Skrining

2. Simple pediatric nutritional risk
score
Binar Panunggal

3. • Umur >1 bulan
• Dirawat di RS ≥48 jam
• Tidak ditujukan untuk pasien dengan variasi
status hidrasi yang besar (hepatopati,
nefropati berat, gagal jantung)

4. Prosedur pengamatan BB
• BB rujukan: BB masuk RS untuk anak tanpa
dehidrasi, BB setelah direhidrasi untuk anak
dengan dehidrasi
• BB ditimbang setiap hari sesuai prosedur
• Malnutrisi di RS: bila terjadi penurunan BB
>2% dari BB rujukan pada akhir perawatan
atau pada penurunan BB terbanyak selama
perawatan

5. Faktor RISIKO
• Kondisi patologis
• Nyeri
• Asupan makanan

6. Kondisi Patologis

7. Nyeri
ANAK <5 tahun: diamati respon nyeri menangis,
gerakan tidak biasa dan lain-lain
SKOR: nyeri (1), tidak ada nyeri (0)
ANAK ≥5 tahun: dengan visual analogue scale
(VAS)
skala 0 (tidak ada nyeri) – 100 (sangat nyeri)
Cut-off: nyeri (>40), tidak ada nyeri (≤40)
SKOR: nyeri (1), tidak ada nyeri (0)

8. Asupan Makanan
• Asupan makanan dihitung selama 48 jam
pertama
• Cut-off: asupan kurang (<50% yang
direncanakan) dan cukup (≥50% yang
direncanakan)
• SKOR: asupan kurang (1), cukup (0)

9. Faktor RISIKO lainnya
• Status gizi awal masuk RS
• Muntah dan diare
• Kemampuan makan

10. Contoh KASUS
Latihan: Kasus Queen Alya (5 tahun)
• Skor:
• Kondisi patologis: derajat 3 ----> skor 3
• Nyeri: ya ----> skor 1
• Asupan makanan = 40% ----> skor 1
• Total skor = 5 ----> risiko tinggi
• Rekomendasi:
• Dihitung asupan makanan dengan teliti (tepat)
• Rujuk ke Tim Asuhan Nutrisi
• Nutrisi enteral atau parenteral

11. Modified simple pediatric
nutritional risk score

12. • Merupakan modifikasi SPNRS
• Yang dimodifikasi: cara mengukur nyeri
(komponen lain: derajat patologis & asupan
makanan sama)
• Definisi malnutrisi di RS berbeda

13. Nyeri

15. Teknis Penggunaan FLACC
Bila pasien bangun:
• Observasi selama 1-5 menit atau lebih lama
• Perhatikan tungkai dan anggota badan yang
tidak tertutup baju
• Ubah posisi pasien dan observasi aktivitasnya
• Nilai tegangan dan tonus
• Mulai menghibur kalau perlu

16. Bila pasien tidur:
• Observasi selama 5 menit atau lebih
• Observasi tungkai dan bagian tubuh yang tidak
tertutup pakaian
• Kalau perlu posisi pasien diubah
• Sentuh bagian tubuh, nilai tegangan dan
tonusnya
NB: bila mungkin pasien melaporkan sendiri
kondisinya

17. Interpretasi
• Total skor: 10
0 = relaks dan nyaman
1-3 = sedikit tidak nyaman (nyeri ringan)
4-6 = nyeri sedang
7-10 = sangat tidak nyaman, nyeri atau
keduanya

18. •Cut-off point malnutrisi di
RS adalah skor 2

19. Paediatric Yorkhill Malnutrition
Score (PYMS)

20. • Dikembangkan oleh the European Society of
Clinical Nutrition and Metabolism (ESPEN)
• Mengakses 4 element atau faktor prediktor
malnutrisi di RS dalam 24 jam pertama
perawatan
• Digunakan untuk anak >1 tahun (<1 tahun
dianggap tidak valid)
• Bila TB tidak dapat diukur , diganti dengan
BB/U dengan standar UK 1990

21. BMI/U Standar UK 1990

23. Screening Tool for Assessment of
Malnutrition in Paediatrics (STAMP)

24. • Mengidentifikasi kekurangan gizi pada pasien
anak

25. 3 item
• Diagnoses with nutritional consequences
• Momentary nutritional intake
• Evaluation of nutritional status (body height
and body weight)

26. Step 1
Diagnoses with nutritional consequences
• Scor 0 = without nutritional consequence
• Score 2 = potential nutritional consequences
• Score 3 = some nutritional consequences

27. • Some nutritional consequences : intestinal
disorders, diarrhea, burns, polytrauma,
Crohn´s disease, cystic fibrosis, dysphagia,
liver disease, major surgical intervention, food
allergies (intolerance), active cancer
treatment, kidney disease, hereditary
metabolic disorders

28. • Potential nutritional consequences : eating
problems, heart disease, cerebral palsy, cleft
lip and palate, celiac disease, diabetes,
gastroesophageal reflux, minor surgery,
neuromuscular disability, psychiatric
disorders, respiratory syncytial virus, a simple
food allergy (intolerance)

29. Step 2
• Assessment of nutritional intake of child
during hospitalization
1. without any change in eating habits (0
points)
2. reduced nutritional intake (2 points)
3. the child does not accept food (3 points)

30. Step 3
• > 3 centile spaces/ ≥ 3 columns apart (or
weight < 2nd centile) (score 3)
• > 2 centile spaces/= 2 columns apart ( score 1)
• 0 to 1 centile spaces/ columns apart (score 0 )

31. Step 4
• Add the scores from steps 1–3 together to
calculate the overall risk of malnutrition
• High risk = ≥4
• Medium risk = 2-3
• Low risk = 0-1

32. Step 5
High risk :
• Take action
• Refer to a Dietitian, nutritional support team
or consultant
• Monitor as per care plan

33. Medium risk :
• Monitor nutritional intake for 3 days
• Repeat STAMP screening after 3 days
• Amend care plan as required

34. Low risk :
• Continue routine clinical care
• Repeat STAMP screening weekly while child is
an in-patient
• Amend care plan as required

35. Screening Tool for Risk On
Nutritional status
and Growth(STRONGkids)

36. 4 items
• Subjective clinical assessment (1 point)
• High risk disease (2 points)
• Nutritional intake and losses (1 point)
• Weight loss or poor weight gain? (1 point)

37. Subjective clinical assessment
• Is the patient in a poor nutritional status
judged by subjective clinical assessment
(diminished subcutaneous fat and/or muscle
mass and/or hollow face)?

38. High risk disease
• anorexia nervosa
• congenital
• heart diseases
• celiac disease
• expected major surgery
• dysmaturity/prematurity
• bronchopulmonary
• dysplasia (maximum age 2 years)
• cystic fibrosis
• digestive fistula

39. • inflammatory bowel disease
• infectious disease
• metabolic disease
• cancer
• pancreatitis
• chronic liver disease
• muscle disease
• chronic kidney disease
• mental handicap/retardation
• sepsis
• short bowel syndrome
• trauma, burns

40. Nutritional intake and losses
• Are one of the following items present?
• Excessive diarrhoea (5 per day) and/or vomiting
(>3 times/day) the last few days?
• Reduced food intake during the last few days
before admission (not including fasting for an
elective procedure or surgery)?
• Pre-existing dietetically advised nutritional
intervention?
• Inability to consume adequate intake because of
pain?

41. Weight loss or poor weight gain?
• Weight loss or no weight gain (infants <1 year)
in the last few weeks/months

42. • 4-5 points (High risk) : Consult doctor and
dietician for full diagnosis and individual
nutritional advice and follow-up, s tart
prescribing sip feeds until further diagnosis
• 1-3 points (Medium risk) : Consult doctor for
full diagnosis; consider nutritional
intervention with dietician, check weight twice
a week and evaluate the nutritional risk after
one week

43. • 0 points ( Low risk) : No intervention
necessary, check weight regularly conform
hospital policy and evaluate the nutritional
risk after one week

44. SGA for Children
Nutrition-Focused Medical History
• Linear growth
• Weight relative to length/height
• Changes in body weight
• Adequacy of dietary intake
• Persistent gastrointestinal symptoms
• Functionl impairment