Dual x-ray absorptiometry monitoring in pediatric short bowel syndrome: an integrative review / Monitorização por absortometria com duplo raio X na síndrome do intestino curto pediátrica: uma revisão integrativa

ABSTRACT Objective: To analyze the bone health of pediatric patients with short bowel syndrome intestinal failure (SBS-IF). Data source: An integrative literature review was performed using the data published in the MEDLINE-PubMed and Scientific Electronic Library Online (SciELO) databases between January 2010 and April 2021, and through a manual search of the reference lists of relevant studies. Studies were included if they assessed bone mineral density by the Dual X-Ray Absorptiometry (DXA) technique, incorporated pediatric patients (up to 20 years of age) with SBS under parenteral nutrition (PN) and were written in English. Eleven primary sources met the inclusion criteria for this study. Data synthesis: Pediatric patients with SBS-IF under long-term parenteral nutrition experienced frequent changes in bone metabolism, leading to osteoporotic fractures and growth failure. These patients have deficiencies in multiple nutrients, such as calcium, magnesium, phosphorus, and vitamin D. Consequently, there are variations in the secretion and regulation of the parathyroid hormone. In addition, the pharmacotechnical limitations related to calcium and phosphorus in the PN solution, use of glucocorticoids, and difficulty performing physical activity are risk factors for the development of metabolic bone disease in pediatric patients with SBS-IF. Conclusions: Low bone mineral density was associated with a high risk of developing osteoporosis, fractures, and growth deficiency in pediatric patients with SBS-IF on PN therapy in the long term.

Objetivo: Analisar a saúde óssea de pacientes pediátricos com síndrome do intestino curto — falência intestinal (SIC-FI). Fontes de dados: Revisão integrativa da literatura usando os dados publicados nas bases de dados Medical Literature Analysis and Retrieval System Online/ United States National Library of Medicine (MEDLINE/PubMed) e Scientific Electronic Library Online (SciELO) entre janeiro de 2010 e abril de 2021 e por meio de busca manual nas listas de referências de estudos relevantes. Foram incluídos estudos em inglês que avaliaram a densidade mineral óssea pela técnica de absorciometria de raio X duplo (DXA), incluíram pacientes pediátricos (até 20 anos de idade) com SIC sob terpia nutricional parenteral. Onze fontes primárias preencheram os critérios de inclusão para este estudo. Síntese dos dados: A pesquisa revelou que pacientes pediátricos com SIC-FI sob nutrição parenteral (NP) de longo prazo tiveram alterações frequentes no metabolismo ósseo, levando a fraturas osteoporóticas e falha de crescimento. Esses pacientes apresentam deficiências de múltiplos nutrientes, como cálcio, magnésio, fósforo e vitamina D. Consequentemente, houve variações na secreção e regulação do hormônio da paratireoide. Além disso, as limitações farmacotécnicas relacionadas ao cálcio e fósforo na solução de NP, o uso de glicocorticoides e dificuldade para realizar atividade física são fatores de risco para o desenvolvimento de doença óssea metabólica em pacientes pediátricos com SIC-FI. Conclusões: A baixa densidade mineral óssea foi associada a um alto risco de desenvolver osteoporose, fraturas e deficiência de crescimento em pacientes pediátricos com SIC-FI sob terapia nutricional parenteral em longo prazo.

Dual x-ray absorptiometry monitoring in pediatric short bowel syndrome: an integrative review.

OBJECTIVE: To analyze the bone health of pediatric patients with short bowel syndrome intestinal failure (SBS-IF). DATA SOURCE: An integrative literature review was performed using the data published in the MEDLINE-PubMed and Scientific Electronic Library Online (SciELO) databases between January 2010 and April 2021, and through a manual search of the reference lists of relevant studies. Studies were included if they assessed bone mineral density by the Dual X-Ray Absorptiometry (DXA) technique, incorporated pediatric patients (up to 20 years of age) with SBS under parenteral nutrition (PN) and were written in English. Eleven primary sources met the inclusion criteria for this study. DATA SYNTHESIS: Pediatric patients with SBS-IF under long-term parenteral nutrition experienced frequent changes in bone metabolism, leading to osteoporotic fractures and growth failure. These patients have deficiencies in multiple nutrients, such as calcium, magnesium, phosphorus, and vitamin D. Consequently, there are variations in the secretion and regulation of the parathyroid hormone. In addition, the pharmacotechnical limitations related to calcium and phosphorus in the PN solution, use of glucocorticoids, and difficulty performing physical activity are risk factors for the development of metabolic bone disease in pediatric patients with SBS-IF. CONCLUSIONS: Low bone mineral density was associated with a high risk of developing osteoporosis, fractures, and growth deficiency in pediatric patients with SBS-IF on PN therapy in the long term.

Arginine and glutamine supplementation on transthyretin levels in severely burned patients: A systematic review.

OBJECTIVE: The aim of this study was to investigate the influence of supplementation with the immunomodulators arginine and glutamine on transthyretin levels in burn patients. METHODS: This systematic review followed the protocol proposed and registered in PROSPERO (CRD42021239526) and was carried out following the PRISMA checklist for systematic reviews. Forty-four studies were evaluated. Of the 44, we included 6 for complete analysis. RESULTS: In five of the six clinical trials, glutamine was the most used immunomodulator (0.5 g·kg·d-1 or 12-14 g/d), followed by arginine in three of the clinical trials (10-14 g/d in adults or 2% of total energy value in children). The findings of the studies were that the patients who received either of these supplements presented the following results: increased transthyretin, lymphoproliferative response, and serum glutamine values, as well as shorter stay in the intensive care unit, a significant reduction in C-reactive protein values, and a tendency toward a faster healing of the burns compared with the control groups. CONCLUSION: In view of the content in the present review, it is possible to affirm that the supplementation of immunomodulators in burn patients is an effective strategy for their treatment, and that the adequate nutritional offer may be a predictor of a favorable outcome. However, regarding the increase in transthyretin values, this finding needs to be considered with reservations as the values can be altered by the inflammatory activity, and not necessarily related to the use of a supplement.

Hypophosphatemia in critically ill pediatric patients receiving enteral and oral nutrition.

BACKGROUND: Hypophosphatemia(HP) is related to several comorbidities in pediatric intensive care units (PICUs). This study aimed to evaluate the incidence of HP in severely ill pediatric patients receiving oral and/or enteral nutrition. The secondary objectives were to investigate the association between HP and the inflammatory state, PICU length of stay, severity, mortality, nutrition status, and protein, energy, calcium, vitamin D, and phosphate intake. METHODS: A prospective, observational cohort study was conducted in a PICU of a quaternary hospital. Participants aged between 28 days and 14 years were included. Anthropometric and laboratory assessments were performed ≤72 h after PICU admission and repeated after 7 days for three consecutive times. Energy, protein, calcium, phosphate, and vitamin D intake per day of hospitalization were recorded individually. The Pediatric Index of Mortality 2 (PIM2) was used to determine each patient's severity score. RESULTS: A total of 103 participants were included in the study. Hypophosphatemic events ranged from 27.2% to 37.5% among the assessments. HP was associated with high C-reactive protein levels (P = .012) and lower energy adequacy (P = .037). Serum phosphorus was inversely correlated (weak correlation) with PIM2 (P = .017). CONCLUSION: HP is common in critically ill pediatric patients, even when they are not receiving parenteral nutrition. It is necessary to monitor serum phosphorus levels and consider the possibility of early replacement, especially in patients showing high levels of inflammation. In addition to inflammation itself, low energy intake and illness severity were related to HP.

Extubation in the pediatric intensive care unit: predictive methods. An integrative literature review. / Extubação em unidade de terapia intensiva pediátrica: métodos preditores. Uma revisão integrativa da literatura.

For extubation in pediatric patients, the evaluation of readiness is strongly recommended. However, a device or practice that is superior to clinical judgment has not yet been accurately determined. Thus, it is important to conduct a review on the techniques of choice in clinical practice to predict extubation failure in pediatric patients. Based on a search in the PubMed®, Biblioteca Virtual em Saúde, Cochrane Library and Scopus databases, we conducted a survey of the predictive variables of extubation failure most commonly used in clinical practice in pediatric patients. Of the eight predictors described, the three most commonly used were the spontaneous breathing test, the rapid shallow breathing index and maximum inspiratory pressure. Although the disparity of the data presented in the studies prevented statistical treatment, it was still possible to describe and analyze the performance of these tests.

Para a extubação orotraqueal em pacientes pediátricos, é fortemente recomendada a avaliação de sua prontidão. No entanto, a utilização de um dispositivo ou prática que fosse superior ao julgamento clínico ainda não foi determinada com exatidão. Assim, é importante realizar uma revisão sobre as técnicas preditoras de escolha na prática clínica para prever a falha de extubação orotraqueal em pacientes pediátricos. A partir de uma busca nas bases de dados PubMed®, Biblioteca Virtual em Saúde, Cochrane Library e Scopus, realizamos um levantamento das variáveis preditoras de falha de extubação orotraqueal mais comumente utilizadas na prática clínica em pacientes pediátricos. Dos oito preditores descritos, observamos três mais usados: teste de respiração espontânea, índice de respiração rápida e superficial e pressão inspiratória máxima. Embora a disparidade dos dados apresentados nos estudos tenha inviabilizado um tratamento estatístico, foi possível, a partir desse meio, descrever e analisar o desempenho desses testes.

Extubação em unidade de terapia intensiva pediátrica: métodos preditores. Uma revisão integrativa da literatura / Extubation in the pediatric intensive care unit: predictive methods. An integrative literature review

RESUMO Para a extubação orotraqueal em pacientes pediátricos, é fortemente recomendada a avaliação de sua prontidão. No entanto, a utilização de um dispositivo ou prática que fosse superior ao julgamento clínico ainda não foi determinada com exatidão. Assim, é importante realizar uma revisão sobre as técnicas preditoras de escolha na prática clínica para prever a falha de extubação orotraqueal em pacientes pediátricos. A partir de uma busca nas bases de dados PubMed®, Biblioteca Virtual em Saúde, Cochrane Library e Scopus, realizamos um levantamento das variáveis preditoras de falha de extubação orotraqueal mais comumente utilizadas na prática clínica em pacientes pediátricos. Dos oito preditores descritos, observamos três mais usados: teste de respiração espontânea, índice de respiração rápida e superficial e pressão inspiratória máxima. Embora a disparidade dos dados apresentados nos estudos tenha inviabilizado um tratamento estatístico, foi possível, a partir desse meio, descrever e analisar o desempenho desses testes.

ABSTRACT For extubation in pediatric patients, the evaluation of readiness is strongly recommended. However, a device or practice that is superior to clinical judgment has not yet been accurately determined. Thus, it is important to conduct a review on the techniques of choice in clinical practice to predict extubation failure in pediatric patients. Based on a search in the PubMed®, Biblioteca Virtual em Saúde, Cochrane Library and Scopus databases, we conducted a survey of the predictive variables of extubation failure most commonly used in clinical practice in pediatric patients. Of the eight predictors described, the three most commonly used were the spontaneous breathing test, the rapid shallow breathing index and maximum inspiratory pressure. Although the disparity of the data presented in the studies prevented statistical treatment, it was still possible to describe and analyze the performance of these tests.

Inflammatory process of patients receiving parenteral nutrition is not exclusively responsible for low selenium and glutathione peroxidase levels.

OBJECTIVE: The aim of this study was to verify if the selenium status of patients residing in locations with selenium-poor soil who receive parenteral nutrition (PN) without selenium supplementation is associated with the inflammatory process. METHODS: This was a prospective cohort study with hospitalized patients who started PN. The analyzed biochemical tests were plasma selenium, glutathione peroxidase (GPx), C-reactive protein, prealbumin, albumin, creatinine, lymphocytes, total cholesterol, high-density lipoprotein, and triglycerides. RESULTS: Seventy-seven patients with a mean age of 56.2 ± 15.7 y were studied. Most of them used PN as a result of clinical issues (70.1%) such as, gastric, renal, or hematologic neoplasia; gastrointestinal dysfunction; pancreatitis; sepsis; trauma without surgical needs; chylothorax; and fistula not related to surgical procedure. There were low levels of plasma selenium (98.7%) and GPx (60%) and elevated C-reactive protein (98.5%) in most cases. At the beginning of PN there was no correlation between selenium and laboratory tests (P > 0.05). At the second evaluation (seventh day of PN), there was a positive correlation of selenium levels with lymphocyte levels (r = 0.36; P = 0.04). After 2 wk of PN, there was a statistically significant correlation between selenium and GPx (r = 0.70; P = 0.02). CONCLUSIONS: Very low values of selenium and GPx from the beginning of PN were identified. The correlation of selenium levels with GPx in only 14 d of PN, regardless of inflammation, may reflect a critical selenium status, mainly because the correlation was verified after the acute phase. Therefore it is important to emphasize that supplementation should be started from the beginning of PN, especially in regions with selenium-deficient soil.

Nutritional Treatment of a Young Infant with Cystic Fibrosis Presenting with Severe Kwashiorkor Dermatosis.

Kwashiorkor in infancy is typically associated to an underlying disease. Edema, a striking feature of this type of malnutrition, can be difficult to assess in this age group. The typical dermatosis of Kwashiorkor is not fully explained the deficiency of one isolated vitamin or micronutrient. This article presents an infant with cystic fibrosis, who developed Kwashiorkor in the third month of life with extensive cutaneous manifestations. An early, individualized and aggressive nutritional intervention with optimized supplementationof sulfur amino acids, vitamins and micronutrients was established, with impressively recovery of overall nutrition and skin manifestations in a relatively short period of time.

Selenium supplementation in pediatric patients using parenteral nutrition: Is it time to do something?

OBJECTIVE: To analyze the nutritional status of selenium and verify the effect of its supplementation in pediatric patients during 14 days of parenteral nutrition (PN). METHOD: This is a series of cases with patients followed for two weeks while using PN. Data collection was performed at the beginning (T0), in the 7th (T1) and 14th days of PN (T2). The supplemented group received 2 µg/kg/day of selenous acid. Weight and height were measured for nutritional status assessment. Tests requested: plasma selenium, albumin, pre-albumin, C-reactive protein (CRP), total cholesterol and HDL-cholesterol. RESULTS: Fourteen (14) patients with inflammatory process and with low or very low weight for their ages were evaluated. In both groups (with and without supplementation), all patients had low selenium levels. Median plasma selenium concentrations were 17.4 µg/L (T0), 23.0 µg/L (T1) and 20.7 µg/L (T2). Increase and reduction of selenium occurred both in patients with high CRP and in those presenting normalization of this parameter. CONCLUSION: Lower plasma selenium levels have been detected since the start of the research and supplementation (2 µg/kg/day of selenous acid) was not to enough to approach the reference values.

Selenium supplementation in pediatric patients using parenteral nutrition: Is it time to do something? / Suplementação de selênio nos pacientes pediátricos em uso de nutrição parenteral: é hora de fazer algo?

Summary Objective: To analyze the nutritional status of selenium and verify the effect of its supplementation in pediatric patients during 14 days of parenteral nutrition (PN). Method: This is a series of cases with patients followed for two weeks while using PN. Data collection was performed at the beginning (T0), in the 7th (T1) and 14th days of PN (T2). The supplemented group received 2 µg/kg/day of selenous acid. Weight and height were measured for nutritional status assessment. Tests requested: plasma selenium, albumin, pre-albumin, C-reactive protein (CRP), total cholesterol and HDL-cholesterol. Results: Fourteen (14) patients with inflammatory process and with low or very low weight for their ages were evaluated. In both groups (with and without supplementation), all patients had low selenium levels. Median plasma selenium concentrations were 17.4 µg/L (T0), 23.0 µg/L (T1) and 20.7 µg/L (T2). Increase and reduction of selenium occurred both in patients with high CRP and in those presenting normalization of this parameter. Conclusion: Lower plasma selenium levels have been detected since the start of the research and supplementation (2 µg/kg/day of selenous acid) was not to enough to approach the reference values.

Resumo Objetivo: Analisar o estado nutricional relativo ao selênio e verificar o efeito da suplementação desse mineral em pacientes pediátricos durante 14 dias de nutrição parenteral (NP). Método: Trata-se de estudo prospectivo de uma série de casos de pacientes acompanhados durante duas semanas de uso de NP. A coleta de dados foi realizada no início (T0), no 7º (T1) e no 14º dia de NP (T2). Após randomização, o grupo suplementado recebeu 2 µg/kg/dia de ácido selenioso. Peso e altura foram aferidos para avaliação do estado nutricional. Exames coletados: selênio plasmático, albumina, pré-albumina, proteína C-reativa (PCR), colesterol total e HDL-colesterol. Resultados: Foram avaliados 14 pacientes com processo inflamatório em curso e com baixo ou muito baixo peso para a idade. Os pacientes (grupo suplementado e não suplementado) tinham baixas concentrações de selênio. A mediana dos valores de selênio plasmático foi de 17,4 µg/L (T0), 23,0 µg/L (T1) e 20,7 µg/L (T2). Aumento e redução de selênio ocorreram tanto nos pacientes com PCR elevada quanto naqueles que apresentaram normalização desse parâmetro. Conclusão: Os níveis de selênio detectados foram muito baixos e a suplementação (2 µg/kg/dia de ácido selenioso) não foi suficiente para normalização dos níveis plasmáticos.

Influence of selenium supplementation on patients with inflammation: A pilot double blind randomized study.

OBJECTIVE: The aim of the study was to analyze the effect of selenium supplementation on patients with inflammation receiving PN. METHODS: This double-blind randomized study included 20 hospitalized patients experiencing an inflammatory process while being fed by PN, who were monitored in three stages: first 72 h (0), day 7 (1), and day 14 (2) of PN. The supplemented patients group (G+S) received 60 µg/d (0.75 µmol) of selenium as selenious acid which was added to the PN bag. The nonsupplemented group (G-S) did not receive selenium. The concentration range of 84 to 100 µg/L (1.07-1.27 µmol/L) was used as a reference of plasma selenium. RESULTS: The study included 20 patients (8 G+S and 12 G-S) mainly diagnosed with cancer and/or sepsis. Most of them were hospitalized in the intensive care unit and were receiving PN for clinical reasons. Plasma selenium was greater in the G+S than in the G-S (P = 0.05) in two stages (0 and 1). Since the start of assessment, C-reactive protein (CRP) levels were elevated; however, there was no statistical difference in CRP values between groups (P > 0.05). There was no significant change of glutathione peroxidase over time or between groups (P > 0.05). CONCLUSION: The selenium concentration was greater in the G+S than in the G-S, acting independently from CRP behavior. However, supplementation was not enough to reach the reference values.

[Is plasma selenium correlated to transthyretin levels in critically ill patients?]

BACKGROUND: Selenium is an essential trace element, but critically ill patients using total parenteral nutrition (PN) do not receive selenium because this mineral is not commonly offered. Threfore, the eval uation of plasma selenium levels is very important for treating or preventing this deficiency. Recent studies have shown that transthyretin may reflect the selenium intake and could be considered a biomarker. However, this issue is still little explored in the literature. OBJECTIVE: This study aims to investigate the correlation of transthyretin with the plasma selenium of critically ill patients receiving PN. METHOD: This was a prospective cohort study with 44 patients using PN without selenium. Blood samples were carried out in 3 stages: initial, 7th and 14th day of PN. In order to evaluate the clinical condition and the inflammatory process, albumin, C-reactive protein (CRP), transthyretin, creatinine and HDL cholesterol levels were observed. To assess the selenium status, plasma selenium and glutathione peroxidase (GPx) in whole blood were measured. Descriptive analyses were performed and the ANOVA, Mann-Whitney and Spearman's coefficient tests were conducted; we assumed a significance level of 5%. RESULTS: A positive correlation of selenium with the GPx levels (r = 0.46; p = 0.03) was identified. During two weeks, there was a positive correlation of transthyretin with plasma selenium (r = 0.71; p = 0.05) regardless of the CRP values. CONCLUSION: Transthyretin may have reflected plasma selenium, mainly because the correlation was verified after the acute phase.

Is plasma selenium correlated to transthyretin levels in critically ill patients? / ¿Se correlacionan los niveles plasmáticos de selenio con los de prealbúmina en los pacientes críticos?

Background: Selenium is an essential trace element, but critically ill patients using total parenteral nutrition (PN) do not receive selenium because this mineral is not commonly offered. Threfore, the evaluation of plasma selenium levels is very important for treating or preventing this deficiency. Recent studies have shown that transthyretin may reflect the selenium intake and could be considered a biomarker. However, this issue is still little explored in the literature. Objective: This study aims to investigate the correlation of transthyretin with the plasma selenium of critically ill patients receiving PN. Method: This was a prospective cohort study with 44 patients using PN without selenium. Blood samples were carried out in 3 stages: initial, 7th and 14th day of PN. In order to evaluate the clinical condition and the inflammatory process, albumin, C-reactive protein (CRP), transthyretin, creatinine and HDL cholesterol levels were observed. To assess the selenium status, plasma selenium and glutathione peroxidase (GPx) in whole blood were measured. Descriptive analyses were performed and the ANOVA, Mann-Whitney and Spearman’s coefficient tests were conducted; we assumed a significance level of 5%. Results: A positive correlation of selenium with the GPx levels (r = 0.46; p = 0.03) was identified. During two weeks, there was a positive correlation of transthyretin with plasma selenium (r = 0.71; p = 0.05) regardless of the CRP values. Conclusion: Transthyretin may have reflected plasma selenium, mainly because the correlation was verified after the acute phase (AU)

Introducción: el selenio es un oligoelemento esencial. Sin embargo, los pacientes críticos con nutrición parenteral (NP) no reciben selenio de forma habitual. La evaluación de los niveles plasmáticos de selenio se vuelve imprescindible en este contexto, para prevenir las deficiencias. Algunos estudios recientes han demostrado que los niveles de prealbúmina pueden reflejar los aportes de selenio y servir como biomarcador del estado de selenio. Esta posibilidad se ha evaluado de una forma insuficiente. Objetivo: investigar la correlación entre los niveles plasmáticos de selenio y de prealbúmina en el paciente crítico. Método: estudio prospectivo de una cohorte de 44 pacientes que recibían NP sin selenio. Se extrajeron muestras de sangre en el momento del inicio y a los 7 y 14 días de NP. Para evaluar la situación clínica y el proceso inflamatorio, se midieron también los niveles de albúmina, proteína C reactiva (PCR), prealbúmina, creatinina y colesterol HDL. Para evaluar el estado de selenio, se midieron los niveles de selenio y de glutation peroxidasa (GPx) en sangre completa. Se realizó un análisis descriptivo así como los siguientes estudios estadísticos: ANOVA, Mann-Whitney y coeficiente de correlación de Spearman, asumiendo un nivel de significación estadística del 5%. Resultados: se encontró una correlación positiva con los niveles de GPX (r = 0,46; p = 0,03). Durante las dos semanas de estudio, hubo correlación entre los niveles plasmático de selenio y de prealbúmina (r = 0,71; p = 0,05), con independencia de los niveles de PCR. Conclusión: la prealbúmina puede reflejar los niveles plasmáticos de selenio, al demostrar una buena correlación tras la fase aguda de la agresión (AU)

Factors impacting the growth and nutritional status of cystic fibrosis patients younger than 10 years of age who did not undergo neonatal screening / Fatores que afetam o crescimento e estado nutricional de pacientes com fibrose cística com idade inferior a 10 anos e que não foram submetidos à triagem neonatal

OBJECTIVE: The aim of this study was to evaluate by clinical and laboratory parameters how cystic fibrosis (CF) affects growth and nutritional status of children who were undergoing CF treatment but did not receive newborn screening. METHODS: A historical cohort study of 52 CF patients younger than 10 years of age were followed in a reference center in Campinas, Southeast Brazil. Anthropometric measurements were abstracted from medical records until March/2010, when neonatal screening program was implemented. Between September/2009 and March/2010, parental height of the 52 CF patients were also measured. RESULTS: Regarding nutritional status, four patients had Z-scores ≤-2 for height/age (H/A) and body mass index/age (BMI/A). The following variables were associated with improved H/A ratio: fewer hospitalizations, longer time from first appointment to diagnosis, longer time from birth to diagnosis and later onset of respiratory disease. Forced vital capacity [FVC(%)], forced expiratory flow between 25-75% of FVC [FEF25-75(%)], forced expiratory volume in the first second [FEV1(%)], gestational age, birth weight and early respiratory symptoms were associated with improved BMI/A. CONCLUSIONS: Greater number of hospitalizations, diagnosis delay and early onset of respiratory disease had a negative impact on growth. Lower spirometric values, lower gestational age, lower birth weight, and early onset of respiratory symptoms had negative impact on nutritional status. Malnutrition was observed in 7.7% of cases, but 23% of children had nutritional risk. .

OBJETIVO: Avaliar por meio de parâmetros clínicos e laboratoriais como a fibrose cística (FC) afeta o crescimento e estado nutricional de crianças submetidas ao tratamento de FC que não foram submetidas à triagem neonatal. MÉTODOS: Uma coorte histórica com 52 pacientes com FC menores de 10 anos foi acompanhada em um centro de referência em Campinas, Sudeste do Brasil. Peso e altura foram coletados de prontuários médicos até março de 2010, quando a triagem neonatal foi implementada. Entre setembro de 2009 a março de 2010 a altura dos pais foi medida. RESULTADOS: Quatro pacientes tiveram escores Z ≤ -2 para altura/idade (A/I) e índice de massa corporal/idade (IMC/A). As seguintes variáveis foram associadas com melhor razão A/I: menor número de hospitalizações, maior tempo entre a primeira consulta e o diagnóstico, maior tempo entre o nascimento e o diagnóstico e início tardio da doença respiratória. Capacidade vital forçada [CVF(%)], fluxo expiratório forçado entre 25-75% da CVF [FEF25-75(%)], volume expiratório forçado no primeiro segundo [VEF1(%)], idade gestacional, peso ao nascer e início dos sintomas respiratórios foram associados com melhor IMC/I. CONCLUSÕES: Maior número de hospitalizações, retardo no diagnóstico e início precoce da doença respiratória tiveram impacto negativo no crescimento. Menores valores espirométricos, menor idade gestacional, menor peso ao nascer e o início precoce dos sintomas respiratórios tiveram impacto negativo no estado nutricional. A desnutrição foi observada em 7,7% dos casos, mas 23% das crianças apresentaram risco nutricional. .

Malnutrition causing neonatal dyslipidemia.

Lipid abnormalities in children have become more common in recent decades. This trend is related to the increase in overweight and obesity. The 2002 National Health and Nutrition Examination Survey reported that the percentage of risk for overweight and overweight in children aged > 6 years is 31%, higher than the previous surveys. Serum lipids tend to increase quickly up to 6 months of age and reach values very close to adult values by age 2. As suggested by the American Heart Association, serum lipid values for children and adolescents (2-19 years old) are considered abnormal when total cholesterol is >200 mg/dL, high-density lipoprotein is <35 mg/dL, low-density lipoprotein is >130 mg/dL, and triglycerides are >150 mg/dL. Dyslipidemia can be found in patients with malnutrition, a severe condition that needs prompt nutrition intervention. This report describes a case of malnutrition causing severe dyslipidemia in a newborn. Primary dyslipidemia was excluded by the presence of primary malnutrition, normal response to a postheparin lipoprotein lipase activity test, a favorable clinical course after nutrition intervention, and relatives' blood lipid levels close to normal that did not indicate familial dyslipidemia. The child was fed fat-free milk formula supplemented with medium-chain triglycerides and had adequate weight gain with a decrease in blood lipids. Subsequently the formula was changed to regular milk-based formula, and the child maintained adequate growth rate. Although blood lipids never returned to normal values for age and sex, they were lower than before treatment.

Nutrição enterica em lactentes ate 6 meses em uma unidade de terapia intensiva pediatrica: estudo de 110 casos / Enteral nutrition in infants up to six months in a pediatric intensive care unit: a study of 110 cases

A desnutrição é freqüente em pacientes graves e a nutrição entérica é o melhor meio para manter o estado nutricional. Os objetivos desse estudo foram analisar as indicações, prescrições, motivos das interrupções e a evolução da terapia nutricional entérica nos pacientes com menos de 6 meses de idade, internados na UTIPED do HC/UNICAMP. Trata-se de estudo retrospectivo baseado em análise de prontuários, com utilização de ficha padronizada. Avaliou-se o gênero, a data de nascimento e de internação, a presença de óbito, uso de leite materno, o peso nos primeiros 30 dias de internação, as quantidades de energia e proteína prescritas e administradas nos primeiros 7 dias, o uso de sedação contínua e ventilação mecânica, a utilização de nutrição parentérica e a aplicação de nutrição entérica nas primeiras 36 horas de internação. Para a análise estatística, utilizaram-se os testes de Wilcoxon, qui-quadrado, exato de Fisher e Mann-Whitney. Em 9 meses, 110 pacientes foram avaliados, com mediana de tempo de internação de 7 dias. As interrupções da dieta relacionaram-se a problemas do funcionamento do hospital, alterações do trato gastrintestinal e as pausas para a prática de procedimentos. Apenas 4 pacientes (7,84%) não tiveram nenhuma interrupção a partir do início da mesma, mostrando que a nutrição não é administrada de forma ideal. À queles que permaneceram no mínimo 7 dias internados e receberam nutrição entérica exclusiva foram selecionados para análise mais detalhada. Restaram 51 pacientes para aporte energético administrado, onde se observou que, em média...

The undernutrition is quite frequently in intensive care patients and the enteral nutrition is the best way to optimize the nutritional status. The aims of this study were to analyze the indications, medical prescriptions, causes of incorrect administration and evolution of the enteral nutrition of the patients 6 months old or younger at the Pediatric Intensive Care Unity, Clinical Hospital (CH/UNICAMP). It was a retrospective study. Data from medical reports were obtained with a registration chart. It was used to obtain data about sex, birthday, admition day, death, previous breast feeding, weight in the first 30 days of hospital stay, amount of energy and protein prescribed and received, time and use of sedation and mechanical ventilation, presence or absence of parenteral nutrition and the possibility of enteral nutrition in the first 36 hours of hospitalar admission. The statistical analysis tests used were Wilcoxon, qui-square, Fisher and Mann-Whitney. In 9 months, 110 patients were evaluated, with median stay in intensive care unit of 7 days. The incorrect administration of the enteral nutrition was related to bad functioning of the hospital, gastrointestinal tract problems and interruptions for procedures. Only 4 patients (7.84%) had nonstop delivery of the enteral nutrition since its start, which shows an imperfect administration of the enteral nutrition. Those patients who were at least 7 days at the hospital and received only enteral nutrition were selected to...