Nutritional Care After Hospital Discharge (NutriCAD): protocol for a stepped-wedge, multicentre, randomised controlled trial in paediatrics
19 affiliations
- 1Department of Neonatal and Paediatric Intensive Care, Erasmus MC, Rotterdam, Netherlands
- 2Internal Medicine, Division of Dietetics, Erasmus MC, Rotterdam, Netherlands
- 3Department of Paediatrics, Albert Schweitzer Hospital, Dordrecht, Netherlands
- 4Department of Paediatrics, Amphia Ziekenhuis, Breda, North Brabant, Netherlands
- 5Department of Paediatrics, Catharina Hospital, Eindhoven, Netherlands
- 6Department of Dietetics, Noordwest Ziekenhuisgroep, Alkmaar, Netherlands
- 7Department of Paediatrics, Gelderse Vallei Hospital, Ede, Netherlands
- 8Department of Dietetics, Albert Schweitzer Hospital, Dordrecht, Netherlands
- 9Department of Dietetics, Amphia Hospital, Breda, Netherlands
- 10Department of Dietetics, Catharina Hospital, Eindhoven, Netherlands
- 11Department of Dietetics, Gelderse Vallei Hospital, Ede, Netherlands
- 12Institute for Medical Technology Assessment (iMTA), Erasmus University Rotterdam, Rotterdam, Netherlands
- 13Obstetrics and Gynaecology, Erasmus MC, Rotterdam, Netherlands
- 14Biostatistics, Erasmus MC, Rotterdam, Netherlands
- 15Department of Paediatrics, Division of Gastroenterology, Hepatology and Nutrition, SickKids, Toronto, Ontario, Canada
- 16Department of Paediatrics and Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
- 17Department of Paediatrics, Division of Gastroenterology, Hepatology, Amsterdam UMC Locatie AMC, Amsterdam, Netherlands
- 18Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC, Rotterdam, Netherlands
- 19Department of Internal Medicine, Erasmus MC, Rotterdam, Netherlands
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.
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BibTeX
@article{steenbergen2026nutritional,
title = {{Nutritional Care After Hospital Discharge (NutriCAD): protocol for a stepped-wedge, multicentre, randomised controlled trial in paediatrics}},
author = {Esther van Steenbergen and Doortje Hage and Ankie Lebon and Herbert van Wering and Janneke Stapelbroek and Eefje Winder-Bakker and Renske Bottema and Merel Baart-Visser and Sandra Van Gils and Evi Van den Berg and Esmée Kroon and Yolah Soldaat and Marten J Poley and Sten Willemsen and Jessie Hulst and Angelika Kindermann and K Dulfer and Elles van der Louw and K Joosten and Sascha Verbruggen},
journal = {BMJ Open},
year = {2026},
month = oct,
doi = {10.1136/bmjopen-2026-122183},
url = {https://bmjopen.bmj.com/lookup/doi/10.1136/bmjopen-2026-122183},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Nutritional Care After Hospital Discharge (NutriCAD): protocol for a stepped-wedge, multicentre, randomised controlled trial in paediatrics
AU - Esther van Steenbergen
AU - Doortje Hage
AU - Ankie Lebon
AU - Herbert van Wering
AU - Janneke Stapelbroek
AU - Eefje Winder-Bakker
AU - Renske Bottema
AU - Merel Baart-Visser
AU - Sandra Van Gils
AU - Evi Van den Berg
AU - Esmée Kroon
AU - Yolah Soldaat
AU - Marten J Poley
AU - Sten Willemsen
AU - Jessie Hulst
AU - Angelika Kindermann
AU - K Dulfer
AU - Elles van der Louw
AU - K Joosten
AU - Sascha Verbruggen
PY - 2026
DA - 2026/10/27
JO - BMJ Open
DO - 10.1136/bmjopen-2026-122183
UR - https://bmjopen.bmj.com/lookup/doi/10.1136/bmjopen-2026-122183
AB - 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.
SN - 2044-6055
SN - 2044-6055
ER -