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Analysis of Compliance and Clinical Outcomes by Expanding Physician’s Departments in Pediatric Nutrition Support Team
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Hae Won Lee, Min Jae Jung, Ji Eun Park, Hee Kwon, Jae Song Kim, Hong Go, Eun Sun Son
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J Clin Nutr 2019;11(2):42-51. Published online December 31, 2019
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DOI: https://doi.org/10.15747/jcn.2019.11.2.42
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 Abstract
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Purpose:Malnutrition in hospitalized children has an impact on growth, morbidity, and mortality. For this reason, the implementation of pediatric nutrition support team (PNST) has been suggested. On April 2017, in Severance Hospital, more PNST physician’s departments participated in PNST, and a PNST physician assigning system was changed to be the same departments with the attending physician and PNST physician. This study performed a comparative analysis of the compliance and clinical outcomes after expanding the participation of the PNST physician’s department. Methods:Pediatric patients, who were referred to a PNST consultant, were divided into two groups: an unmatched group (different departments with the attending physician and PNST physician [154 patients, 233 consultations from May 2016 to October 2016]), and a matched group (same departments with the attending physician and PNST physician [169 patients, 302 consultations from May 2017 to October 2017]). The PNST compliance and clinical outcomes, such as the total delivered/required caloric and protein ratio, % ideal body weight (%IBW), serum total protein, and serum albumin, in the two groups were compared. Results:The compliance was significantly higher in the matched group than the unmatched group (63.4% vs. 47.3%, P=0.005). Although there was no significant difference, the total delivered/required caloric and protein ratio, and %IBW in the matched group tended to increase. The serum total protein (0.7±0.7 g/dL vs. –0.4±1.3 g/dL, P=0.004) and serum albumin (0.5±0.5 g/dL vs. –0.1±0.6 g/dL, P=0.003) were significantly higher in the matched group. Conclusion:After expanding the physician’s departments in PNST, the compliance was significantly higher in the matched group and the clinical outcomes tended to better. The physician assigning system to be matched with the departments between the attending physician and the PNST physician may help increase the compliance of NST consultations, resulting in an improvement of the patient’s clinical outcomes.
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Effects of Parenteral Nutrition in Pediatric Patients with Hematopoietic Stem Cell Transplantation
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Soo Young Lim, Min Jae Jung, Ji Eun Park, Jae Song Kim, Soo Hyun Kim, Chuhl Joo Lyu, Eun Sun Son
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J Clin Nutr 2018;10(1):9-19. Published online June 30, 2018
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DOI: https://doi.org/10.15747/jcn.2018.10.1.9
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Purpose:This study examined the effects of parenteral nutrition (PN) on the nutritional status, clinical improvement, and PN-related complications in pediatric patients who had undergone hematopoietic stem cell transplantation (HSCT). Methods:A retrospective audit of 110 pediatric patients (age≤18), who underwent HSCT from March 2015 to February 2017 was undertaken. The patients were divided into 3 groups based on the ratio of daily calorie supplementation to the daily calorie requirement (ROCS). The clinical factors related to the nutritional status, such as difference in body weight (BW), body mass index (BMI), percent ideal body weight (PIBW), total protein (T.protein), and albumin; the early clinical outcome, such as PN-duration, length of hospitaliaztion (LOH), engraftment day (ED), graft-versus-host disease, sepsis, pneumonia and mucositis; and PN-related complications, including elevation of total bilirubin (T.bil), direct bilirubin (D.bil), aspartate aminotransferase, alanine aminotransferase, glucose and cholesterol levels, and hepatic veno-occlusive disease were analyzed using the electronic medical records. Additional analysis subject to auto-HSCT and allo-HSCT patients was also performed. Results:The very-low-ROCS, low-ROCS, and satisfied-ROCS group were 30 (27.3%), 47 (42.7%), and 33 (30.0%) patients, respectively. The PN-duration (P=0.005, z=–2.271), LOH (P=0.023, z=–2.840), ED (P<0.001, z=–3.695), T.bil elevation (P<0.001, z=–3.660), and D.bil elevation (P=0.002, z=–3.064) tended to decrease with increasing ROCS. The difference in the PN-duration (P=0.017), ED (P=0.001), T.bil elevation (P=0.001), and D.bil elevation (P=0.011) in the 3 groups was statistically significant. In the auto-HSCT patients, the change in BW (P=0.031, z=+2.154), PIBW (P=0.029, z=+2.187), and BMI (P=0.021, z=+2.306) tended to increase. In the allo-HSCT patients, the change in T.protein (P=0.022, z=+2.286) increased but the ED (P=0.021, z=–2.304) decreased. Conclusion:Aggressive PN supplementation has an effect on maintaining the nutritional status and achieving better early outcomes in pediatric HSCT patients, whereas it has no effect on increasing the PN-related complications.
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