Utjecaj nutritivnoga statusa na pojavnost nozokomijalnih gastrointestinalnih i respiratornih infekcija u pedijatrijskoj populaciji

doctoral thesis

• Title (english): Impact of nutritional status on incidence of nosocomial gastrointestinal and respiratory infections in paediatric population
• Author: Tena Niseteo
• Mentor: Sanja Kolaček (mentor)
• Committee member: Irena Colić-Barić (član povjerenstva)
• Granter: University of Zagreb; Faculty of Food Technology and Biotechnology; (Department of Food Quality Control); (Laboratory for Nutrition Science); Zagreb
• Defense date and country: 2017-03-14, Croatia
• Scientific / art field, discipline and subdiscipline: BIOTECHNICAL SCIENCES; Nutrition
• Universal decimal classification (UDC): 613 - Hygiene. Personal health and hygiene. Dietetics. Occupational diseases. Addictions. Sexual hygiene

Abstract

Pothranjenost u bolnicama pokazuje visoku prevalenciju čak i do 50% u hopitalizirana djece u najrazvijenijim zemljama svijeta. Glavni je cilj ovog istraživanja odrediti povezanost pothranjenosti i pojavnosti nozokomijalnih gastrointestinalnih i respiratornih infekcija u pedijatrijskih bolesnika, dok su sekundarni ciljevi u prvom redu bili odrediti prevalenciju pothranjenosti djece u trenutku bolničkog prijema i prilikom otpusta, istražiti utjecaj hospitalizacije na nutritivni status bolesnika, istražiti utjecaj pothranjenosti ali i nozokomijalnih infekcija na duljinu hospitalizacije te procijeniti energijski unos pedijatrijskih bolesnika tijekom hospitalizacije. Riječ je o opažajnom, prospektivnom, longitudinalnom, kohortnom istraživanju provedenim na četiri pedijatrijska odjela tijekom točno jedne godine. Svoj unovačenoj djeci određen je nutritivni status unutar 24 sata od bolničkog prijema i na samom otpustu. Pothranjena djeca uspoređena su s onom normalno uhranjenom u donosu na: pojavnost infekcija, promjenu tjelesne mase i duljine hospitalizacije. U istraživanje je uključeno 367 pedijatrijskih bolesnika (djevojčice 184/50,1%; dječaci 183/49,9%) srednje dobi 7.26 godina, (raspon: 1 mj -18 god). U trenutku hospitalizacije 47 bolesnika (12.8%) bilo je pothranjeno od čega umjereno pohranjenih (BMI −2 to −3 SDS) 7.9%, a teško pothranjenih (BMI <−3 SDS) 5.7%. Ukupno je 21 bolesnik (5.7%) dobio nozokomijalnu infekciju gdje su pothranjena djeca značajno prednjačila (11/47 (23.4%) naspram 11/318 (3.5%); p<0. 001). Duljina hospitalizacije bila je značajno dulja u djece koja su pothranjena (12.3 naspram 7.3 dana; p =0.004). Binarnom logističkom regresijom pokazano je da su šanse da pothranjeno dijete dobije nozokomijalnu infekciju 5 puta veće (RR 5.1 (95% CI 2,276-11,485)) nego u normalno uhranjenog djeteta, a rizik se dodatno povećava prolongiranom hospitalizacijom. Tijekom hospitalizacije više od 40% svih bolesnika gubi na tjelesnoj masi, a njih preko 50% ima energijski unos manji od 60% preporučenog dnevnog unosa. Konačno se može zaključiti da su pothranjeni pedijatrijski bolesnici bili značajno dulje hospitalizirani i boravili su u bolnici čak 4 dana dulje u usporedbi s nepothranjenim bolesnicima te su znatno češće obolijevala od nozokomijalnih gastrointestinalnih i respiratornih infekcija u usporedbi sa ostalom hospitaliziranom djecom, odnosno pothranjeni bolesnici imali su 5 puta veći rizik da obole od nozokomijalnih infekcija.

Abstract (english)

Malnutrition in hospitals indicates a high prevalention, even 50% in some developed countries troughout the world. The main aim of this study was to analyze the impact of malnutrition on the incidence of nosocomial infections in hospitalized children and secondary goals were to determine influence of hospitalization on nutritional status, malnutrition and presence of infection on length of hospital stay (LOS) and to determine the energy intake during the hospitalization. This was a prospective cohort study which included children hospitalized at four Pediatric Departments during a period of 1 year. In all children standardized anthropometry was performed within the first 24 hours after admission and on discharge. Malnourished children were compared to non-malnourished in relation to: weight change during hospital stay, frequency of nosocomial infections and LOS. 367 of pediatric patients were included into the study (girls 184/50,1%; boys 183/49,9%); mean age 7.26 years, (range: 1 m-18 y). At hospital admission overall 47 patients (12.8%) were malnourished; moderate malnutrition (BMI −2 to −3 SDS) was present in 7.9% patients and severe malnutrition (BMI <−3 SDS) in 5.7%. In respect to the weight change during the hospital stay, at the time of discharge significantly lower number of children were severely malnourished (decrease from 5.7% to 2.7%, p<0.001). Altogether 21 children (5.7%) experienced nosocomial infection where malnourished children acquired nosocomial infections significantly more often in comparison to other pediatric patients (11/47 (23.4%) vs. 11/318 (3.5%), respectively; p<0. 001). Lastly, the LOS was significantly longer in children who were malnourished (12.3 vs. 7.3 days, respectively; p =0.004). Binary logistic regression showed that odds of acquiring nosocomial infections were 5 times higher (RR 5.1 (95% CI 2.276-11.485)) in children who were malnourished, moreover, risk increased with prolonged hospital stay. During the hospitalization more than 40% of all patients lost weight, and more than 50% of patients has had energy intake lower than 60% of Recommended Daily Allowances (D-A-CH). Finally we can conclude that malnourished paediatric patients were significantly longer in hospital for even 4 days in relation to non-malnourished children and they more often developed nosocomial gastrointestinal and respiratory infections.

• Keywords: nutritivni status; antropometrija; unos hrane; pothranjenost; nozokomijalne infekcije; duljina hospitalizacije
• Keywords (english): nutritional status; anthropometry; food intake; malnutrition; nosocomial infections; length of hospitalisation
• Language: croatian
• URN:NBN: urn:nbn:hr:159:892445
• Study programme: Title: Nutrition; Study programme type: university; Study level: postgraduate; Academic / professional title: doktor znanosti/doktorica znanosti (doktor znanosti/doktorica znanosti)
• Type of resource: Text
• Extent: 130 str. : 30 cm
• File origin: Born digital
• Access conditions: Access restricted to students and staff of home institution
• Created on: 2021-02-25 10:37:28