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Nutritional Care After Hospital Discharge (NutriCAD): protocol for a stepped-wedge, multicentre, randomised controlled trial in paediatrics

Year: 2026

Type: article

Abstract: INTRODUCTION: In the Netherlands, an estimated 60 000–70 000 children are hospitalised annually, of whom approximately 9% are acutely malnourished or at high risk at the time of admission. Every year, 3000 children are discharged with ongoing nutritional support. Disjointed postdischarge care often leads to prolonged enteral feeding dependency, feeding difficulties and nutritional deterioration. A structured, multidisciplinary follow-up programme may improve nutritional outcomes, reduce healthcare utilisation and support family well-being. The Nutritional Care After Hospital Discharge (NutriCAD) study aims to evaluate whether a tailored, multidisciplinary nutritional care programme with a parent empowerment component is cost-effective and improves growth, feeding behaviour and parental well-being in children discharged from hospital with nutritional support. METHODS AND ANALYSIS: NutriCAD is a stepped-wedge cluster randomised controlled trial conducted in one academic and five general hospitals in the Netherlands. 260 children (term-born neonates to 18 years) discharged with newly initiated enteral nutritional support will be enrolled. At baseline, all hospitals deliver usual care; clusters sequentially cross over to the intervention at 3 monthly intervals. The intervention comprises an individually tailored nutritional plan and a structured parent empowerment programme, delivered at discharge and at 6-week, 12-week and 18-week outpatient follow-up visits. The primary outcomes are change in weight-for-age SD-score (children <1 year) or weight-for-height SD-score (children ≥1 year) and change in height-for-age SD-score from discharge to 6 months postdischarge. Secondary outcomes are changes in body composition, duration and frequency of nutritional support and/or dependency on nasogastric tube feeding, nutritional requirements and intake, feeding behaviour of the child, parental stress, quality of life of children and parents, cost-effectiveness of tailored nutritional care and barriers and facilitators of implementation of the multidisciplinary team 6 months after discharge. Analyses will follow the intention-to-treat principle using mixed-effects regression models, adjusted for clustering and predefined confounders. ETHICS AND DISSEMINATION: The protocol and informed consent forms were approved by the Institutional Review Board of Erasmus MC, Rotterdam (MEC-2023-0490). Formal ethical approval was waived at all other participating sites, each of which obtained local Board of Directors authorisation. Written informed consent is obtained from parents or legal guardians; participants aged 12–15 years also provide written assent, and participants aged 16 years and older provide their own written consent. Results will be disseminated through peer-reviewed publications and national and international scientific conferences. TRIAL REGISTRATION NUMBER: NCT06603792.

Source: BMJ Open

DOI: 10.1136/bmjopen-2026-122183