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Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
A multicentre development and evaluation of a dietetic referral score for nutritional risk in sick infants
Konstantinos Gerasimidis1, Shamsi Milani1, Andrew Tester1
1School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life Sciences, University of Glasgow, New Lister Building, Glasgow Royal Infirmary, G31 2ER, United Kingdom.
Insights
A new tool, the infant early nutrition warning score (iNEWS), effectively identifies hospitalized infants at nutritional risk. This simple screening method helps ensure timely dietetic intervention for better infant recovery.
Area of Science:
- Pediatric Nutrition
- Clinical Assessment Tools
- Hospitalized Infant Care
Background:
- Unrecognized nutritional issues can impede recovery in hospitalized infants.
- Nutritional risk screening is recommended upon admission, but infant-specific tools are scarce.
- Developing a reliable screening tool for infants is crucial for timely intervention.
Purpose of the Study:
- To develop and validate a nutritional risk screening tool for hospitalized infants.
- To identify sick infants requiring specialized dietetic input.
- To improve nutritional management and recovery outcomes in pediatric hospital settings.
Main Methods:
- Recruited hospitalized infants from the UK, Greece, and Iran.
- Measured weight, skinfold thickness, and mid-upper arm circumference (MUAC).
- Developed and validated the infant early nutrition warning score (iNEWS) using screening questions and dietetic assessments.
Main Results:
- The iNEWS demonstrated good sensitivity and specificity in predicting the need for dietetic input across cohorts (e.g., 84% sensitivity, 91% specificity in the UK).
- Infants with high iNEWS scores exhibited significantly lower skinfold thickness and MUAC.
- Underweight, poor weight changes, and reduced intake were key predictors for requiring dietetic support.
Conclusions:
- The infant early nutrition warning score (iNEWS) is a simple and effective tool for identifying hospitalized infants at nutritional risk.
- iNEWS facilitates the timely referral of infants needing dietetic intervention.
- This tool can aid in optimizing nutritional care for hospitalized infants, potentially improving recovery.
Background & Aims:
Unrecognized nutritional issues may delay recovery in hospitalized infants. It has been proposed that nutritional risk screening should be performed at hospital admission, but few tools include infants. The aim of this study was to develop and test a tool to identify sick infants in need of dietetic input.
Methods:
Hospitalised infants were recruited from hospitals in the United Kingdom (UK), Greece and Iran. Weight, skinfold thickness and mid upper arm circumference (MUAC) were measured, with detailed dietetic assessment in the UK and Greece. Simple screening questions were used in the UK cohort to formulate a score (infant early nutrition warning score-iNEWS) which was then validated in the Greek and Iranian groups.
Results:
After dietetic assessment, 20 (9.6%) UK and 22 (22%) Greek infants were rated as needing dietetic input. Underweight, poor weight gain/loss and reduced intake were all independent predictors of perceived need for dietetic input in stepwise multivariate regression analysis. The score based on these items (iNEWS), had 84% sensitivity, 91% specificity and 49% positive predictive value to predict need for dietetic input in the UK cohort. In the Greek cohort this was 86%, 78% and 53% respectively. In all three countries, infants with high iNEWS had significantly lower average skinfold thickness (between -1 and -1.8 SD, p < 0.0001) and MUAC (between -1.8 and -2 SD, p < 0.0001) than those at low risk.
Conclusions:
iNEWS, a simple nutritional risk tool, identifies most hospitalised infants who need dietetic input.
Clinical Trial Registration:
https://clinicaltrials.gov/ct2/show/NCT03323957.
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