目的 应用儿科营养筛查-评估工具对小儿消化营养科住院儿童营养状况进行分析,了解营养不良风险发生率以及不同营养状况下临床结局及生化指标差异,为合理营养干预提供依据。方法 利用中华医学会肠外肠内营养学分会儿科学组开发的儿科营养筛查-评估工具——“儿科营养筛查”APP对上海交通大学医学院附属新华医院小儿消化营养科2018年3月至2020年10月入院的患儿进行营养筛查,并对存在营养不良风险的患儿进行营养评估,分析不同营养状况下临床结局及生化指标差异。结果 共入选624例患儿,男368例,女256例,0~1岁组（不含1岁）158例,1~3岁组95例,>3岁组371例。营养筛查结果表明营养不良风险的发生率为56.25%,0~1岁组营养不良风险最高（89.24%）。按疾病进行分组,短肠综合征患儿营养不良风险最高（90.05%）,其次为急性胰腺炎（88.89%）和慢性腹泻（75.00%）。对比无营养不良风险组,营养不良风险组住院天数明显延长,住院费用增加,感染发生率更高,总蛋白、白蛋白、血红蛋白、维生素D水平明显降低（P均<0.05）。营养评估提示中度营养不良和重度营养不良的发生率分别为35.89%和16.37%,0~1岁组中度和重度营养不良发生率最高,分别为34.61%和36.54%（P均<0.05）。相较正常组、中度营养不良组,重度营养不良组患儿的住院天数、住院费用、感染发生率明显增高,总蛋白、白蛋白水平减低（P均<0.05）。结论 消化科患儿营养不良风险和中重度营养不良的发生率较高。小年龄组患儿营养不良风险和重度营养不良发生率更高。存在营养不良风险或中重度营养不良的患儿,住院天数延长,住院费用增加,感染发生率增高,总蛋白、白蛋白、25-羟维生素D水平降低。

Objectives To recognize the nutritional status of hospitalized children by the pediatric nutrition screening-assessment tool, to analyze the differences in clinical outcomes and biochemical indicators under different nutritional status, and to provide evidence for reasonable nutritional intervention. Methods A pediatric nutrition screening-assessment tool, named as Pediatric Nutrition Screening APP, developed by Working group of Pediatrics, Chinese Society of Parental and Enteral Nutrition was used to nutritional screening and assessment of children admitted to the Division of Gastroenterology and Nutrition Xinhua Hospital from March 2018 to October 2020, and to evaluate children at risk of malnutrition and analyze the difference in clinical outcomes and biochemical indicators under different nutritional status. Results A total of 624 children were enrolled, including 368 males and 256 females. There were 158 children in the 0-1 year old group, 95 children in the 1-3 years old group, and 371 children in elder than 3 years old group. Nutrition screening showed that the incidence of malnutrition risk was 56.25%, and the risk of malnutrition was 89.24%, the highest in the 0-1 year old group. Grouped by disease, children with short bowel syndrome have the highest risk of malnutrition at 90.05%, followed by acute pancreatitis at 88.89%, and chronic diarrhea at75.00%. Compared with the non-malnutrition risk group, the children in the malnutrition risk group had significantly longer duration of hospitalization, more hospitalization expenses, higher infection rates, and significantly reduced total protein, albumin, hemoglobin, and 25-(OH)-Vitamin D levels (all P<0.05). Nutrition assessment indicated that the incidence of moderate malnutrition and severe malnutrition were 35.89% and 16.37%, respectively. The incidence of moderate malnutrition and severe malnutrition in the 0-1 year old group were the highest, 34.61% and 36.54%, respectively (both P<0.05). In the normal group, moderate malnutrition group, and severe malnutrition group, the duration of hospitalization, hospitalization expenses, and infection rate stepped up, and the levels of total protein, albumin levels stepped down (all P<0.05). Conclusions The risk of malnutrition and the incidence of moderate and severe malnutrition were higher in children in gastroenterology ward. Children under small age had higher risk of malnutrition and incidence of moderate to severe malnutrition. Under malnutrition status, children had longer hospitalization, increased hospitalization expenses, and higher infection rate, and lower levels of total protein, albumin, and 25-hydroxyvitamin D.