The Effect of Different Nutritional Nursing Support on the Nutritional Status and Disease Recovery of Elderly Patients with Gastrointestinal Tumors during the Perioperative Period.

Objective: This study explored the effect of different nutritional nursing support on nutritional status, immune function, postoperative bowel motility, and complications in elderly patients with gastrointestinal tumors during the perioperative period. Methods: 300 patients with gastrointestinal tumors treated in the Department of Gastroenterology and anorectal surgery of Hangzhou First People's Hospital Affiliated with the Medical College of Zhejiang University from February 2018 to March 2020 were selected as the research objects in this study. Patients were divided into the early enteral nutrition (EEN) and total parenteral nutrition (TPN) groups (150 cases in each group) according to the principle of odd and even admission numbers. The patients in the EEN and TPN groups were given enteral nutrition nursing support and parenteral nutrition nursing support, respectively. The nutritional status, immune function, postoperative bowel motility, and complication rate of the two groups were evaluated 7 days after the operation. Results: The nutritional indexes decreased 3 days after the operation and gradually recovered 7 days after the operation in both groups with different nutritional nursing support. The Hb, TRF, PAB, and ALB indexes in the TPN group were significantly lower than those in the EEN group (P < 0.01). On the 7th day after the operation, the indexes of peripheral blood immunoglobulin (IgG, IgM, and IgA) were significantly lower than those in the TPN group, and T lymphocyte subsets (CD4, CD8, and CD4/CD8) demonstrated that the immunological indexes of patients in the EEN group were significantly higher than those in the TPN group (P < 0.01). In terms of intestinal peristalsis, the time of first exhaust and first defecation in the EEN group was significantly shorter than that in the TPN group (P < 0.01) during the perioperative period. Furthermore, both groups had different degrees of complications, while patients demonstrated a lower complication rate in the EEN group compared to those in the TPN group, suggesting a safer postoperative mode. The results of subgroup analysis showed that the nutritional indexes of the gastric cancer group 7 days after operation were significantly higher than those of the colorectal cancer group under EEN and TPN nutritional support modes. Conclusion: Clinical results have suggested that enteral nutrition nursing support can improve the perioperative nutritional status of elderly patients with gastrointestinal tumors by enhancing the immune function and promoting intestinal peristalsis. Meanwhile, the postoperative EEN mode reduces the rate of complications and demonstrates higher safety. Therefore, it has a high clinical application value.

Nutritional support for children and young people: nasogastric tubes.

The need to offer nutritional support to children and young people is commonplace for health professionals. This article explores the use and indication of nasogastric tubes (NGT) in children and young people, before explaining the process of inserting NGTs and the ongoing management of this method of nutritional support.

Nutritional Care in Relation to COVID-19.

The following article was written after the initial wave of the COVID-19 pandemic in the UK. On reflection of clinical practice during this time, it was noted by the ICU team that the majority of ventilated patients appeared to have lost weight during their stay. Unfortunately, there was no ability to weigh patients during the pandemic, so this weight loss was a subjective observation. Regardless, this observation lead the ICU dietitian to retrospectively audit prescribed versus delivered feed. It was found that only 10% of admissions received the prescribed daily volume of feed within the first 7 days of admission. A further 6% of admissions were within 10% of achieving daily prescribed target volumes. The main reasons for this were proning patients, high gastric residual volumes and the overwhelming nature of the pandemic. Three areas of practice have been highlighted that will improve feed delivery should a second wave occur. 1. A nasojejunal team comprising 20 members of the ICU multidiciplinary team will be established to insert bedside nasojejunal tubes in all ICU patients on admission. 2. All proned patients will be enterally fed and practice adjusted as per British Dietetic Association recommendations. 3. The international enteral feeding guidelines regarding hypocaloric feeding for the first 7 days will not be followed due to minimal clinical evidence for the ICU COVID-19 demographic.

Effects of using the MyFood decision support system on hospitalized patients' nutritional status and treatment: A randomized controlled trial.

BACKGROUND & AIMS: Compliance to guidelines for disease-related malnutrition is documented as poor. The practice of using paper-based dietary recording forms with manual calculation of the patient's nutritional intake is considered cumbersome, time-consuming and unfeasible among the nurses and does often not lead to appropriate nutritional treatment. We developed the digital decision support system MyFood to deliver a solution to these challenges. MyFood is comprised of an app for patients and a website for nurses and includes functions for dietary recording, evaluation of intake compared to requirements, and a report to nurses including tailored recommendations for nutritional treatment and a nutritional care plan for documentation. The study aimed to investigate the effects of using the MyFood decision support system during hospital stay on adult patients' nutritional status, treatment and hospital length of stay. The main outcome measure was weight change. METHODS: The study was a parallel-arm randomized controlled trial. Patients who were allocated to the intervention group used the MyFood app during their hospital stay and the nurses were encouraged to use the MyFood system. Patients who were allocated to the control group received routine care. RESULTS: We randomly assigned 100 patients (51.9 ± 14 y) to the intervention group (n = 49) and the control group (n = 51) between August 2018 and February 2019. Losses to follow-up were n = 5 in the intervention group and n = 1 in the control group. No difference was found between the two groups with regard to weight change. Malnutrition risk at discharge was present in 77% of the patients in the intervention group and 94% in the control group (p = 0.019). Nutritional treatment was documented for 81% of the patients in the intervention group and 57% in the control group (p = 0.011). A nutritional care plan was created for 70% of the intervention patients compared to 16% of the control patients (p < 0.001). CONCLUSIONS: The intervention had no effect on weight change during hospital stay. A higher proportion of the patients in the control group was malnourished or at risk of malnutrition at hospital discharge compared to the patients in the intervention group. The documentation of nutritional intake, treatment and nutritional care plans was higher for the patients using the MyFood system compared to the control group. This trial was registered at clinicaltrials.gov (NCT03412695).

Cross-cultural adaptation and validation of questionnaire for knowledge, attitudes, and behavioral intentions in Italian nurses with regard to provision of artificial nutrition and hydration to patients terminally ill with cancer.

OBJECTIVES: Decision-making on artificial nutrition and hydration for patients terminally ill with cancer can be influenced by nurses' knowledge, attitudes, and behavioral intentions. A comprehensive 57-item questionnaire including six sections on the knowledge, attitudes, and behavioral intentions in providing artificial nutrition and hydration to patients terminally ill with cancer has been developed and used in Taiwan. However, the questionnaire needs further psychometric testing and adaptation for other cultures. This study aimed to cross-culturally adapt the questionnaire within the Italian cultural context and test its psychometric properties. METHODS: The questionnaire was translated into Italian and cross-culturally adapted per the recommendations by Beaton. A panel of 10 experts assessed content validity. A multicenter cross-sectional study was conducted with 411 nurses to test its psychometric properties. Dimensionality and construct validity were assessed through exploratory and confirmatory factor analyses. Reliability was estimated by composite ω and traditional methods, such as the Kuder Richardson formula-20 and Cronbach's α coefficients. RESULTS: The overall content validity index was 0.85. A confirmatory factor analysis was conducted for the knowledge section and the four attitudes sections. A preliminary analysis for the behavioral intentions section yielded non acceptable results. The internal consistency of the scales was adequate (range, 0.64-0.93). CONCLUSIONS: This study constituted a notable advancement in the psychometric testing of the tool, and provides evidence that the Italian version of the questionnaire has acceptable psychometric characteristics for the sections on knowledge and attitudes.

Interventions to prevent and treat malnutrition in older adults to be carried out by nurses: A systematic review.

AIMS AND OBJECTIVES: To identify interventions to prevent and treat malnutrition in older adults, which can be integrated in nursing care, and to evaluate the effects of these interventions on outcomes related to malnutrition. BACKGROUND: Older adults are at great risk for malnutrition, which can lead to a number of serious health problems. Nurses have an essential role in nutritional care for older adults. Due to a lack of evidence for nursing interventions, adequate nursing nutritional care still lags behind. DESIGN: Systematic review. METHOD: We searched for and included randomised controlled trials on interventions, which can be integrated in nursing care for older adults, to prevent and treat malnutrition. We assessed the risk of bias with the Cochrane tool and evidence for outcomes with the GRADE. The PRISMA statement was followed for reporting. RESULTS: We included 21 studies of which 14 studies had a high risk of bias. Identified interventions were oral nutritional supplements, food/fluid fortification or enrichment, dietary counselling and educational interventions. In evaluating the effects of these interventions on 11 outcomes related to malnutrition, significant and nonsignificant effects were found. We graded the certainty of evidence as very low to moderate. CONCLUSION: Although slight effects were found in protein intake and body mass index, there is no convincing evidence about the effectiveness of the four identified interventions. There seems no harm in using these interventions, although it should be kept in mind that the evidence is sparse. Therefore, there is a need for high-quality research in building evidence for interventions in nursing nutritional care. RELEVANCE TO CLINICAL PRACTICE: Nurses can safely provide oral nutritional supplements and food/fluid fortification or enrichment, and give dietary counselling and education to older adults, as they are well placed to lead the essential processes of nutritional care to older adults.

Incorporating the latest pediatric nutrition support guidelines into clinical practice.

Optimal nutrition support in critically ill children is associated with improved outcomes and decreased mortality. Nutrition provision often competes with other care priorities in critically ill patients. The 2017 Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Pediatric Critically Ill Patient supplement clinician knowledge and inform best practices for nutrition therapy in this vulnerable patient population.

Employing a Nutrition Nurse in Neonatal Intensive Care Unit Improved Nutrition and Growth Outcomes in Preterm Neonates.

BACKGROUND: Nutrition nurses are clinical nurse specialists with knowledge and experience in nutrition support. We aimed to investigate the nutrition and growth outcomes after employment of a nutrition nurse in our level III neonatal intensive care unit (NICU). METHODS: A retrospective cohort study including preterm neonates < 34 weeks and < 2000 g were conducted. Nutrition and growth outcomes of infants in pre-nutrition-nurse and post-nutrition-nurse periods were compared. Primary outcome was presence of postnatal growth retardation (PGR) at term-equivalent age (body weight < 10 percentile at 40 weeks postmenstrual age). RESULTS: Infants in pre-nutrition-nurse (n = 38) and post-nutrition-nurse (n = 40) periods were similar with regard to gestational age, birth weight, gender, and perinatal characteristics. The initiation of parenteral nutrition after admission to NICU (30.8 ± 24.1 vs 6.7 ± 7.6 hours, P < 0,001) and attainment of full enteral feedings (27.3 ±18.1 vs 18.7 ± 11.3 days, P = 0.034) were earlier in post-nutrition-nurse period. First feeds were more commonly started with breast milk (29% vs 75%, P < 0.001); breastfeeding was more common at discharge (79% vs 95%, P = 0.045) and longer in duration (6.1 ± 7.3 vs 8.4 ± 6.3 months, P = 0.008) in post-nutrition-nurse period. Primary outcome PGR at term-equivalent age was lower in post-nutrition-nurse period (57.9% vs 27.5%, P = 0.007). CONCLUSION: Employing a nutrition nurse improved quality of nutrition support, increased breastfeeding, and decreased PGR in preterm neonates. Further prospective evaluation of outcomes in the presence of a nutrition nurse is needed to generalize these findings to other NICUs.

Three Nurse-administered Protocols Reduce Nutritional Decline and Frailty in Older Gastrointestinal Surgery Patients: A Cluster Randomized Trial.

OBJECTIVE: To evaluate the effects of the modified Hospital Elder Life Program (mHELP) comprising 3 nurse-administered protocols in older patients undergoing gastrointestinal (GI) surgery. DESIGN: Cluster randomized trial. SETTING: Two 36-bed GI wards at a university-affiliated medical center in Taiwan. PARTICIPANTS: Older patients (≥65 years, N = 377) were recruited if they were scheduled for elective GI surgery with an expected length of hospital stay >6 days. After transferring to the GI ward after surgery, participants were randomly assigned to the mHELP or control group (1:1) by room rather than individually because most patient units are double- or triple-occupancy rooms. INTERVENTION: The mHELP protocols (early mobilization, oral and nutritional assistance, and orienting communication) were administered daily with usual care by a trained nurse until hospital discharge. The control group received usual care only. MEASURES: Outcomes were in-hospital nutritional decline, measured by body weight and Mini-Nutritional Assessment (MNA) scores, and Fried's frailty phenotype. Return of GI motility was examined as a potential mechanism contributing to observed outcomes. RESULTS: Participants (mean age = 74.5 years; 56.8% male) primarily underwent colorectal (56.5%), gastric (21.2%), and pancreatobiliary (13.8%) surgery. Participants who received the mHELP [for a median of 7 days (interquartile range = 6-10 days)] had significantly lower in-hospital weight loss and decline in MNA scores (weight -2.1 vs -4.0 lb, P = .002; score -3.2 vs -4.0, P = .03) than the control group. The mHELP group also had significantly lower rates of incident frailty during hospitalization (12.0% vs 21.7%, P = .022), and persistent frailty (50.0% vs 92.9%, P = .03). Participants in the mHELP group had trends toward an accelerated return of GI motility. CONCLUSION AND IMPLICATIONS: The mHELP effectively reduced nutritional decline, prevented new frailty, and promoted recovery of frailty present before admission. These nurse-administered protocols might be useful in other settings, including conditions managed at home or in nursing facilities.

Stuck in tradition-A qualitative study on barriers for implementation of evidence-based nutritional care perceived by nursing staff.

AIMS AND OBJECTIVES: To explore the barriers for nutritional care as perceived by nursing staff at an acute orthopaedic ward, aiming to implement evidence-based nutritional care. BACKGROUND: Previous studies indicate that nurses recognise nutritional care as important, but interventions are often lacking. These studies show that a range of barriers influence the attempt to optimise nutritional care. Before the implementation of evidence-based nutritional care, we examined barriers for nutritional care among the nursing staff. DESIGN: Qualitative study. METHODS: Four focus groups with thirteen members of the nursing staff were interviewed between October 2013-June 2014. The interview guide was designed according to the Theoretical Domains Framework. The interviews were analysed using qualitative content analysis. RESULTS: Three main categories emerged: lacking common practice, failing to initiate treatment and struggling with existing resources. The nursing staff was lacking both knowledge and common practice regarding nutritional care. They felt they protected patient autonomy by accepting patient's reluctance to eat or getting a feeding tube. The lack of nutritional focus from doctors decreased the nursing staffs focus leading to nonoptimal nutritional treatment. Competing priorities, physical setting and limited nutritional supplements were believed to hinder nutritional care. CONCLUSION: The results suggest that nutritional care is in a transitional state from experience- to evidence-based practice. Barriers for nutritional care are grounded in lack of knowledge among nursing staff and insufficient collaboration between nursing staff and the doctors. There is a need for nutritional education for the nursing staff and better support from the organisation to help nursing staff provide evidence-based nutritional care. RELEVANCE TO CLINICAL PRACTICE: This study contributes with valuable knowledge before the implementation of evidence-based nutritional care. The study provides an understanding of barriers for nutritional care and presents explanations to why nutritional care has failed to become an integrated part of the daily treatment and care.

Changes in the dysphagia and nutritional status of patients with brain injury.

AIMS AND OBJECTIVES: To evaluate the degree of improvement in the dysphagia and nutritional status of patients with brain injuries after removal of the nasogastric tube. BACKGROUND: The nurse should assess patients' dysphagia, after removal of the nasogastric tube, and immediately reflect the changes in patient care. Accordingly, the critical roles of nurses in caring for patients with dysphagia involve providing appropriate nutritional therapy as well as preventing aspiration pneumonia and nutritional imbalance. Assessment of the patient's dysphagia on a regular basis and analysis of nutritional status according to the degree of dysphagia are necessary to determine the appropriate timing for providing nursing interventions and to develop protocols for the provision of a therapeutic diet. DESIGN: Prospective observational study. METHODS: This study was conducted on 56 patients with dysphagia after a brain injury. Data were collected using the Gugging Swallowing Screen (GUSS) test and Swallowing Symptom Questionnaire (SSQ). Descriptive statistics, chi-square tests, t tests, and MANOVA were analysed using SPSS 22.0. RESULTS: Patient's dysphagia was observed over the course of 2 weeks. After 14 days, the severity of dysphagia decreased from 91.1%-35.7%, while the number of participants with normal swallowing increased from 1.8%-58.9%. Dysphagia in patients with brain injury improved gradually over time. A significant difference was observed in the serum albumin level of patients with dysphagia (F = 9.51, p = .003, Wilk's λ = .034). CONCLUSIONS: Most of the patients with brain injury developed moderate dysphagia immediately after removal of the nasogastric tube. However, after 14 days had elapsed, the percentage of patients recovering from dysphagia increased to 58.9%. Proper dietary patterns were not adequately provided depending on the degree of patient's dysphagia after removal of the nasogastric tube. Assessing the degree of dysphagia using the GUSS test and providing appropriate diet prevent malnutrition in patients with dysphagia. RELEVANCE TO CLINICAL PRACTICE: This study was conducted in patients who developed complications of dysphagia after a brain injury. Using the Gugging Swallowing Screen (GUSS) test, the changes in the degree of dysphagia were repeatedly measured at different times: 4, 7 and 14 days after the removal of the nasogastric tube. Provision of appropriate diet and changes in the nutritional status were analysed to determine the proper timing for nursing intervention in patients with dysphagia. The data obtained from this study could serve as a basis for developing diet provision protocols for patients with dysphagia.

Adherence to a Nurse-Driven Feeding Protocol in a Pediatric Intensive Care Unit.

BACKGROUND: Patients admitted to pediatric intensive care units (PICUs) often experience prolonged periods without nutrition support, which may result in hospital-induced malnutrition and longer length of stay. Nurse-driven feeding protocols have been developed to prevent unnecessary interruptions or delays to nutrition support. The primary objective of this study was to identify compliance and reasons for noncompliance to a feeding protocol at a tertiary care hospital PICU in Canada. The secondary aim was to determine the mean time (hours) spent without any form of nutrition and to identify reasons for time spent without nutrition. MATERIALS AND METHODS: This was a prospective cohort audit, consisting of 150 consecutive PICU admissions (January-February 2016). Exclusion criteria consisted of patient mortality within 48 hours (n = 1) and patients who were still admitted at the end of the data collection timeframe (n = 7). The remaining cohort consisted of 142 consecutive admissions. Data collection took place in real time and included patient demographics, diagnostic categories, time spent without nutrition, reasons for interruptions to nutrition support, and reasons for noncompliance to the protocol. Observations were obtained through paper and computer charts and conversing with clinicians. RESULTS: There was a 95% compliance rate to the protocol and an average of 25.6 hours spent without nutrition per patient. The most prevalent reason for noncompliance was an avoidable delay to restart feeds before/after procedures or after surgery. CONCLUSIONS: A nurse-driven feeding protocol may reduce time spent without nutrition. Future research is required to examine the relationship between adherence to feeding protocols and clinical outcomes.

Ações de alimentação e nutrição na estratégia saúde da família: estrutura e processo de trabalho / Food and nutrition actions in the family health strategy: structure and work process / Acciones de alimentación y nutrición en la estrategia salud de la familia: estructura y proceso de trabajo

Objetivo: caracterizar as ações de alimentação e nutrição no âmbito da estratégia saúde da família, analisando a estrutura e o processo de trabalho. Método: estudo transversal desenvolvido em 2010, em 20(29,85%) das unidades básicas de saúde da família do município de Campina Grande. As informações foram obtidas nas unidades de saúde, mediante questionário individual, aplicado aos enfermeiros, e outro respondido pela equipe de saúde. O projeto foi aprovado pelo Comitê de Ética em Pesquisa da UEPB (355013300009). Resultados: na ausência do nutricionista, os médicos e enfermeiros são os profissionais que desenvolvem as principais atividades de alimentação e nutrição. Esses profissionais, além de não contarem com estrutura adequada, como materiais educativos, enfrentam problemas relacionados à demanda, adesão e situação socioeconômica da população, destacando-se a importância de capacitação profissional. Conclusão: o desenvolvimento das ações de alimentação e nutrição na atenção básica precisa de nutricionista que trabalhe com o apoio de uma equipe multidisciplinar.

Objective:to characterize food and nutrition actions in the context of the family health strategy, and analyze the structure and work process. Method: this cross-sectional study was conducted in 2010 at 20 (29.85%) of the family health primary care units of Campina Grande. Data was collected by questionnaires answered individually by nurses and collectively by the healthcare team. The project was approved by the UEPB research ethics committee (No. 0355013300009). Results: in the absence of nutritionists, doctors and nurses conduct the main food and nutrition activities. These professionals, in addition to lacking proper structure, such as educational materials, face problems related to user population demand, adherence and socioeconomic status, and professional training is particularly important. Conclusion: food and nutrition actions in primary health care require the inclusion of nutritionists working with the support of a multidisciplinary team.

Objetivo: caracterizar las acciones de alimentación y nutrición en el ámbito de la estrategia salud de la familia, analizando la estructura y el proceso de trabajo. Método: estudio transversal desarrollado en 2010 en 20 (29,85% de las unidades básicas de salud de la familia del municipio de Campina Grande. Las informaciones fueron obtenidas en las unidades de salud mediante aplicación de un cuestionario individual, aplicado a los enfermeros, y otro respondido por los miembros de las unidades. El proyecto fue aprobado por el Comité de Ética en Investigaciones de la UEPB (355013300009). Resultados: en la ausencia de nutricionista, los médicos y enfermeros son los profesionales que desarrollan las principales actividades de alimentación y nutrición. Esos profesionales, además de no contar con estructura adecuada, como materiales educativos, enfrentan problemas relacionados a la demanda, adhesión y situación socioeconómica de la población, destacando-se la importancia de capacitación profesional. Conclusión: el desarrollo de las acciones de alimentación y nutrición en la atención primaria necesita de nutricionista que trabaje con el apoyo de una equipe multidisciplinar.

The use of oral nutritional supplements in the acute care setting.

Oral nutritional supplements offer support to patients in acute care who are undernourished or at risk of malnutrition. Yet doubts remain over cost and compliance. Omorogieva Ojo, Senior Lecturer in Primary Care at University of Greenwich weighs up the evidence.

ESPEN guideline on ethical aspects of artificial nutrition and hydration.

BACKGROUND: The worldwide debate over the use of artificial nutrition and hydration remains controversial although the scientific and medical facts are unequivocal. Artificial nutrition and hydration are a medical intervention, requiring an indication, a therapeutic goal and the will (consent) of the competent patient. METHODS: The guideline was developed by an international multidisciplinary working group based on the main aspects of the Guideline on "Ethical and Legal Aspects of Artificial Nutrition" published 2013 by the German Society for Nutritional Medicine (DGEM) after conducting a review of specific current literature. The text was extended and introduced a broader view in particular on the impact of culture and religion. The results were discussed at the ESPEN Congress in Lisbon 2015 and accepted in an online survey among ESPEN members. RESULTS: The ESPEN Guideline on Ethical Aspects of Artificial Nutrition and Hydration is focused on the adult patient and provides a critical summary for physicians and caregivers. Special consideration is given to end of life issues and palliative medicine; to dementia and to specific situations like nursing care or the intensive care unit. The respect for autonomy is an important focus of the guideline as well as the careful wording to be used in the communication with patients and families. The other principles of Bioethics like beneficence, non-maleficence and justice are presented in the context of artificial nutrition and hydration. In this respect the withholding and withdrawing of artificial nutrition and/or hydration is discussed. Due to increasingly multicultural societies and the need for awareness of different values and beliefs an elaborated chapter is dedicated to cultural and religious issues and nutrition. Last but not least topics like voluntary refusal of nutrition and fluids, and forced feeding of competent persons (persons on hunger strike) is included in the guideline.

A Nursing Survey on Nutritional Care Practices in French-Speaking Pediatric Intensive Care Units: NutriRéa-Ped 2014.

OBJECTIVES: Malnutrition in critically ill children contributes to morbidity and mortality. The French-speaking pediatric intensive care nutrition group (NutriSIP) aims to promote optimal nutrition through education and research. METHODS: The NutriSIP-designed NutriRéa-Ped study included a cross-sectional survey. This 62-item survey was sent to the nursing teams of all of the French-speaking pediatric intensive care units (PICUs) to evaluate nurses' nutrition knowledge and practices. One nurse per PICU was asked to answer and describe the practices of their team. RESULTS: Of 44 PICUs, 40 responded in Algeria, Belgium, Canada, France, Lebanon, Luxemburg, and Switzerland. The majority considered nutrition as a priority care but only 12 of the 40 (30%) had a nutrition support team, 26 of the 40 (65%) had written nutrition protocols, and 19 of 39 (49%) nursing teams felt confident with the nutrition goals. Nursing staff generally did not know how to determine nutritional requirements or to interpret malnutrition indices. They were also unaware of reduced preoperative fasting times and fast-track concepts. In 17 of 35 (49%) PICUs, the target start time for enteral feeding was within the first 24 hours; however, frequent interruptions occurred because of neuromuscular blockade, fasting for extubation or surgery, and high gastric residual volumes. Combined pediatric neonatal intensive care units were less likely to perform systematic nutritional assessment and to start enteral nutrition rapidly. CONCLUSIONS: We found a large variation in nursing practices around nutrition, exacerbated by the lack of nutritional guidelines but also because of the inadequate nursing knowledge around nutritional factors. These findings encourage the NutriSIP to improve nutrition through focused education programs and research.

Nefrolitíase pediátrica: uma complicação daamamentação ineficaz? / Pediatric nephrolithiasis: a complication of ineffective breastfeeding

A nefrolitíase constitui-se na formação de conglomerados cristalinose de matriz orgânica que podem se localizar no trato urinário, comdimensões e localização capazes de conferir significado clínico-patológico.Os fatores dietéticos têm sido mostrados como fatores de riscopara a ocorrência de litíase urinária. O presente artigo teve por objetivorelatar e relacionar com a assistência de enfermagem, por meio de umplano de cuidados, um caso ocorrido entre dezembro de 2014 e fevereirode 2015, em um hospital público do Distrito Federal, Brasil, em quea criança tinha como sintomatologia principal a eliminação de cálculosrenais de diferentes tamanhos e em grande quantidade por meiodo canal urinário. A associação com o aleitamento materno ineficaz éexplicada no sentido em que a habilidade da criança até os seis mesesde vida em manejar alguns alimentos distintos do leite materno é limitada,pois seus sistemas digestivo e renal ainda estão imaturos. Os fatosdescritos neste estudo evidenciam a importância da atuação profissionalno manejo do aleitamento materno exclusivo e no aconselhamentonutricional e de saúde, tendo em vista que estes são fatores modificáveisfrente à prevenção de patologias e complicações.(AU)

Nephrolithiasis consists of the formation of crystalline clusters and organicmatrix that can be located in the urinary tract, with dimensionsand location capable of providing clinical and pathological significance.Dietary factors have been shown to be risk factors for the occurrenceof urolithiasis. This article aims to describe and relate to nursingcare through a care plan, a case occurred between December 2014 andFebruary 2015 in a public hospital in the Distrito Federal, Brazil, inwhich the child had as main symptoms the elimination of kidney stonesof different sizes and in large quantities through the urinary tract.The association with ineffective breastfeeding is explained in the sensethat the child’s ability to six months of life in handling some distinctbreast milk foods is limited because their digestive and renal systemsare still immature. The facts described in this study show the importanceof professional practice in the management of exclusive breastfeedingand nutrition counseling and health, given that these factorsare modifiable front of prevention of diseases and complications.(AU)