和生长风险筛查工具（STRONG）对706例外科住院患儿进行营养风险筛查,同时记录住院期间患儿营养支持情况、感染性并发症发生率、住院时间、术后住院时间以及住院总费用等资料进行分析。结果：706例外科住院患儿中,有11.5%存在高度营养风险,46.0%为中度营养风险,42.5%为低度营养风险;先天性肥厚性幽门狭窄、肠梗阻、先天性心脏病患儿居高度营养风险发生率前3位;婴儿高度营养风险的发生率明显高于其他年龄段患儿（P<0.01）;81例高度营养风险患儿中有52例（64.2%）接受了肠外营养支持;高度营养风险患儿住院期间较低度营养风险患儿更容易出现体重丢失（P<0.05）,其感染性并发症、住院时间、术后住院时间以及住院总费用均明显高于中、低度营养风险患儿（均P<0.01）。结论：外科住院患儿存在中、高度营养风险;营养风险评分对患儿临床结局存在影响;目前外科住院患儿的营养支持仍不规范,需推广住院儿童营养风险筛查并进行规范的营养支持。     

脓毒症儿童的营养风险与营养支持研究进展

儿童脓毒症是危重病医学所面临的主要课题。有关研究表明,营养风险可能是间接影响脓毒症发生率及病死率的危险因素之一。通过营养风险筛查与评估,为评定脓毒症患儿是否具有营养风险、是否需要营养支持以及营养支持对患儿预后的影响提供参考依据。目前国内有关脓毒症儿童营养风险及营养支持的研究报道较少。本文主要对脓毒症儿童的营养风险与营养支持的研究进展作一综述。     

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??Objective??To use the modified pediatric malnutrition risk screening tool to investigate the prevalence of malnutrition in hospitalized children and assess the clinical effectiveness of the screening tool??to provide the basis for nutritional assessment and reasonable nutrition support. Methods??Choose hospitalized children in Xinhua Hospital Affiliated to Shanghai Jiao Tong University of Medicine from August 2014 to September 2015 as the investigation subjects. The modified pediatric malnutrition risk screening tool was used to further explore the relationship between results of nutritional risk screening and the clinical outcome. Results??The screening results showed that the total incidence of malnutrition in 2632 hospitalized children was 53.2%. The younger the hospitalized children were??the higher the incidence of malnutrition risk was??χ2??59.89??P??0.05??. There was statistical difference among children with different diseases in incidence of malnutrition risk??χ2??425.12??P??0.05????and the incidence of malnutrition was higher in the alimentary system disease group??70.1%?? and hematological malignancies group??86.7%?? than in other disease groups. In the absence of nutritional support??the lengthof hospital stay of children with malnutrition was significantly longer??Z??-9.293??P??0.05????and there was a significant difference in the outcome of the disease??χ2??4.937??P??0.05????the incidence of complications during hospitalization had a rising trend??but the difference was not statistically significant??χ2??2.203??P??0.05??. Conclusion??The results suggest that the modified pediatric malnutrition risk screening tool can effectively screen out the risk of malnutrition in hospitalized children?? with better clinical predictability.     

住院患儿营养评价和营养风险筛查工具应用

目前随着经济快速发展和居民生活水平提高,我国儿童膳食营养得到了明显改善,且与慢性代谢性疾病发生发展密切相关的营养过剩已成为日趋严峻的公共卫生问题。但疾病状态下住院患儿的营养消耗状况仍令人担     

改良儿科营养风险筛查工具的临床应用

目的 探讨改良儿科营养风险筛查工具及营养评估在临床中的应用,为建立儿科规范化营养管理流程提供理论依据.方法 回顾性分析16249例住院患儿的入院营养风险筛查和营养评估资料,将患儿按营养风险程度分为高营养风险组(588例)、中营养风险组(4330例)、无营养风险组(11331例),对比各营养风险组患儿的营养评估情况,分析...     

Assessment of nutritional status in children with cancer: A narrative review

A child's appropriate development stems in large part from proper nutrition. Malnutrition is an adverse prognostic factor in children with cancer, and its prevalence is highly variable. Currently, there is no standardized definition and assessment method of nutritional status in pediatric oncology. A complete nutritional assessment includes anthropometry, biochemical, clinical, and dietary assessments. In this article, we explore these methods and suggest practical approaches for pediatric cancer units depending on the levels of care that these can provide. We also advise on the monitoring and follow‐up of children with cancer during and after treatment, and discuss potential areas for future research.     

住院患儿营养风险筛查及营养评估

目的 调查住院患儿的营养风险及营养不良发生情况,为临床进行营养支持提供依据.方法 采用STRONGkids营养风险筛查工具对651例住院患儿进行营养风险筛查,并通过体格测量评估儿童营养状况,同时记录住院期间患儿的诊断、住院时间等资料并进行分析.结果 651例住院患儿中,7.07％(46例)存在高度营养风险,80.95％(527例)存在中度营养风险,11.98％(78例)为低度营养风险.营养不良检出率是22.58％,其中中度营养不良111例(17.05％),重度营养不良36例(5.53％).先天性心脏病、慢性肝病、慢性肾病为存在高度营养风险疾病前3位(x2=21.43,P＜0.01);根据营养评价的结果显示患有先天性心脏病、慢性肾病的患儿发生重度营养不良的比例远高于其他疾病(x2=16.53,P＜0.05).高度营养风险患儿住院期间较低度营养风险患儿更容易出现体质量丢失(P＜0.05),其住院时间明显长于中、低度营养风险患儿(P＜0.05).结论 住院患儿营养不良发生率高,营养风险不同导致临床结局不同;STRONGkids评分法评估住院儿童的营养风险,能早期发现住院期间营养不良以及有恶化可能的患者,有利于及时给予全面的营养评估以及早期合理的营养治疗,改善临床结局.     

Assessment of nutritional status and nutritional risk in hospitalized Iranian children

Aims: This study aimed to define the nutritional state of children admitted to a tertiary Iranian hospital and to evaluate nutritional risk score tools in these children. Methods: The anthropometry of hospitalized and healthy children from the same community was determined. Three nutritional risk score tools were applied to all inpatients. Results: One hundred and nineteen inpatients were recruited along with a comparison group of 100 children. The prevalence of under‐nutrition in the inpatient group was 25.2% and 3% in the community group (p < 0.0001). Obesity/overweight was more prevalent in the community group than the inpatients (22% versus 2.5%: p = 0.04). Severely malnourished children had a longer hospital stay than those with normal nutrition (p < 0.0001). The nutritional risk score tools identified between 83% and 90% of the malnourished patients in the moderate and high‐risk groups. The STRONG_kids tool correlated more strongly with anthropometric measurements than the other tools. The length of hospital stay was associated with risk status (p = 0.004). Conclusion: Hospitalized Iranian children have higher rates of under‐nutrition than healthy children from the same community. NRS tools were able to identify children at nutritional risk; however, variable utility was observed. Further assessment of NRS tools in the developing setting is required.     

The influence of nutrition on clinical outcomes in children with cancer

Adequate and appropriate nutrition is essential for growth and development in children; all put at risk in those with cancer. Overnutrition and undernutrition at diagnosis raise the risk of increased morbidity and mortality during therapy and beyond. All treatment modalities can jeopardize nutritional status with potentially adverse effects on clinical outcomes. Accurate assessment of nutritional status and nutrient balance is essential, with remedial interventions delivered promptly when required. Children with cancer in low‐ and middle‐income countries (LMICs) are especially disadvantaged with concomitant challenges in the provision of nutritional support. Cost‐effective advances in the form of ready‐to‐use therapeutic foods (RUTF) may offer solutions. Studies in LMICs have defined a critical role for the gut microbiome in the causation of undernutrition in children and have demonstrated a beneficial effect of selected RUTF in redressing the imbalanced microbiota and improving nutritional status. Challenges in high‐income countries relate both to concerns about the potential disadvantage of preexisting obesity in those newly diagnosed and to undernutrition identified at diagnosis and during treatment. Much remains to be understood but the prospects are bright for offsetting malnutrition in children with cancer, resulting in enhanced opportunity for healthy survival.