Development of the Pediatric Integrated Nutrition Pathway for Acute Care (P-INPAC) using a modified Delphi technique

Area of Science:

• Pediatric Nutrition
• Clinical Pathway Development
• Malnutrition Management

Background:

• Disease-related malnutrition (DRM) is prevalent in hospitalized children, affecting one in three upon admission.
• Children are susceptible to nutritional decline during hospital stays, yet systematic DRM detection is lacking in Canada.
• Standardized approaches are needed to improve nutritional care for pediatric inpatients.

Purpose of the Study:

• To develop a pediatric, inpatient nutritional care pathway.
• The pathway aims to standardize and improve hospital care for disease-related malnutrition.
• Based on evidence, resource feasibility, and expert consensus.

Main Methods:

• A multidisciplinary pediatric working group developed the pathway.
• Methods included literature review, adaptation of the adult Integrated Nutrition Pathway for Acute Care (INPAC), and a modified Delphi consensus process.
• Consensus was defined as ≥80% agreement on pathway components.

Main Results:

• The Pediatric Integrated Nutrition Pathway for Acute Care (P-INPAC) was developed.
• P-INPAC includes screening within 24 hours and assessment using Subjective Global Nutritional Assessment (SGNA) within 48 hours of admission.
• It outlines prevention and treatment plans for DRM, categorized into standard, advanced, and specialized care.

Conclusions:

• An evidence-informed, consensus-based pathway (P-INPAC) for pediatric inpatient nutrition care has been established.
• Further research is required to assess the feasibility of implementation and evaluate P-INPAC's effectiveness in clinical practice.
• Integrating P-INPAC into practice is crucial for addressing pediatric malnutrition in hospitals.