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Medical nutrition therapy plays integral role in surgery

Medical nutrition therapy plays integral role in surgery

The body needs certain nutrients, such as vitamin D and calcium, to build and maintain healthy bones. Staff members at Shriners Hospitals for Children — Erie Ambulatory Surgery Center and Outpatient Specialty Care Center have seen many children who are not good candidates for surgery because they have low amounts of these minerals.

A large percentage of the patient population is clinically diagnosed with failure to thrive, being underweight or overweight. Furthermore, patients will often have problems with their nutrition due to medical conditions, feeding challenges, medications and psychosocial stressors.

To get these children ready for surgery, Wendi Connelly, R.D., L.D.N., a registered dietitian at the Erie Medical Center who specializes in pediatric nutrition, provides medical nutrition therapy (MNT).

Prior to surgery, Connelly will have patients undergo a nutrition screening process and, if needed, she will perform an individual nutrition assessment where she obtains detailed information, along with the patient’s weight, height and body mass index (BMI).

Connelly will look at the child’s medical and social histories, psychological stressors and diet history. Family structure, size and/or cultural beliefs may impact nutrition status, as well. She will also ask:

  • What does the child’s daily intake of solids and liquids include?
  • How often do they eat?
  • Are they tube fed or orally feeding?
  • Are there orthopaedic conditions impairing their ability to achieve normal weight?

Some other factors that are important to the assessment include medications, general appearance, signs of malnutrition or dehydration, excessive drooling or vomiting.

This data assists Connelly in establishing intake and weight goals and determining appropriate daily calories, protein and fat (which may include supplements). Each MNT plan is specific to the child and the surgical goals. Based on the assessment and MNT outcomes over time, Connelly offers clinical data to the physician along with a recommended timeframe for surgery.

Joshua Pahys, M.D., orthopaedic surgeon, has found the MNT services are necessary. “It is common for early onset scoliosis patients, as well as patients with complex spinal deformities, to be severely underweight,” he said. “These patients have heightened metabolic demands and despite parents’ and pediatricians’ best efforts, the patients still remain vastly underweight. This has prohibited us from doing surgery on some patients as they are too undernourished to undergo an extensive procedure and reliably heal postoperatively.”

Connelly noted that proper nutrition plays a critical role after surgery too. “A child’s body must be in the strongest state possible in order for a full recovery to happen,” she said. “Children who are malnourished experience more frequent infectious complications, longer postoperative stays and recovery time, increased complications with anesthesia, delayed wound healing, and may not achieve goals in physical, occupational and speech therapy.”

When physicians and dietitians work closely together in MNT, they ensure optimal nutritional health for their patients, which improves outcomes and allows patients to reach their fullest potential.

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