Lymphocyte count as a sign of immunoparalysis and its correlation with nutritional status in pediatric intensive care patients with sepsis: A pilot study.

OBJECTIVES:: Developing malnutrition during hospitalization is well recognized worldwide, and children are at a relatively higher risk for malnutrition than adults. Malnutrition can lead to immune dysfunction, which is associated with a higher mortality rate due to sepsis, the most frequent cause of death in pediatric intensive care units (PICUs). The aim of this study was to investigate whether malnourished patients are more likely to have relative or absolute lymphopenia and, consequently, worse prognoses. METHODS:: We enrolled 14 consecutive patients with sepsis whose legal representatives provided written informed consent. Patients were classified as normal or malnourished based on anthropometric measurements. As an additional evaluation of nutritional status, serum albumin and zinc were measured on the 1st and 7th days of hospitalization. Lymphocyte count was also measured on the 1st and 7th days. Clinicaltrials.gov: NCT02698683. RESULTS:: Malnutrition prevalence rates were 33.3% and 42.8% based on weight and height, respectively. Laboratory analyses revealed a reduction of serum albumin in 100% of patients and reduction of zinc in 93.3% of patients. A total of 35% of patients had fewer than 500 lymphocytes/mm3 on their first day in the PICU. Lymphocyte counts and zinc concentrations significantly increased during hospitalization. CONCLUSIONS:: Nutritional evaluations, including anthropometric measurements, were not correlated with lymphocyte counts. Lymphocyte counts concomitantly increased with zinc levels, suggesting that micronutrient supplementation benefits patients with sepsis.

Lymphocyte count as a sign of immunoparalysis and its correlation with nutritional status in pediatric intensive care patients with sepsis: A pilot study

OBJECTIVES: Developing malnutrition during hospitalization is well recognized worldwide, and children are at a relatively higher risk for malnutrition than adults. Malnutrition can lead to immune dysfunction, which is associated with a higher mortality rate due to sepsis, the most frequent cause of death in pediatric intensive care units (PICUs). The aim of this study was to investigate whether malnourished patients are more likely to have relative or absolute lymphopenia and, consequently, worse prognoses. METHODS: We enrolled 14 consecutive patients with sepsis whose legal representatives provided written informed consent. Patients were classified as normal or malnourished based on anthropometric measurements. As an additional evaluation of nutritional status, serum albumin and zinc were measured on the 1st and 7th days of hospitalization. Lymphocyte count was also measured on the 1st and 7th days. Clinicaltrials.gov: NCT02698683. RESULTS: Malnutrition prevalence rates were 33.3% and 42.8% based on weight and height, respectively. Laboratory analyses revealed a reduction of serum albumin in 100% of patients and reduction of zinc in 93.3% of patients. A total of 35% of patients had fewer than 500 lymphocytes/mm3 on their first day in the PICU. Lymphocyte counts and zinc concentrations significantly increased during hospitalization. CONCLUSIONS: Nutritional evaluations, including anthropometric measurements, were not correlated with lymphocyte counts. Lymphocyte counts concomitantly increased with zinc levels, suggesting that micronutrient supplementation benefits patients with sepsis.

Avaliação de reação adversa a medicamentos em um caso de confusão mental / Adverse drug reaction assessment in a mental confusion case

Objetivo: mostrar a sistemática de avaliação de reação adversa a medicamentos realizada em um caso. Descrição do caso: uma menina de 9 anos de idade estava com AIDS em estágio clínico-imunológico C3, e em tratamento com esquema de...

Objective: to underline the importance of a systematic surveillance focusing drug's adverse effects proceeded in one case. Case report: a nine year-old girl was affected by AIDS in C3 clinical-immunological stadium, and received...

Métodos dialíticos alternativos em terapia intensiva pediátrica / Alternative dialytic methods in pediatric intensive therapy

Os autores enfatizam a utilidade das várias modalidades terapêuticas dos métodos de substituiçäo renal em terapia intensiva pediátrica. As técnicas que näo acarretam súbita modificaçäo do estado volêmico e que sejam de uso contínuo säo as preferidas para a estabilizaçäo hemodinâmica dos pacientes. A hemofiltraçäo, em suas diferentes formas de aplicaçäo (CAVH, CVVH, CAVDH, CVVDH), tem se revelado adequada como técnica alternativa à diálise peritoneal. Nas situaçöes em que há inviabilidade de utilizaçäo da membrana peritoneal, pode ser método de escolha para se obter rápida regulaçäo hidroeletrolítica. As dificuldades de uso na faixa etária pediátrica se devem aos cuidados redobrados no controle volêmico, espoliaçäo sanguínia, necessidade de transfusöes freqüentes, utiliza äo de anticoagulaçäo, manutençäo da temperatura corpórea e necessidade de hemofiltros pequenos e de alta eficácia. A utilizaçäo da hemofiltraçäo para outros objetivos, como a remo äo de mediadores da resposta inflamatória, permanece controversa. A estabilizaçäo hemodinâmica secundária à remoçäo de fluídos e regulaçäo eletrolítica parece ser o fator preponderante na melhora dos pacientes. Este artigo revê as regras gerais para início, implementaçäo e manutençäo de um programa de substituiçäo renal através da hemofiltraçäo em terapia intensiva.