RESUMO
AIM: Identification of critically ill children upon presentation to the emergency department (ED) is challenging, especially when resources are limited. The objective of this study was to identify ED risk factors associated with serious clinical deterioration (SCD) during hospitalisation in a resource-limited setting. METHODS: A retrospective case-control study of children less than 18 years of age presenting to the ED in a large, freestanding children's hospital in Peru was performed. Cases had SCD during the first 7 days of hospitalisation whereas controls did not. Information collected during initial ED evaluation was used to identify risk factors for SCD. RESULTS: A total of 120 cases and 974 controls were included. In univariate analysis, young age, residence outside Lima, evaluation at another facility prior to ED presentation, congenital malformations, abnormal neurologic baseline, co-morbidities and a prior paediatric intensive care unit admission were associated with SCD. In multivariate analysis, age < 12 months, residence outside Lima and evaluation at another facility prior to ED presentation remained associated with SCD. In addition, comatose neurological status, hypoxaemia, tachycardia, tachypnoea and temperature were also associated with SCD. CONCLUSIONS: Many risk factors for SCD during hospitalisation can be identified upon presentation to the ED. Using these factors to adjust monitoring during and after the ED stay has the potential to decrease SCD events. Further studies are needed to determine whether this holds true in other resource-limited settings.
Assuntos
Deterioração Clínica , Serviço Hospitalar de Emergência/organização & administração , Hospitais Pediátricos/organização & administração , Equipe de Assistência ao Paciente/organização & administração , Adolescente , Análise de Variância , Estudos de Casos e Controles , Criança , Pré-Escolar , Países em Desenvolvimento , Feminino , Mortalidade Hospitalar , Hospitalização/estatística & dados numéricos , Humanos , Lactente , Masculino , Análise Multivariada , Avaliação das Necessidades , Peru , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida , Resultado do TratamentoRESUMO
La presencia de Desnutrición infantil y sus múltiples consecuencias sobre todo en el desarrollo cerebral, son procesos ampliamente reconocidos, siendo un serio problema endémico en nuestro país; el cual tiene una de las mayores riquezas ictiológicas en el mundo, la cual podría representar una solución al problema de la desnutrición infantil. Se realizó el presente estudio, que tuvo como objetivo determinar el efecto del complemento nutricional en base a la Anchoveta en el desarrollo psicomotor de niños de 3 años con desnutrición crónica moderada. La presente investigación de corte experimental fue realizada en un poblado de extrema pobreza con altos índices de desnutrición. Observándose el efecto del complemento nutricional en base a Anchoveta en el periodo aproximado de 6 meses, sobre el desarrollo psicomotor de niños de 3 años con desnutrición crónica moderada, Concluyendo que existe mejoría clínica y de significancia estadística en el desarrollo psicomotor de estos niños, así como en la velocidad de recuperación de sus tallas.
The presence of child malnutrition and its impact on the brain development are a serious endemic problem in our country, even though it has one of the biggest ichthyological richness in the world, which could mean a solution for child malnutrition. This study had as a main objective to determine the effect of the nutritional complement based on anchovy on the psychomotor development on 3 years old children with chronic moderate malnutrition. The present research has an experimental basis which was conducted in a village of extreme poverty that holds a high rate of malnutrition. Observing the effect of the nutritional complement based on anchovy, on the period of six months on the psychomotor development on 3 years old children. Concluding that exist a clinical improvement and a statistical significance on the psychomotor development of those children, as well as the rapid recuperation to their regular height.