Çocuk ve adölesanlarda hastane malnütrisyonunun belirlenmesi ve kullanılan ölçeklerin psikometrik özelliklerinin ve kullanışlılığının değerlendirilmesi
Yükleniyor...
Tarih
2016
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Ege Üniversitesi, Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Giriş ve Amaç: Malnütrisyon, nütrisyonel yetersizliğe bağlı, önlenebilen veya tedavi edilebilen, normal vücut kompozisyonundaki değişiklik olarak tanımlanmaktadır. Hastanede yatan olgulardaki morbidite, mortalite, hastanede yatış süreleri, hayat kalitesi, gelişen komplikasyonlar ve maliyet üzerinde malnütrisyonun olumsuz etkisi olduğu gösterilmiştir. Hastanede yatan çocukların malnütrisyonu riskini saptamak için belirlenmiş standart bir tarama testi yoktur. Ancak bu amaç için geliştirilmiş nütrisyonel risk tarama tabloları bulunmaktadır: Paediatric Yorkhill Malnutrition Score (PYMS), Nutritional Risk Sreening (NRS 2002), Screening Tool for the Assessment of Malnutrition in Paediatrics (STAMP), Screening Tool for Risk of Impaired Nutritional Status and Growth (STRONGkids), Pediatric Subjective Nutritional Assessment(SGNA) isimli ölçme araçlarıdır.
Bu çalışmada, düzey 3 yataklı birim hizmeti alan çocuk ve adölesanlarda ağırlık kayıp sıklığını belirlemek, beslenme risk taraması yapmak, risk tarama ölçeklerinin ağırlık kaybı öngörülerinin kıyaslanması amaçlanmıştır.
Gereç ve Yöntem: Bu çalışma için, Ege Üniversitesi Hastanesi Çocuk Sağlığı ve Hastalıkları Anabilim Dalı‟na 01.05.2015-30.04.2016 tarihleri arasında yatarak izlenen 1 ay–17 yaş arası 332 çocuk ve adolesan üzerinde çalışılmıştır. Çalışmada yukarıda ismi geçen NRS, SGNA, STAMP, PYMS, STRONGkids beslenme risk tarama yöntemleri hastaneye yatışta doktor, hemşire ve diyetisyen tarafından ve çıkışta doktor tarafından uygulanmıştır. Yaş,kilo,boy,kol çevresi ve trisepsderikalınlığı yatış, çıkışta ölçülmüştür. Çalışmaya konu olan hastaların seçimi mevsimlere ve yaş gruplarına (grup1: 1-12 ay, grup2: 1-5 yaş, grup3: 5-10 yaş, grup4: 10-15 yaş, grup5: >15 yaş) bölünerek, eşit dağılım ile yapılmıştır. Hastanede yatış süresince ağırlık kaybeden, ağırlık artışı sağlanan, ağırlığı sabit kalan çocukların sıklığı belirlenmiş; grupların başvuru bulguları ve tarama ölçeklerinin ayırıcı özellikleri karşılaştırılmıştır. Bulgular: 332 olgunun 161‟i (%48,5) kız ve yaş ortalaması 84,6±69,8 ay idi.Gomez sınıflandırmasına göre olguların 127‟sinde (%38,2); Waterlow sınıflandırmasına göre ise olguların 111‟inin (%33,4) malnütrisyon vardı.
Ağırlık kaybı olan hastalar arasında %26,2 olgu ile 1-5 yaş arası; tartı alımı olan hastalar arasında ise ise %33,5 olgu 1-12 ay arası en yüksek vücut ağırlıkları değişimine sahip yaş gruplarıydı ve vücut ağırlıklarındaki değişim anlamlı olarak bulundu (p = 0.01). 1-12 ay arası tartı alımının yüksek olmasının potansiyel nedeni olarak bu yaş grubunun temel besin öğesi olan anne sütünün etkisine bakıldı. Tartı alımı olan grupta anne sütü alımının anlamlı olarak daha yüksek olduğu görüldü (p = 0.02). 1-5 yaş arası olgularda, anne sütü alımı ile kilo alımı arasındaki ilişkiye bakıldığında ağırlık kaybı olan grupta anne sütü alımının daha az olduğu saptandı (p = 0.02). Ağırlık kaybı olan grupta hastanede yatış süresi daha uzun olarak görülmüştür. (10.1±15.7 gün; p = 0,02)
Risk tarama ölçekleri STAMP, PYMS, STRONGkids ve NRS arasında, sadece PYMS yüksek-orta risk saptanması çıkış vücut ağırlığında tartı kaybı olması ile ilişkili bulunmuştur. PYMS testinin tarama testlerinde olduğu gibi sensivitesi yüksek (%91,8) olup, spesifitesi düşük bulunmuştur. PYMS, Strongkids, STAMP testleri her üç uygulamacı arasında çok iyi derecede uyum saptanmıştır (kappa > 0.70).
Sonuç: Üçüncü düzey hastane yatışlarında, ağırlık değişikliği hastaların çoğunda gözlenmektedir. Süt çocuklarında, anne sütü devamlılığı malnütrisyondan korumaktadır. Beslenme risk ölçeklerinin birbirlerine üstünlüğü tespit edilmemiştir.
Beslenme risk tarama ölçekleri, kronik hastaları bulunan, daha ağır seyirli enfeksiyon hastalarının izlendiği 3. düzey hastaneler için yeterli olmamaktadır. Yeni bir beslenme risk tarama ölçeğinin geliştirilmesine ihtiyaç duyulmaktadır.
Background: Malnutrition is defined as the change in normal body composition due to nutritional deficiencies, which can be prevented or treated. In hospitalized patients, the negative effects of malnutrition has been shown on morbidity, mortality, length of hospitalization, quality of life, complications and costs.. There is no screening test for determining the mulnutrition risk of hospitalized children. Yet, nutritional risk screening tables have been to this end: Paediatric Yorkhill Malnutrition Score (PYMS), Nutritional Risk Sreening (NRS 2002), Screening Tool for the Assessment of Malnutrition in Paediatrics (STAMP), Screening Tool for Risk of Impaired Nutritional Status and Growth (STRONGkids), Pediatric Subjective Nutritional Assessment (SGNA). The aim of this study is to determine the frequency of weight loss, screen nutrition riskand to compare the weight-loss predictions of the risk screening scales for children and adolescents in level 3 bed unit service. Methodology: For this study, 332 children and adolescents were recruited between 01.05.2015–30.04.2016, who were hospitalized at the Child Health and Diseases Department of the Ege University Hospital and were aged between 1 month to 17 years. The abovementioned nutritional risk screening methods – NRS, SGNA, STAMP PYMS, STRONGkids – have been applied by a doctor, a nurse and a dietitian at admission, and by a doctor at discharge. Age, weight, height, arm circumference and triceps skin fold thickness were measured at admission and discharge. The selection of the patients which were subject of this study has been made with respect to the seasons of the year and age groups (group 1: 1-12 months, group2: 1-5 years, group3: 5-10 years, group4: 10-15 years, Group5: >15years), on the basis of an equal distribution. The frequency of children with weight loss, weight gain and constant weight during hospitalization, have been determined; findings at application of the groups and distinctive features of screening tables have been compared. Results: 161 (48.5%) of the 332 cases were female and the mean age was 84.6 ± 69.8 months. According to Gomez classification 127 (38.2%), according to Waterlow classification 111 patients (33.4%) had malnutrition. Among the patiens with weight loss group2 (1-5 years) with 26.2% of patients and among the patients with weight gain group1 (1-12 months) with 33.5% of patients registered the highest weight change and those changes in body weight were significant (p = 0.01). As a potential driver of the high weight gain in group1, the impact of breast milk, which is the basic nutrition of this age group, has been investigated. The impact of breast milk was found to be significantly higher in the group with weight gain (p = 0.02). As to the patienst aged 1-5 years, looking into the relationship between breast milk intake and weight gain in retrospect, weight loss in the breastfed group was found to be less (p = 0.018). In the group with weight loss, the length of stay in the hospital was longer (10.1 ± 15.7 days; p = 0.02). Among the nutritional risk screening tools NRS, STAMP, PYMS, and STRONGkids, only PYMS high-intermediate risk was found to be associated with body weight loss at discharge. As with the screening test, the sensitivity of PYMS was found to be high (91.8%), but its specificity was found to be lower. PYMS, STRONGkids, STAMP tests were found to have good alignment between the three practitioners (Kappa > 0.70). Conclusion: In third level of hospital admissions, weight changes are observed in most patients. At infants, continuation of breastfeeding protects from malnutrition. None of the nutritional sreening tools is established to be superior to the others. Nutritional screening tools are not enough for third-level hospitals which have patients with chronic diseases and admitt severe-infection patients. There is a need for developing a new nutritional screening scale.
Background: Malnutrition is defined as the change in normal body composition due to nutritional deficiencies, which can be prevented or treated. In hospitalized patients, the negative effects of malnutrition has been shown on morbidity, mortality, length of hospitalization, quality of life, complications and costs.. There is no screening test for determining the mulnutrition risk of hospitalized children. Yet, nutritional risk screening tables have been to this end: Paediatric Yorkhill Malnutrition Score (PYMS), Nutritional Risk Sreening (NRS 2002), Screening Tool for the Assessment of Malnutrition in Paediatrics (STAMP), Screening Tool for Risk of Impaired Nutritional Status and Growth (STRONGkids), Pediatric Subjective Nutritional Assessment (SGNA). The aim of this study is to determine the frequency of weight loss, screen nutrition riskand to compare the weight-loss predictions of the risk screening scales for children and adolescents in level 3 bed unit service. Methodology: For this study, 332 children and adolescents were recruited between 01.05.2015–30.04.2016, who were hospitalized at the Child Health and Diseases Department of the Ege University Hospital and were aged between 1 month to 17 years. The abovementioned nutritional risk screening methods – NRS, SGNA, STAMP PYMS, STRONGkids – have been applied by a doctor, a nurse and a dietitian at admission, and by a doctor at discharge. Age, weight, height, arm circumference and triceps skin fold thickness were measured at admission and discharge. The selection of the patients which were subject of this study has been made with respect to the seasons of the year and age groups (group 1: 1-12 months, group2: 1-5 years, group3: 5-10 years, group4: 10-15 years, Group5: >15years), on the basis of an equal distribution. The frequency of children with weight loss, weight gain and constant weight during hospitalization, have been determined; findings at application of the groups and distinctive features of screening tables have been compared. Results: 161 (48.5%) of the 332 cases were female and the mean age was 84.6 ± 69.8 months. According to Gomez classification 127 (38.2%), according to Waterlow classification 111 patients (33.4%) had malnutrition. Among the patiens with weight loss group2 (1-5 years) with 26.2% of patients and among the patients with weight gain group1 (1-12 months) with 33.5% of patients registered the highest weight change and those changes in body weight were significant (p = 0.01). As a potential driver of the high weight gain in group1, the impact of breast milk, which is the basic nutrition of this age group, has been investigated. The impact of breast milk was found to be significantly higher in the group with weight gain (p = 0.02). As to the patienst aged 1-5 years, looking into the relationship between breast milk intake and weight gain in retrospect, weight loss in the breastfed group was found to be less (p = 0.018). In the group with weight loss, the length of stay in the hospital was longer (10.1 ± 15.7 days; p = 0.02). Among the nutritional risk screening tools NRS, STAMP, PYMS, and STRONGkids, only PYMS high-intermediate risk was found to be associated with body weight loss at discharge. As with the screening test, the sensitivity of PYMS was found to be high (91.8%), but its specificity was found to be lower. PYMS, STRONGkids, STAMP tests were found to have good alignment between the three practitioners (Kappa > 0.70). Conclusion: In third level of hospital admissions, weight changes are observed in most patients. At infants, continuation of breastfeeding protects from malnutrition. None of the nutritional sreening tools is established to be superior to the others. Nutritional screening tools are not enough for third-level hospitals which have patients with chronic diseases and admitt severe-infection patients. There is a need for developing a new nutritional screening scale.