Hulst, J.M.

Eosinophilic myenteric ganglionitis as a cause of chronic intestinal pseudo-obstruction (Article)

2012-01-01T00:00:00Z

Enteral Nutrition in Children with Short-Bowel Syndrome: Current Evidence and Recommendations for the Clinician (Article)

2010-03-01T00:00:00Z

The optimal enteral feeding regimen in children with short-bowel syndrome (SBS) is debated by clinicians. The purpose of this article is to present an overview of published data on feeding strategies in children with SBS. A structured literature search (years 1966 through 2007) was done to identify human studies in children directly addressing nutrition (or specified nutrients) in relation to SBS. Eight relevant studies retrieved were graded by seven experts according to the Scottish Intercollegiate Guidelines Network criteria. This grading system is based on the study design and methodological quality of individual studies. Recommendations were made based on the outcome according to the Scottish Intercollegiate Guidelines Network if appropriate and on expert opinion otherwise. The most important recommendations are:•Enteral nutrition should be initiated as soon as possible after bowel resection to promote intestinal adaptation.•Enteral nutrition should be administered in a continuous fashion.•Breast milk or standard polymeric formula (depending on the child's age) is recommended as preferred type of nutrition.•Bottle-feeding (small volumes) should be started as soon as possible in neonates to stimulate the suck and swallow reflexes. Solid food can be introduced at the age of 4 to 6 months (corrected for gestational age if necessary) to stimulate oral motor activity and to avoid feeding aversion behavior. The team of experts concluded that high-quality research on the preferred types of enteral and oral nutrition in children with SBS is scarce. Multicenter prospective studies on the effects of feeding strategies on bowel adaptation, fecal production, linear growth, and clinical outcome are required to find the optimal feeding regimen in children with SBS.

National malnutrition screening days in hospitalised children in the Netherlands (Article)

2010-02-01T00:00:00Z

Objective: Nationwide prevalence studies on malnutrition in hospitalised children have not been done. This study aimed to investigate the prevalence of malnutrition of all newly admitted children in The Netherlands during 3 consecutive days. Design: Prospective observational study. Setting: Paediatric wards of 44 hospitals (7 academic and 37 general). Participants: A total of 424 children aged ≥30 days and hospitalised for ≥ 1 day were included, 63% male, 86% non-white. Median age was 3.5 years and median hospital stay was 2 days. Main outcome measures: SD scores < -2 for weight for height and height for age were considered to indicate acute and chronic malnutrition, respectively. Results: Overall 19% of the children had acute and/or chronic malnutrition at admission (academic 22% and general 17%). The proportion of children with chronic malnutrition was significantly higher in academic hospitals (14% vs 6%). Logistic regression analysis allowing for age, underlying disease, ethnicity, surgery and type of centre showed a significant relation between the presence of malnutrition at admission and underlying disease (odds ratio (OR) 2.2). For chronic malnutrition both underlying disease and non-white ethnicity were significantly related to a higher prevalence (OR 3.7 and OR 2.8, respectively). Multiple regression analysis showed that children with acute malnutrition stayed on average 45% longer (95% CI 7% to 95%) in the hospital than children without such malnutrition. Conclusions: This unique nationwide study shows that 19% of children admitted to Dutch hospitals are malnourished at admission. This high prevalence underlines the need for routine screening and treatment of malnutrition in hospitalised children.

Dutch national survey to test the STRONGkids nutritional risk screening tool in hospitalized children (Article)

2010-02-01T00:00:00Z

Background & aims: Children admitted to the hospital are at risk of developing malnutrition. The aim of the present study was to investigate the feasibility and value of a new nutritional risk screening tool, called STRONGkids, in a nationwide study. Methods: A Prospective observational multi-centre study was performed in 44 Dutch hospitals (7 academic and 37 general), over three consecutive days during the month of November 2007.The STRONGkidsscreening tool consisted of 4 items: (1) subjective clinical assessment, (2) high risk disease, (3) nutritional intake, (4) weight loss. Measurements of weight and length were performed. SD-scores <-2 for weight-for-height and height-for-age were considered to indicate acute and chronic malnutrition respectively. Results: A total of 424 children were included. Median age was 3.5 years and median hospital stay was 2 days. Sixty-two percent of the children were classified " at risk" of developing malnutrition by the STRONGkidstool. Children at risk had significantly lower SD-scores for weight-for-height, a higher prevalence of acute malnutrition and a longer hospital stay compared to children with no nutritional risk. Conclusions: The nutritional risk screening tool STRONGkidswas successfully applied to 98% of the children. Using this tool, a significant relationship was found between having a " high risk" score, a negative SD-score in weight-for-height and a prolonged hospital stay.

Ondervoeding bij een vijfde van kinderen opgenomen in Nederlandse ziekenhuizen (Article)

2010-01-01T00:00:00Z

Doel: Het onderzoeken van de prevalentie van ondervoeding bij kinderen opgenomen in Nederlandse ziekenhuizen. Opzet & Methode: Prospectief observationeel onderzoek. Gedurende 3 opeenvolgende dagen werden alle kinderen die werden opgenomen op de kinderafdelingen van 44 Nederlandse ziekenhuizen (7 academisch, 37 algemeen) gescreend op ondervoeding. In totaal werden 424 kinderen geïncludeerd (63% jongens, 86% kaukasisch) met een leeftijd ≥ 30 dagen en een opnameduur van tenminste 1 dag. De mediane leeftijd was 3,5 jaar, de mediane opnameduur 2 dagen. Gewicht en lengte werden gemeten bij opname. Standaarddeviatiescores (SD-scores) < -2 voor gewicht-naar-lengte en lengte-voor-leeftijd werden beschouwd als acute respectievelijk chronische ondervoeding. Resultaten: In totaal was 19% van de kinderen acuut of chronisch ondervoed bij opname (academische ziekenhuizen 22%, algemene ziekenhuizen 17%). Het aandeel kinderen met chronische ondervoeding was significant hoger in de academische ziekenhuizen (14 versus 6%). Logistische regressieanalyse, rekening houdend met leeftijd, onderliggende ziekte, etniciteit, chirurgie en type ziekenhuis, toonde een statistisch significant verband tussen ondervoeding bij opname en onderliggende ziekte (OR: 2,2). Voor chronische ondervoeding waren zowel onderliggende ziekte als niet-kaukasische etniciteit significant gerelateerd aan een hogere prevalentie (OR: 3,7 en 2,8 respectievelijk). Multipele regressieanalyse toonde aan dat kinderen met acute ondervoeding bij opname gemiddeld 45% langer in het ziekenhuis lagen (95%-BI: 7-95) dan kinderen met een normale voedingstoestand. Conclusie: Deze unieke nationale studie laat zien dat 19% van de kinderen bij opname in een ziekenhuis ondervoed zijn. Deze hoge prevalentie laat zien dat screening op en behandeling van ondervoeding noodzakelijk is bij kinderen die in een ziekenhuis worden opgenomen.

Malnutrition in pediatric hospital patients: Current issues (Article)

2010-01-01T00:00:00Z

Malnutrition in hospitalized children is still very prevalent, especially in children with underlying disease and clinical conditions. The purpose of this review is to describe current issues that have to be taken into account when interpreting prevalence data. Weight-for-height and height-for-age standard deviation scores are used for classification for acute and chronic malnutrition, respectively. Body mass index for age can also be used for the definition of acute malnutrition but has a few advantages in the general pediatric population. The new World Health Organization child-growth charts can be used as reference but there is a risk of over- and underestimation of malnutrition rates compared with country-specific growth references. For children with specific medical conditions and syndromes, specific growth references should be used for appropriate interpretation of nutritional status. New screening tools are available to identify children at risk for developing malnutrition during admission. Because of the diversity of medical conditions and syndromes in hospitalized children, assessment of nutritional status and interpretation of anthropometric data need a tailored approach.

Long-term health status in childhood survivors of meningococcal septic shock (Article)

2008-11-01T00:00:00Z

Objective: To assess long-term health status in patients who survived meningococcal septic shock in childhood. Design: Medical and psychological follow-up of a cross-sectional cohort. Setting: Pediatric intensive care unit (PICU) of a tertiary care university hospital. Participants: All consecutive patients with septic shock and purpura who required intensive care between 1988 and 2001. Intervention: Patients and their parents were invited to our follow-up clinic 4 to 16 years after PICU discharge. Outcome Measures: Health status was assessed with a standard medical interview, physical examination, renal function test, and the Health Utilities Index Mark 2 (HUI2) and 3 (HUI3). Results: One hundred twenty patients (response rate 71%) participated in the follow-up (median age at PICU admission, 3.1 years; median follow-up interval, 9.8 years; median age at follow-up, 14.5 years). Thirty-five percent of patients had 1 or more of the following neurological impairments: severe mental retardation with epilepsy (3%), hearing loss (2%), chronic headache (28%), and focal neurological signs (6%), like paresis of 1 arm. One of the 16 patients with septic shock-associated acute renal failure at PICU admission showed signs of mild chronic renal failure (glomerular filtration rate, 62 mL/min/1.73m2; proteinuria; and hypertension). Scores were significantly lower on nearly all HUI2 and HUI3 attributes compared with Dutch population data, indicating poorer health in these patients. Conclusions: In patients who survived meningococcal septic shock in childhood, one-third showed long-term neurological impairments, ranging from mild to severe and irreversible. Patients reported poorer general health as measured by HUI2 and HUI3.

Prevalence of malnutrition in pediatric hospital patients (Article)

2008-10-01T00:00:00Z

Purpose of review: Hospital protein-energy malnutrition and its adverse consequences were already described back in 1980. The purpose of this review is to describe the current prevalence of malnutrition in hospitalized children and to describe current risk groups. Recent findings: Different definitions have been used to describe malnutrition. According to WHO criteria, the SD score with a cutoff of less than -2 should be used to define malnutrition and to compare prevalence data. Using the SD score for weight for height or equivalent criteria, the prevalence of acute malnutrition over the last 10 years in hospitalized children in Germany, France, the UK and the USA varied between 6.1 and 14%, whereas in Turkey up to 32% of patients with malnutrition were reported. Acute malnutrition is still highly prevalent in children with an underlying disease; however, the prevalence rate seems lower in children with cystic fibrosis and malignancies. Summary: The prevalence of acute malnutrition of children admitted to hospital is still considerably high, but there is a scarcity of data concerning the nutritional status during hospital admission. Screening tools to identify children at risk of developing malnutrition might be helpful.

Nutritional Assessment of Critically Ill Children: the search for practical tools (Doctoral Thesis)

2004-04-22T00:00:00Z

Critically ill children are at risk of deteriorating nutritional status when admitted to an intensive care unit. This may lead to malnutrition, which is associated with increased morbidity and mortality. While adequate feeding is essential for complete recovery and normal functional outcome of the growing child, caregivers on admission tend to focus on the primary medical problem. In order to provide good nutritional care it seems essential to fully assess the child’s nutritional status and needs. Various methods are available, and it is the child’s age, clinical presentation, and illness severity that determine which of them is most suitable as individual approach. This thesis describes the prevalence of malnutrition in critically ill children and investigates the applicability and usefulness of the available assessment methods for identifying children with poor initial nutritional status or at risk of developing malnutrition. We focused on the feasibility of routine use in the pediatric ICU setting. In this thesis we analyzed data obtained from a cohort of children receiving intensive care in the Erasmus MC-Sophia Children’s Hospital during the year 2001. This cohort consisted of preterm neonates, term neonates and older children aged 30 days-16 years.