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Nutritional assessment: an integral part of the preoperative pediatric surgical evaluation
Insights
Pediatric surgical patients have high rates of acute protein calorie malnutrition (PCM). Routine nutritional assessment is crucial for identifying at-risk children before surgery.
Area of Science:
- Pediatric Surgery
- Nutritional Science
- Clinical Medicine
Background:
- Protein calorie malnutrition (PCM) is prevalent in hospitalized adults, increasing surgical risks.
- Limited data exist on PCM prevalence in pediatric surgical populations.
Purpose of the Study:
- To determine the prevalence of acute PCM in hospitalized children.
- To assess the necessity of routine nutritional assessment in pediatric surgical patients.
Main Methods:
- Nutritional assessment of 198 pediatric patients.
- Analysis of PCM prevalence across different pediatric subgroups (infants, trauma, burn, elective, complex surgery patients).
Main Results:
- Overall acute PCM prevalence was 54% in pediatric patients.
- Prevalence reached 63% in infants under three months.
- Surgical patients undergoing complex procedures showed a 64% prevalence of acute PCM.
Conclusions:
- Acute protein calorie malnutrition is highly prevalent in hospitalized pediatric and pediatric surgical patients.
- Comprehensive nutritional assessment is essential for identifying at-risk pediatric surgical patients.
Abstract:
Comprehensive nutritional assessment in adults has revealed that 50% of hospitalized patients suffer from acute protein calorie malnutrition (PCM), a state which correlates with increased surgical morbidity and mortality. We report our results examining the same question in children, and on the basis of these data suggest that nutritional assessment be a routine part of the preoperative evaluation of all pediatric surgical patients. We studied 198 children and found that the overall prevalence of acute PCM was 54%; but if premature and term infants less than three months of age are selected, the prevalence of acute PCM was a striking 63%. If only surgical patients are considered, the prevalence of acute PCM among patients hospitalized for trauma or burns was 31% for elective operation 39%, and for acute but complex operative procedures 64%. These data demonstrate that a remarkably high prevalence of acute PCM exists among hospitalized pediatric and pediatric surgical patients. Whether aggressive perioperative nutritional support can reverse such acute PCM and favorably influence morbidity and mortality is currently speculation, but that acute protein calorie malnutrition is far more prevalent among hospitalized pediatric patients that is generally realized, and that comprehensive nutritional assessment is essential to identify the "at risk" nutritionally deprived pediatric surgical patient, have now been proven.