EARLY NUTRITION PROTOCOL FOR IN- AND OUT-PATIENTS DURING COVID-19 PANDEMIC

OBJECTIVE: Recent SARS-COV2 pandemic put Healthcare System in severe overload. It is well demonstrated that malnutrition is related to worse outcomes in acute and chronic diseases. During this sanitary emergency the Clinical Nutrition Unit in Bologna developed an early nutrition protocol for hospital ad home COVID-19 patients. METHODS AND PROCEDURES: Recently published recommendations regarding nutritional needs in COVID-19 patients and general Clinical Nutrition Guidelines were searched on PubMed. RESULTS: The hospital algorithm considered three different steps: oral feeding, enteral feeding and parenteral nutrition, recommending early nutrition therapy (within 24-48 hours of hospitalization). We arranged a modified oral "COVID diet" consisting in soft or creamy hypercaloric-hyperproteic meals in disposable packages . As far as artificial nutrition is concerned we chose hypercaloric, high-protein Oral Nutrition Supplements (ONS), enteral formulas and parenteral formulas, all enriched with EPA and DHA. Due to high micronutrients requirements each patient was recommended high-dose uniparenteral vitamin D and thiamine. For home COVID-19 patients screening using NRS-2003 was recommended: for those at low nutritional risk we provided general nutritional advice; for those at intermediate risk we suggested a dietitian consultation for personalized nutritional plan or ONS prescription. For those at high nutritional risk the nutritionist physician evaluation was suggested for disease-specific ONS or artificial nutrition prescription. All patients were suggested vitamin D 2000 IU / day and a multivitamin supplement. CONCLUSION: During COVID-19 pandemic continuous clinical updating and adaptation to new clinical settings helped to develop an Early Nutrition Protocol for fast nutritional assessment and treatment in a large number of patients and emergency conditions.