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G224 A systematic review to determine if undernutrition is prognostic of infection complications in children following surgery
  1. R Hill1,2,
  2. S Paulus3,
  3. MP Dey4,
  4. MA Hurley2,
  5. B Carter2
  1. 1Department of Cardiac Surgery, Alder Hey Children’s NHS Trust, Liverpool, UK
  2. 2School of Health, University of Central Lancashire, Preston, UK
  3. 3Department of Immunology and Infectious Disease, Alder Hey Children’s NHS Trust, Liverpool, UK
  4. 4School of Medicine and Dentistry, University of Central Lancashire, Preston, UK


Background Hospitalisation has a major impact on the nutritional status of children1. Although incidence of undernutrition has been reported, fewer studies have investigated its effect on patient outcome following paediatric surgery.

Review methods

Key electronic bibliographic and research databases were searched. Inclusion criteria were studies in children <18 years evaluating preoperative nutritional status and reporting postoperative infection complications. Quality assessment was performed using Newcastle-Ottawa Scale2 for cohort and case-control studies. Appraisal and data extraction were performed independently by two reviewers. Effect estimates and 95% confidence intervals were extracted or calculated using Chi Square or Fisher’s Exact tests as appropriate.

Results Two reviewers screened a total of 1108 references. Ten cohort and two case-control studies using a plethora of nutritional assessments were included in the review. Postoperative infection complications reported were either combined or individual e.g. wound infection. Quality of the evidence was judged as low in the majority of studies, with two of moderate and two of very low quality. Direct comparison between studies was not possible due to clinical and diagnostic heterogeneity. Direction of effect on univariate analysis was suggestive of a relationship between undernutrition and postoperative infection complications.

Conclusion The lack of a consistently applied method of nutritional assessment, combined with small sample sizes, makes it difficult to draw strong conclusions. There is tentative low quality evidence suggesting undernutrition may be predictive of combined infection complications following surgery in children, but insufficient evidence to determine if this relationship persists when considering specific infection complications. Larger studies, using gold-standard nutritional assessment, and designed to investigate undernutrition with outcome are warranted to investigate this relationship further.


  1. Pichler J, Hill SM, Shaw V, Lucas A. Prevalence of undernutrition during hospitalisation in a children’s hospital: what happens during admission? Eur J Clin Nutr 2014; 68:730–735

  2. Wells GA, Shea B, O’Connell D, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses., 2011

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