Admission factors associated with nutritional status deterioration and prolonged pediatric intensive care unit stay in critically ill children: PICU-ScREEN multicenter study.

BACKGROUND: Early identification of patients in the pediatric intensive care unit (PICU) at risk of nutritional status (NS) deterioration and poor outcomes is desirable. We aimed to identify factors associated with NS deterioration and prolonged PICU stay. METHODS: Prospective cohort study in eight Brazilian PICUs with children <18 years with a PICU stay >72h. We used multivariable logistic regression to identify the clinical, laboratory, and nutrition variables at admission that were associated with outcomes. NS deterioration was defined as the reduction in weight-for-age, body mass index-for-age or mid-upper arm circumference-for-age z-score ≥1 during PICU stay. Prolonged PICU stay was defined as ≥13 days. RESULTS: We enrolled 363 eligible patients, median age 11.3 months (interquartile range:3.1-45.6) and 46% had at least one complex chronic condition (CCC). NS deterioration was observed in 23% of participants and was associated with CCC (odds ratio [OR]:2.71; 95% confidence interval [CI]:1.44-5.09), after adjusting for severity risk score, leukocyte count, obesity, and PICU site. Prolonged PICU stay was associated with age <2 years (OR:1.95; 95%CI:1.03-3.66), fluid overload (>10%) over the first 72h (OR:2.66; 95%CI:1.50-4.73), and hypoalbuminemia (<3.0 g/dL) (OR:2.05; 95%CI:1.12-3.76), after adjusting for CCC, severity risk score, undernutrition, early nutrition therapy, and PICU site. CONCLUSIONS: CCC at admission was associated with NS deterioration. Age <2 years, fluid overload, and hypoalbuminemia at PICU admission were associated with prolonged PICU stay. These factors must be further evaluated as part of an admission nutrition screening tool for critically ill children.

Unemployment, poverty, and hunger in Brazil in Covid-19 pandemic times / Desemprego, pobreza e fome no Brasil em tempos de pandemia por Covid-19

ABSTRACT This scientific note presents preliminary developments of the Covid-19 pandemic on unemployment, poverty, and hunger in Brazil. The data on unemployment rate, un employment insurance claims, contingent of families in extreme poverty, and food insecurity was collected in government information systems, research published by public agencies, scientific articles, and in news portals. In an upward trajectory since 2015, the increase in unemployment and the number of families in extreme poverty was exacerbated after the pandemic began, drastically reducing the purchase power and access to healthy and adequate food, affecting mainly women and the populations of the Northern and Northeastern regions. Between January and September 2020, there was a 3% increase in unemployment in Brazil and, in October 2020, there were almost 485 thousand more families in extreme poverty compared to January of the same year. There are inadequate and insufficient responses from the Brazilian government to the articulated set of problems. The Covid-19 pandemic is a new element that potentiates the recent increase in hunger in Brazil, which occurs in parallel with the dismantling of the Food and Nutrition Security programs and the expansion of fiscal austerity measures, started with the political-economic crisis in 2015. There is an urgent need to recover the centrality of the agenda to fight hunger in Brazil, associated with the development of more robust contributions on the impact of the pandemic on the phenomena of poverty and hunger.

RESUMO Nesta nota científica apresentam-se desdobramentos preliminares da pandemia de Covid-19 sobre o desemprego, a pobreza e a fome no Brasil. Utilizaram-se dados sobre a taxa de desocupação, solicitações de seguro-desemprego e contingente de famílias em extrema pobreza e em insegurança alimentar, coletados em sistemas de informação governamentais, em pesquisas publicadas por órgãos públicos, em artigos científicos e em portais de notícias. Em trajetória ascendente, desde 2015, identificou-se um aumento do desemprego e do número de famílias em extrema pobreza após a instauração da pandemia, o que pode reduzir drasticamente o poder de compra e o acesso à alimentação adequada e saudável, afetando, principalmente, as mulheres e a população das regiões Norte e Nordeste. Entre janeiro e setembro de 2020, houve o aumento de 3% desemprego no Brasil e, em outubro de 2020, havia quase 485 mil famílias a mais em situação de extrema pobreza, relativamente a janeiro do mesmo ano. Verificam-se respostas inadequadas e insuficientes do governo brasileiro frente ao conjunto articulado de problemas. A pandemia de Covid-19 consiste em um novo elemento potencializador do aumento recente da fome no Brasil, que ocorre paralelamente ao desmonte dos programas de Segurança Alimentar e Nutricional e à ampliação de medidas de austeridade fiscal iniciadas com a crise político-econômica em 2015. Urge resgatar a centralidade da agenda de combate à fome no Brasil, associadamente ao desenvolvimento de contribuições mais robustas sobre o impacto da pandemia nos fenômenos da pobreza e da fome.