Abstract:
Background and aim: Malnutrition is prevalent among hospitalised children. Early detection of malnutrition can allow for timely nutrition assessment and intervention to prevent further nutritional deterioration. Children admitted to Starship Child Health (SCH) are screened with the STRONGkids malnutrition screening; however, several barriers with the application of the tool have been identified. This study aimed to investigate whether an alternative tool, the Paediatric Nutrition Screening Tool (PNST) classifies patients to the same malnutrition risk category as STRONGkids and evaluate the acceptability of a high energy, high protein (HEHP) supplemental food as a nutrition intervention for patients identified as moderate malnutrition risk.
Methods: STRONGkids screening tool scores from admissions between February 2019 to April 2019 were retrospectively screened with the PNST. Malnutrition risk and level of agreement between the tools were investigated. The implementation of a ward-level distributed HEHP snack was piloted and acceptability evaluated through patient questionnaires.
Results: STRONGkids classified a greater proportion (65.1%) of children as moderate malnutrition risk compared to the PNST using original and adjusted cut-off values (7.5% and 29.1%, respectively). The level of agreement between the two tools was poor (𝑘=0.063) when using PNST original cut-offs, and improved to a slight agreement (𝑘=0.277) when using PNST adjusted cut-off values. The sample size for the HEHP was small (n=11) due to impacts from COVID. Forty-five percent of patients disliked the pudding and more than half (64%) reported the pudding was made difficult to eat by factors such as texture, taste, and fullness.
Conclusions: This study identified the STRONGkids screening tool as the better tool to identify moderate malnutrition risk. As PNST only has two categories of malnutrition risk and there is limited research available on its validity and applicability, STRONGkids appears to be the favourable tool for the SCH clinical setting. Overall acceptability of the HEHP snack could not be determined due to the small sample size of the study. The optimal delivery method of the HEHP is yet to be determined.