Effects of hospital stay on nutritional status in children

Effects of hospital stay on nutritional status in childrenObjective: Malnutrition is a condition affecting different organ systems, suppressing particularly immune system. Malnutrition is related to more than 50% of deaths among childhood. More serious malnutrition is recognised in children who require hospitalization, and may lead to negative effects on the length of hospital stay, morbidity, mortality, quality of life and cost of the treatment. On the other hand, it is reported that there is a negative impact of hospitalization on nutritional status of the patient. Data of the literature on this issue are limited concerning children. In this study, it is aimed to investigate nutritional status of children on admission to hospital, and effects of hospital stay on the nutritional status of the children, as well as the relationship between the nutritional status, diagnosis and length of hospital stay.Patients and Methods: Thirty hundred one children at age of 1 month to 18 years who were hospitalised and followed at the inpatient pediatric service of Dokuz Eylul University Hospital in the period between May and August in 2009, were included in the study. Body weight and height, mid-arm circumference, triceps skin fold thickness were measured on admission and discharge from the hospital. Age, sex, diagnosis, and length of the hospital stay were recorded. Nutritional anthropometric data on admission and discharge from the hospital were compared.Results: One hundred fourty six of 301 (48.5%) subjects were girls. The mean age was 6,2±5,3 years. The mean duration of hospital stay was 7,6±7,4 days. Concerning diagnosis, 32.5% of the cases had infectious disease, 20.2% neurological disease, 11% congenital heart disease, 10.6% malignancy, 7.3% urinary tract disease, 4.3% connective tissue disease, 4.3% gastrointestinal system disease, 3.3% non-malignant hematological disorders, 3% chronic respiratory disease, 1.3% endocrine disease, while the other 2% was due to other diagnosis. 30.2% of the cases had acute malnutrition on admission. Acute malnutrition was found highest in the age groups of 1-24 months (32.6%) and 10-18 years of age (38.9%). Malnutrition was observed at 42.4%, 34.3%, and 32.7% rates, in children having congenital heart diseases, malignancy, and neurological diseases, respectively. 28.2% of all the subjects had acute malnutrition at discharge. There was no any difference between on admission and the discharge in frequency of malnutrition (p>0.05). Children with malnutrition on admission were observed to improve significantly with regard to body weight for height (p<0.05). During hospital stay, body weight for height of the children with malnutrition showed an increase in the age groups of 1-24 months and 2-6 years, while a decrease in the age group of 10-18 years (p<0.05). Body weight for height values of the children having infection and neurological diseases were found to be improved on discharge (p<0,05). 73,6% of children had mild malnutrition on admission and they found to be improved with regard to body weight for height at discharge (p<0,05).Conclusion: 30.2% pediatric patients are at nutritional risk at the time of hospital admission in our hospital. In general, hospitalization in cases did not increase the frequency of malnutrition. Nutritional status of well-nourished one month- 10 year-old group children was not influenced. However unfavourable effects for the patients in the adolescent period drew attention. Hospitalization did not give rise to favourable effects on the nutritional status in children with congenital heart diseases in spite of predisposition to malnutrition, but patients with neurological and infectious diseases displayed improvement.Although hospital stay in children does not affect the nutritional status adversely in general, it does not reduce the high frequency of malnutrition which is the major cause of mortality and morbidity in childhood. New strategies are necessary to raise the awareness of health workers and to treat malnutrition effectively during hospital stay.Key words: hospital malnutrition, child, Turkey, nutritional status, anthropomety