Enhanced Nutritional Support for Patients with Complex Needs

A new, comprehensive nutrition program at Cincinnati Children’s is ensuring that patients with complex medical conditions receive optimal nutritional support across the continuum of care.

The program, created by pediatric gastroenterologists Marialena Mouzaki, MD, MSc, and Stephanie Oliveira, MD, formalizes and expands existing nutrition support services for hospitalized patients. The two physicians lead weekly nutritional support rounds in pediatric oncology and the intensive care unit for patients on enteral or parenteral nutrition. In addition, they consult on inpatients with acute or chronic nutritional issues, spanning from malnutrition to specific disease-related nutritional deficiencies. Their goal is to incorporate evidence-based protocols and be a resource for providers who are caring for patients with complex nutritional needs.

The importance of nutritional status

“Often with complex patients, it is easy to not prioritize nutritional care because providers are focusing on other important things, including survival,” says Oliveira, who completed a fellowship in advanced pediatric nutrition at Cincinnati Children’s in 2017. “But research shows that a patient’s nutritional status is important, and directly linked to length of stay, complications during hospitalization and overall mortality.”

The program serves a variety of patients, including children who are having difficulty gaining weight after a heart transplant, patients who had a significant bowel resection, obese patients with a critical illness, and others. Mouzaki, who serves as the nutrition program’s medical director, and Oliveira also provide ad hoc consults for other patients as needed. Eventually, the goal is to provide nutritional support through formalized rounds in other areas of the hospital where the patient stay is longer and where patients are at increased nutritional risk.

"Research shows that a patient’s nutritional status is important and directly linked to length of stay, complications during hospitalization and overall mortality."

Stephanie Oliveira, MD on the importance of nutritional care

The value of rounds

“Doing rounds with a registered dietitian and/or team is a practice that—according to the literature—leads to better patient outcomes than just having the physician or dietitian round separately,” says Mouzaki, who was the director of clinical nutrition at the Hospital for Sick Children in Toronto prior to joining the faculty at Cincinnati Children’s in 2017. “Rounding also is an opportunity for all of us to learn from each other, and for Stephanie and me to provide support to dietitians who may be fairly junior or have had limited exposure to patients with complex nutritional issues.”

Mouzaki adds that she and Oliveira are developing a nutrition clinic to follow up on children who are at risk of malnutrition or were malnourished while in the hospital, to make sure that nutritional support remains a focus.

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