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Development of the Pediatric Integrated Nutrition Pathway for Acute Care (P-INPAC) using a modified Delphi technique.
Applied Physiology Nutrition and Metabolism 2024 Februrary 7
One in three hospitalized children have disease related malnutrition (DRM) upon admission to hospital, and all children are at risk for further nutritional deterioration during hospital stay, however, systematic approaches to detect DRM in Canada are lacking. To standardise and improve hospital care, the multidisciplinary pediatric working group of the Canadian Malnutrition Taskforce aimed to develop a pediatric, inpatient nutritional care pathway based on available evidence, feasibility of resources, and expert consensus. The working group (n=13) undertook a total of four meetings: an in-person meeting to draft the pathway based on existing literature and modelled after the Integrated Nutrition Pathway for Acute Care (INPAC) in adults, followed by three online surveys and three rounds of on-line Delphi consensus meetings to achieve agreement on the draft pathway. In the first Delphi survey, 32 questions were asked, whereas in the second and third round 27 and 8 questions were asked respectively. Consensus was defined as any question/ issue in which at least 80 % agreed. The modified Delphi process allowed the development of an evidence-informed, consensus-based pathway for inpatients , the Pediatric Integrated Nutrition Pathway for Acute Care (P-INPAC). It includes screening < 24 hours of admission, assessment with use of Subjective Global Nutritional Assessment (SGNA) < 48 hours of admission, as well as prevention, and treatment of DRM divided in standard, advanced and specialized nutrition care plans. Research is necessary to explore feasibility of implementation and evaluate the effectiveness by integrating P-INPAC into clinical practice.
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