Trauma Nutrition Clinical Pathway — ICU

Assessment for Malnutrition

Poor nutritional status on subjective clinical assessment
- Diminished subcutaneous fat, muscle mass, hollow face
Reduced caloric intake in days before admission
Prior nutritional intervention required
Recent weight loss or lack of weight gain in infants

Reference

Dutch National Survey to Test the STRONGkids Nutritional Risk Screening Tool in Hospitalized Children

Diagnosis of Malnutrition

Weight for Length Z-score (1 mos – 2 yrs)	Z-score ≤ -1.00
BMI for Age Z-score (> 2 yrs of age)	Z-score ≤ -1.00
Length or Height for age Z-score	Z-score ≤ -3.00
Mid-Upper Arm Circumference	Z-score ≤ -1.00
Weight Gain Velocity (< 2 yrs of age)	Less than 75% of the norm for expected weight gain
Weight Loss (2-20 yrs)	≥ 5% usual body weight
Deceleration in Weight for Length or BMI for Age Z-score	Decline in ≥ 1 Z-score
Inadequate Nutrient Intake	≤ 75% of estimated energy or protein needs

Reference

Consensus Statement of the Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition: Indicators Recommended for the Identification and Documentation of Pediatric Malnutrition (Undernutrition)

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The clinical pathways are based upon publicly available medical evidence and/or a consensus of medical practitioners at The Children’s Hospital of Philadelphia (“CHOP”) and are current at the time of publication. These clinical pathways are intended to be a guide for practitioners and may need to be adapted for each specific patient based on the practitioner’s professional judgment, consideration of any unique circumstances, the needs of each patient and their family, and/or the availability of various resources at the health care institution where the patient is located.

Accordingly, these clinical pathways are not intended to constitute medical advice or treatment, or to create a doctor-patient relationship between/among The Children’s Hospital of Philadelphia (“CHOP”), its physicians and the individual patients in question. CHOP does not represent or warrant that the clinical pathways are in every respect accurate or complete, or that one or more of them apply to a particular patient or medical condition. CHOP is not responsible for any errors or omissions in the clinical pathways, or for any outcomes a patient might experience where a clinician consulted one or more such pathways in connection with providing care for that patient.