Audit of Nutritional Blood Screen in Patients with Feeding Problems in a Community Paediatric Setting

Background: Community paediatricians commonly deal with feeding difficulties in patients with neurodevelopmental problems. There are no clear guidelines available regarding which patients should have a nutritional blood screen if there are no overt signs of vitamin deficiency. There is a wide variation in practice amongst medical staff.

Objective: To determine rationale for sending a nutritional blood screen and to determine how this influences management.

Methods: A retrospective audit of vitamin blood levels sent from patients of 6 community paediatric consultants from 1/7/17 to 31/7/18. Of those patients; diagnosis, reason for testing, growth parameters and haemoglobin level were recorded, if available.

Results: 12 patients had vitamin blood tests sent in the study period. Demographics of the patients; 9:3 male:female, age range 1-5 years, range of diagnosis recorded included autistic spectrum disorder, epilepsy, and developmental delay. The most common reason for testing was restricted diet in 5/12 patients.

Results of investigations; 12 patients had Vitamin D levels tested (3 deficient), 2 Vitamin A (normal), 2 Vitamin E (normal), 1 Vitamin C (sample insufficient). 9 patients had a haemoglobin tested (1 patient deficient <10g/dl). Growth parameters were recorded for 10/12 patients and none had faltering growth. Cost of the tests were obtained from the biochemistry laboratory. (Vitamin D £14, Vitamin C £6, Vitamin A,E £10).

Conclusion: This small study highlights that testing vitamin levels in patients with restricted diet has limited benefit and is not cost effective, in this setting. Following discussion with the multidisciplinary team, it was thought that a food diary with dietetic input and daily multivitamin was sufficient in patients with no overt signs of deficiency. Education of staff regarding signs and symptoms of deficiency was carried out to raise awareness of patients at risk.