Nutritional assessment: An integral part of the preoperative pediatric surgical evaluation

Comprehensive nutritional assessment in adults has revealed that 50% of hospitalized patients suffer from acute protein calorie malnutrition (PCM), a state which correlates with increased surgical morbidity and mortality. We report our results examining the same question in children, and on the basis of these data suggest that nutritional assessment be a routine part of the preoperative evaluation of all pediatric surgical patients. We studied 198 children and found that the overall prevalence of acute PCM was 54%; but if premature and term infants less than three months of age are selected, the prevalence of acute PCM was a striking 63%. If only surgical patients are considered, the prevalence of acute PCM among patients hospitalized for trauma or burns was 31%, for elective operation 39%, and for acute but complex operative procedures 64%. These data demonstrate that a remarkably high prevalence of acute PCM exists among hospitalized pediatric and pediatric surgical patients. Whether aggressive perioperative nutritional support can reverse such acute PCM and favorably influence morbidity and mortality is currently speculation, but that acute protein calorie malnutrition is far more prevalent among hospitalized pediatric patients than is generally realized, and that comprehensive nutritional assessment is essential to identify the "at risk" nutritionally deprived pediatric surgical patient, have now been proven.