Review of nutritional assessment and clinical outcomes in pediatric surgical patients: does preoperative nutritional assessment impact clinical outcomes?
BACKGROUND
Malnourished adult patients who undergo surgical procedures tend to have worse clinical outcomes compared to well-nourished patients. In the pediatric surgical patient, nutritional assessment is considered a critical aspect of the initial evaluation, but a correlation between preoperative malnutrition and poor surgical outcomes is not clear. We hypothesized that an evidence-based review would reveal that measures of nutritional assessment in children would not correlate pre-operative malnutrition with poor surgical outcomes.


METHODS
A search of major English language medical databases (Medline, Cochrane, SCOPUS) was conducted for the key words nutritional assessment, pediatric, children, surgery, and outcomes. All methods of nutritional assessment in pediatric surgery were evaluated for their relevance and relation to outcomes after surgery. The Oxford Center for Evidence Based Medicine (CEBM) classification for levels of evidence was used to develop grades of clinical recommendation for each variable studied.


RESULTS
35 articles were evaluated after an exhaustive literature search, of which six met inclusion criteria for this review. There is a paucity of high quality evidence correlating preoperative malnutrition in pediatric surgical patients with clinical outcomes. Factors contributing to the low level of evidence include a lack of high quality randomized controlled trials, a lack of consensus in study design and methods, and utilization of incongruous methods of nutritional assessment, including methods that may be unproven in the study population.


CONCLUSIONS
Larger multi center randomized studies are needed to offer higher level of evidence to support nutritional intervention prior to major elective pediatric surgery.
St. Joseph's Regional Medical Center, Paterson NJ. SUNY Buffalo, 2130 Millburn Avenue, Suite C-1, Maplewood NJ 07040. Electronic address: Scottwessner@gmail.com.
Scott
S
Wessner
St. Joseph's Regional Medical Center, 703 Main St., Paterson NJ 07503. Electronic address: sathyabc@yahoo.com.
Sathyaprasad
S
Burjonrappa
D000886:Anthropometry; D002648:Child; D015362:Child Nutrition Disorders / Q000150:complications*; D019317:Evidence-Based Medicine; D006801:Humans; D015596:Nutrition Assessment; D017063:Outcome Assessment, Health Care; D057234:Preoperative Period; D018570:Risk Assessment; D013514:Surgical Procedures, Operative
Anthropometry; Nutritional Assessment; Pediatric surgery; Risk Assessment; Surgical Outcomes