Peds II: SGNA

Question 1

Define pediatric malnutrition

Answer 1

Deficit of intake leading to negative outcomes
* “An imbalance between nutrient requirements and intake, resulting in cumulative deficits of energy, protein or micronutrients that may negatively affect growth, development and other relevant outcomes.”

Question 2

Markers of malnutrition

Answer 2

None of them tell the whole story and not neccessarily individualized to the patient
* Anthropometrics
* Intake
* Estimated needs
* Lab values

Question 3

Describe the SGNA

Answer 3

SGNA (subjective global nutritional assessment) is an abbreviated nutritional assessment and considered a gold standard for diagnosing pediatric malnutrition in hospitals
* Takes 10 – 15 minutes to complete
* Nutrition history and nutrition focused physical exam (NFPE) → fat and muscle wasiting; fluid status
* Subjective → Use your clinical judgement; the SGNA is a guide.

Question 4

Indicators of the SGNA

Answer 4

Nutrition focused medical history
* Appropriateness of current height for age → a) length/height z-score; b) serial growth; c) appropriate considering mid parental hieght?
* appropriateness of current weight for height
* unintentional changes in body weight → a) changes in weight for age z-score (serial weight); b) weight loss; c) change in past 2 weeks
* Adequacy of dietary intake → a) adequacy; b) current intake versus usual; c) duration of change
* GI symptoms → a) GI symptoms; b) duration of symptoms
* Functional capacity → a) functional capacity; b) function in past 2 weeks
* metabolic stress of disease

Physical exam
* loss of subcutaneous fat
* muscle wasting
* edema (nutrition related)

Question 5

Examples of metabolic stress

Answer 5

• Moderate: Routine surgery, fractures, infections, pressure sores
• Severe: Major surgery, trauma, multiple injuries, severe sepsis

Question 6

SGNA malnutrition risk

Answer 6

Normal
* Growing normally, adequate intake, no GI symptoms
OR
* Moderate malnutrition, but significant, continued improvement in most areas

Moderate
* Definite signs of weigh loss or poor weight gain, poor intake
* May or may not show signs of decreased functional capacity or fat/muscle wasting
* Potential to progress to severe malnutrition
OR
* Severe malnutrition with significant, continued improvements in most areas

Severe
* Progressive malnutrition with significant weight loss / poor weight gain and decreased intake
* Excessive GI losses and/or acute metabolic stress and decreased functional capacity
* Clear fat and muscle wasting in most areas
* Severe rating in most categories with no signs of improvement

Question 7

SGNA Case Study - Olivia

Answer 7

Notes