Welcome to the 9th EAPS Congress Programme Scheduling

Abstract Body

Nutritional assessment and identifying ‘at risk’ patients: Although the European Society of Enteral and Parenteral Nutrition (ESPEN) recommends the use of nutritional screening in hospitalised children, there is no standardised approach as to how this should be completed. The terms “nutrition screening” and “nutritional assessment”, are often used interchangeably, although relate to quite different processes. Nutritional screening is a process to identify patients who are already malnourished or at risk of becoming so. Nutritional assessment refers to the characterisation of specific nutritional problems. Nutritional risk is affected by a multitude of factors including; nutritional and disease state, requirements and intake, amongst others. The purpose of this talk will be to consider the differences between nutrition screening and nutrition assessment, to review factors associated with nutrition risk and finally, to explore considerations to ensure nutrition deficits are managed and that nutrition support is continued until nutrition goals are achieved.

Abstract Body

In critically ill children, early enteral nutrition is recommended, but it may expose children at risk of refeeding syndrome, an acute metabolic disturbance that occurs after reintroduction of nutrition. The main physiological problems are deficiencies of thiamine, phosphate, magnesium and potassium. The refeeding syndrome can manifest as a mild electrolyte disorder or a severe electrolyte disorder leading, without supplementation, to severe organ failure and death.

In 2020, the American Society for Parenteral and Enteral Nutrition (ASPEN) published consensus recommendations for identifying patients with or at risk for refeeding syndrome. ASPEN Criteria for identifying patients at risk include, in particular, children who are malnourished, those with recent weight loss, fat or muscle loss, low energy intake, and/or abnormal serum potassium, phosphorus, or magnesium concentrations. The ASPEN clinical definition of refeeding syndrome includes a significant electrolyte disturbance (≥10% decrease in phosphorus, potassium, and/or magnesium) and/or organ dysfunction resulting from a decrease in any of these elements and/or due to thiamine deficiency, occurring within 5 days of reintroducing calories.

The approaches to avoid causing refeeding syndrome and those for its treatment are often the same. On admission, nutritional status should be assessed, including anthropometric measurements and diet history, to identify at-risk patients. These latter should receive more progressive energy intake and be monitored more closely for electrolyte abnormalities. Treatment of established refeeding syndrome should be aimed at correcting underlying electrolyte abnormalities and may include a reduction in energy intake. Treatment should include supplementations, which depends on the severity of the refeeding syndrome.