Poor nutrition is an underrecognized cause of significant morbidity in hospitalized children.1,2 In addition to presenting with poor nutrition at the time of admission, children often suffer worsening of their nutritional status during the course of a hospitalization,3,4 often due to providers’ underrecognition of ongoing poor intake (see Fig 1). Pediatric hospitalists can and should play a central role in recognizing and treating this common comorbid condition.
FIGURE 1
Percentage of BMI decrease ≥0.25 SD during hospitalization in 496 pediatric patients. Subjects were grouped by their Z -score at admission in the hospital. Although highly malnourished children lost the most in terms of BMI, even normally nourished children lost a statistically significant amount of weight during admission. Reprinted from Campanozzi A, Russo M, Catucci A, et al. Hospital-acquired malnutrition in children with mild clinical conditions. Nutrition 2009;25(5):540–547, with permission from Elsevier.3 [medium]
In this article we highlight the important issue of malnutrition in hospitalized pediatric patients and propose a general approach to nutritional assessment and supplementation for the pediatric hospitalist.
Malnutrition is defined as a state in which a deficiency (or excess) of energy, protein, and other nutrition causes measurable adverse effects on the body and on growth (in children), and may impact clinical outcome.5 The term “nutritional deterioration” has been used to describe significant weight loss in hospitalized children, a precursor to acute malnutrition. Although the term malnutrition includes both overnutrition (obesity) and undernutrition, in this article we focus specifically on undernutrition.
Recent studies in developed countries have estimated the prevalence of malnutrition in hospitalized children as 12% to 24%.1,3,5,6 Despite many medical advances over the past 20 years, the prevalence of malnutrition among hospitalized children has not decreased. Malnutrition is known to have detrimental effects …
Four case reports are presented, followed by a discussion of the acute, potentially life-threatening manifestations of the cholesterol embolism syndromes. Every major organ system except the lungs may be directly affected by cholesterol emboli; devastating consequences encompass cerebral, myocardial, spinal cord, intestinal, renal, and other visceral organ infarction, as well as peripheral and perineal gangrene. Additional complications include severe hypertension, gastrointestinal bleeding, and hemodynamic instability. Anticoagulants and thrombolytic therapy may exacerbate atheromatous embolism and are relatively contraindicated. Aggressive supportive therapy may improve chances of survival, but long-term prognosis is poor. Prevention remains the most important aspect in this devastating disorder.
