Standardized Feeding Approach Mitigates Weight Loss in Infants with Congenital Heart Disease.

OBJECTIVE: To evaluate the effect of a standardized feeding approach using a clinical nutrition pathway on weight-for-age Z score (WAZ) over hospital length of stay (HLOS) for infants with congenital heart disease (CHD). STUDY DESIGN: A 10-year retrospective cohort study examined eligible infants who underwent neonatal cardiac surgery between July 2009 and December 2018 (n = 987). Eligibility criteria included infants born at least 37 weeks of gestation and a minimum birth weight of 2 kg who underwent cardiac surgery for CHD within the first 30 days of life. Using the best linear unbiased predictions from a linear mixed effects model, WAZ change over HLOS was estimated before and after January 2013, when the standardized feeding approach was initiated. The best linear unbiased predictions model included adjustment for patient characteristics including sex, race, HLOS, and class of cardiac defect. RESULTS: The change in WAZ over HLOS was significantly higher from 2013 to 2018 than from 2009 to 2012 (ß = 0.16; SE = 0.02; P < .001), after controlling for sex, race, HLOS, and CHD category, indicating that infants experienced a decreased WAZ loss over HLOS after the standardized feeding approach was initiated. Additionally, differences were found in WAZ loss over HLOS between infants with single ventricle CHD (ß = 0.26; SE = 0.04; P < .001) and 2 ventricle CHD (ß = 0.04; SE = 0.02; P = .04). CONCLUSIONS: These data suggest that an organized, focused approach for nutrition therapy using a standardized pathway improves weight change outcomes before hospital discharge for infants with single and 2 ventricle CHD who require neonatal cardiac surgery.

Elaboração de um protocolo de terapia nutricional para pacientes queimados em um centro de tratamento de referência: Relato de experiência / Elaboration of a nutritional therapy protocol for burned patients in a reference treatment center: Experience report

OBJETIVO: Descrever a trajetória da construção de um protocolo de terapia nutricional para pacientes queimados em um centro de tratamento de referência. RELATO DE EXPERIÊNCIA: Para a construção do protocolo, foi inicialmente elaborado um fluxograma sistematizando as etapas da atenção nutricional ao paciente queimado. Feito isso, percebeu-se a necessidade de construir um instrumento facilitador para tomada de decisões relativas à conduta nutricional. Com esta finalidade, foram realizadas estimativas das necessidades energéticas do paciente queimado, com base nas equações preditivas encontradas na literatura e em indivíduo de referência eutrófico, conforme perfil nutricional predominante na unidade. Os resultados foram dispostos em tabela comparativa, estratificados por sexo, faixa etária e percentual de superfície corporal queimada (%SCQ) e analisados para definir a melhor forma de estimar as necessidades energéticas dos pacientes na prática clínica. Ainda com base nesta estimativa, nas recomendações encontradas na literatura científica e na dieta oral padrão da unidade, que fornece aproximadamente 2548Kcal/dia e 105g/dia de proteína, foram elaboradas sugestões sobre quando e como prescrever suplementos orais nutricionalmente completos, módulo de proteína, glutamina e indicar terapia nutricional enteral para estes pacientes, conforme a %SCQ (<20%, 20%-30%, >40%). CONCLUSÃO: A aplicação deste protocolo na prática clínica pode otimizar a terapia nutricional do paciente queimado, de forma a minimizar a deterioração e/ou recuperar o estado nutricional destes pacientes, contribuindo para melhores desfechos clínicos.

OBJECTIVE: To describe the trajectory of the construction of a nutritional therapy protocol for burn patients in a reference treatment center. EXPERIENCE REPORT: For the construction of the protocol, initially a flowchart was prepared, systematizing the stages of nutritional care with burned patients. That done, it was realized the need to build a facilitating instrument for making decisions regarding nutritional conduct. For this purpose, estimates of the burned patient's energy needs were performed, based on the predictive equations found in the literature and in eutrophic reference individual, according to the predominant nutritional profile in the unit. The results were displayed in a comparative chart, stratified by sex, age and total body surface area (%TBSA) and analyzed to define the best way to estimate the energy needs of patients in clinical practice. Based on this estimate, in the recommendations found in the scientific literature and the unit's standard oral diet which provides approximately 2548Kcal/day and 105g/day of protein, suggestions were made about when and how to prescribe nutritionally complete oral supplements, protein module, glutamine and provide enteral nutritional therapy to these patients, according to %TBSA (<20%, 20%, 30%, >40%). CONCLUSION: The application of this protocol in clinical practice can optimize a nutritional therapy of the burned patient, in order to minimize the deterioration and/or recover their nutritional status, contributing to the best clinical outcomes.

Quality indicators in nutrition therapy and clinical outcomes in a neonatal intensive care unit / Indicadores de qualidade da terapia nutricional e desfechos clínicos em uma unidade de terapia intensiva neonatal

ABSTRACT Objective To associate quality indicators in nutritional therapy and pre-determined clinical outcomes in a neonatal unit. Methods A total of 81 premature newborns were monitored regarding the time to initiate nutrition therapy, time to meet energy needs, energy and protein adequacy, cumulative energy deficit, adequacy of the nutritional formula and fasting periods; weight gain, the occurrence of necrotizing enterocolitis, mortality and length of stay in the intensive care unit. The data were analyzed with the Statistical Package for the Social Sciences at 5% significance level. Results The time to start enteral nutrition and the calories infused/kg/day were predictors of length of hospital stay F(2.46)=6.148; p=0.004; R2=0.211; as well as the cumulative energy deficit+birth weight+infused calories/kg/day (F=3.52; p<0.001; R2=0.422); cumulative energy deficit+calories infused/kg/day+fasting time for Enteral Nutrition (F=15.041; p<0.001; R2=0.474) were predictors of weight gain. The time to start enteral nutrition, gestational age and birth weight were inversely associated with the occurrence of necrotizing enterocolitis (β=-0.38; β=-0.198; β=-0.002). Early enteral nutrition predisposed to mortality (β=0.33). Gestational age, birth weight and calories infused/kg/day were inversely related to mortality (β=-0.442; β=-0.004; β=-0.08). Conclusions Considering the associations between indicators and outcomes, routine monitoring of the time to start enteral nutrition, energy adequacy, energy deficit and fasting time is recommended.

RESUMO Objetivo Associar indicadores de qualidade em terapia nutricional e desfechos clínicos pré-determinados em uma unidade neonatal. Métodos 81 recém-nascidos prematuros foram monitorados quanto ao tempo para início da terapia nutricional, tempo para atingir as necessidades energéticas, adequação energética e proteica, déficit energético cumulativo, adequação da fórmula nutricional e períodos de jejum; ganho de peso, à ocorrência de enterocolite necrosante, à mortalidade e ao tempo de internação na unidade. Os dados foram analisados no Statistical Package for the Social Sciences a 5% de significância. Resultados O tempo para início da nutrição enteral e as calorias infundidas/kg /dia foram preditores do tempo de internação F(2,46)= 6,148; p=0,004; R2=0,211; assim como o déficit energético cumulativo + peso ao nascer + calorias infundidas/kg/dia (F=3,52; p<0,001; R2=0,422); déficit energético cumulativo + calorias infundidas/kg/dia + tempo de jejum de Nutrição Enteral (F =15,041; p<0,001; R2=0,474) foram preditores do ganho de peso. O tempo para início da nutrição enteral, a idade gestacional e o peso ao nascer estiveram inversamente associados à ocorrência da enterocolite necrosante β=-0,38; β=-0,198; β=-0,002). A nutrição enteral precoce predispôs à mortalidade (β=0,33). Estiveram inversamente relacionados à mortalidade, a idade gestacional, o peso ao nascer e as calorias infundidas/kg/dia (β=-0,442; β=-0,004; β=-0,08). Conclusão Considerando-se as associações entre indicadores e desfechos, recomenda-se o monitoramento rotineiro do tempo para início da nutrição enteral; da adequação energética; do déficit energético e do tempo de jejum.

[Comparison of expert recommendations on clinical nutrition for hospitalized patients with COVID-19]. / Comparación de las recomendaciones de expertos sobre nutrición clínica en pacientes hospitalizados con COVID-19.

INTRODUCTION: Introduction: in SARS-CoV-2-infected patients nutritional requirements are increased. These patients present symptoms that make food intake and nutrient absorption difficult, therefore involving nutritional risk. On the other hand, acute respiratory complications require prolonged ICU stays, and this predisposes to increased malnutrition and loss of skeletal muscle mass and function, which can lead to poor quality of life, disability and morbidity long after discharge. For this reason, the world's leading nutrition societies and associations believe that nutritional therapy should be considered a part of the basic treatment of patients with COVID-19. Methods: we have reviewed and compared 9 expert recommendations (ER) published by nutrition societies and associations from China, Spain, Brazil, Europe, Colombia, Australia, America, and the United Kingdom, in relation to critical and non-critical hospitalized patients due to the COVID-19 pandemic. Conclusions: the 9 ERs reviewed agree on the importance of nutritional management in critical and non-critical hospitalized patients with COVID-19, as well as on the early detection of nutritional risk, the intervention, and subsequent follow-up. Even so, each published document has its own particularities and puts a special stress on some specific aspect.

INTRODUCCIÓN: Introducción: la infección por SARS-CoV-2 implica riesgo nutricional debido a la dificultad de cubrir los requerimientos nutricionales aumentados en presencia de una sintomatología que dificulta la ingesta y la absorción de nutrientes. Por otro lado, las complicaciones respiratorias agudas requieren estancias prolongadas en unidades de cuidados intensivos (UCI) y esto predispone a una mayor desnutrición y a pérdida de masa y función del músculo esquelético, que a su vez puede conducir a una mala calidad de vida, discapacidad y morbilidad mucho después del alta. Por este motivo, las principales sociedades y asociaciones de nutrición clínica del mundo consideran que la terapia nutricional debe considerarse parte del tratamiento básico de los pacientes con COVID-19. Métodos: se han revisado y comparado 9 recomendaciones de expertos (RE) publicadas por sociedades y asociaciones de nutrición clínica de China, España, Brasil, Europa, Colombia, Australia, América y Reino Unido, a raíz de la pandemia por COVID-19, en relación a los pacientes hospitalizados críticos y no críticos. Conclusiones: las 9 RE revisadas coinciden en la importancia del tratamiento nutricional en los pacientes hospitalizados críticos y no críticos con COVID-19, así como en la detección precoz del riesgo nutricional, la intervención y el seguimiento. Aun así, cada documento publicado tiene sus propias particularidades e incide especialmente en algún aspecto.

Nutrition in times of Covid-19, how to trust the deluge of scientific information.

PURPOSE OF REVIEW: The Covid-19 pandemic has daunted the world with its enormous impact on healthcare, economic recession, and psychological distress. Nutrition is an integral part of every person life care, and should also be mandatorily integrated to patient care under the Covid-19 pandemic. It is crucial to understand how the Covid-19 does develop and which risk factors are associated with negative outcomes and death. Therefore, it is of utmost importance to have studies that respect the basic tenets of the scientific method in order to be trusted. The goal of this review is to discuss the deluge of scientific data and how it might influence clinical reasoning and practice. RECENT FINDINGS: A large number of scientific manuscripts are daily published worldwide, and the Covid-19 makes no exception. Up to now, data on Covid-19 have come from countries initially affected by the disease and mostly pertain either epidemiological observations or opinion papers. Many of them do not fulfil the essential principles characterizing the adequate scientific method. SUMMARY: It is crucial to be able to critical appraise the scientific literature, in order to provide adequate nutrition therapy to patients, and in particular, to Covid-19 infected individuals.

Brazilian Nutritional Consensus in Hematopoietic Stem Cell Transplantation: Graft- versus -host disease.

The Brazilian Consensus on Nutrition in Hematopoietic Stem Cell Transplantation: Graft- versus -host disease was approved by Sociedade Brasileira de Transplante de Medula Óssea , with the participation of 26 Brazilian hematopoietic stem cell transplantation centers. It describes the main nutritional protocols in cases of Graft- versus -host disease, the main complication of hematopoietic stem cell transplantation.

Brazilian Nutritional Consensus in Hematopoietic Stem Cell Transplantation: Adults.

The nutritional status of patients submitted to hematopoietic stem cell transplant is considered an independent risk factor, which may influence on quality of life and tolerance to the proposed treatment. The impairment of nutritional status during hematopoietic stem cell transplant occurs mainly due to the adverse effects resulting from conditioning to which the patient is subjected. Therefore, adequate nutritional evaluation and follow-up during hematopoietic stem cell transplant are essential. To emphasize the importance of nutritional status and body composition during treatment, as well as the main characteristics related to the nutritional assessment of the patient, the Brazilian Consensus on Nutrition in Hematopoietic Stem Cell Transplant: Adults was prepared, aiming to standardize and update Nutritional Therapy in this area. Dietitians, nutrition physicians and hematologists from 15 Brazilian centers thar are references in hematopoietic stem cell transplant took part.

Brazilian Nutritional Consensus in Hematopoietic Stem Cell Transplantation: Adults / Consenso Brasileiro de Nutrição em Transplante de Células-Tronco Hematopoiéticas: Adultos

ABSTRACT The nutritional status of patients submitted to hematopoietic stem cell transplant is considered an independent risk factor, which may influence on quality of life and tolerance to the proposed treatment. The impairment of nutritional status during hematopoietic stem cell transplant occurs mainly due to the adverse effects resulting from conditioning to which the patient is subjected. Therefore, adequate nutritional evaluation and follow-up during hematopoietic stem cell transplant are essential. To emphasize the importance of nutritional status and body composition during treatment, as well as the main characteristics related to the nutritional assessment of the patient, the Brazilian Consensus on Nutrition in Hematopoietic Stem Cell Transplant: Adults was prepared, aiming to standardize and update Nutritional Therapy in this area. Dietitians, nutrition physicians and hematologists from 15 Brazilian centers thar are references in hematopoietic stem cell transplant took part.

RESUMO O estado nutricional do paciente submetido ao transplante de células-tronco hematopoéticas é considerado fator de risco independente, podendo influenciar na qualidade de vida e na tolerância ao tratamento proposto. O comprometimento do estado nutricional durante o transplante de células-tronco hematopoéticas ocorre principalmente devido aos efeitos adversos decorrentes do condicionamento ao qual o paciente é submetido. Desta forma, a adequada avaliação nutricional e o acompanhamento durante o transplante de células-tronco hematopoéticas tornam-se imprescindíveis. Com o objetivo de salientar a importância do estado nutricional e da composição corporal durante o tratamento, bem como as principais características relacionadas à avaliação nutricional do paciente, o Consenso Brasileiro de Nutrição em Transplante de Células-Tronco Hematopoiéticas: Adulto foi elaborado visando uniformizar e atualizar a Terapia Nutricional nesta área. Com a participação de nutricionistas, nutrólogos e hematologistas de 15 centros brasileiros referências em transplante de células-tronco hematopoéticas

Brazilian Nutritional Consensus in Hematopoietic Stem Cell Transplantation: Graft- versus -host disease / Consenso Brasileiro de Nutrição no Transplante de Células Tronco Hematopoiéticas: doença do enxerto contra o hospedeiro

ABSTRACT The Brazilian Consensus on Nutrition in Hematopoietic Stem Cell Transplantation: Graft- versus -host disease was approved by Sociedade Brasileira de Transplante de Medula Óssea , with the participation of 26 Brazilian hematopoietic stem cell transplantation centers. It describes the main nutritional protocols in cases of Graft- versus -host disease, the main complication of hematopoietic stem cell transplantation.

RESUMO O Consenso Brasileiro de Nutrição no Transplante de Células Tronco Hematopoiéticas: doença do enxerto contra o hospedeiro foi aprovado pela Sociedade Brasileira de Transplante de Medula Óssea, com a participação de 26 centros brasileiros de transplante de células-tronco hematopoiéticas. O Consenso descreve as principais condutas nutricionais em casos de doença do enxerto contra o hospedeiro, a principal complicação do transplante de células-tronco hematopoiéticas.

Systematization of Nutritional Care In Endoscopic Treatment for Obesity.

PURPOSE: Propose the systematization of nutritional care in the endoscopic treatment of obesity. METHOD: This is a bibliographical review, since the initial proposal was a systematic review. This method became unfeasible due to the inexistence of studies that address this theme. Thus, a bibliographic survey was carried out, considering the endoscopic treatment as a restrictive treatment, as well as the information referring to case reports and multicentric studies. RESULTS: Nutrition participation involves nutritional assessment and diagnosis, dietary planning pertinent to the adequate evolution of food consistency, as well as the use of food supplements compatible with the Gastric Sleeve due to food restriction. The Bariatric Plate Model (BPM) can be useful in the nutritional education of the patient after gastric endosuture, associated with water consumption and the performance of scheduled physical exercise, as well as periodic monitoring with the multiprofessional team. CONCLUSIONS: Specialized nutritional care is necessary, through a protocol of nutritional assistance defined after gastric endosuture, in order to achieve long-term weight loss and maintenance goals. The BPM can be an excellent form of nutritional education, observing protein intake as a macronutrient base.

Mapping the implementation of evidence-based nutritional management in primary health care settings: a scoping review protocol.

REVIEW QUESTION/OBJECTIVE: The objective of this scoping review is to systematically map and categorize the wide variety of interventions and programs that might be classified under the umbrella term "evidence-based nutritional management in primary healthcare". The development of this scoping review will provide a better understanding of how evidence-based nutritional management has been implemented by healthcare professionals in primary health care settings, especially of barriers and facilitators to implementing evidence-based nutritional management. Therefore, three research questions were chosen to guide the scoping review.

Dieta enteral prescrita versus dieta infundida / Dieta enteral prescrita versus dieta infundida / Diet enteral prescribed versus diet infused

Objective: To evaluate the prescribed volume of enteral feeding versus the volume infused, identifying the diet for interruption, and expenses generated by these interruptions. Methods: Observational study with adults and elderly patients receiving enteral nutrition in a private hospital in São Paulo. Data collection was performed by means of electronic medical records. Results: The infused volume was significantly lower than the amount prescribed in the five days of monitoring in the entire sample. The main complication in the experimental diet was diarrhea. Spending on non-diet administration amount to 41.4% of the amount spent for this service. Conclusion: This study contributes to the performance and nutritionist performance in conjunction with the multidisciplinary team in Nutrition Therapy aiming at the improvement of the patient.

Objetivo: Avaliar o volume prescrito de dieta enteral versus o volume infundido, identificando as causas de interrupção da dieta e os gastos gerados por essas interrupções. Métodos: Estudo observacional, com pacientes adultos e idosos, recebendo nutrição enteral em um hospital particular de São Paulo. A coleta de dados foi realizada por meio de prontuário eletrônico. Resultados: O volume infundido foi significantemente menor que o volume prescrito, nos cinco dias de acompanhamento, em toda a amostra. A principal intercorrência na administração da dieta foi a diarreia. Os gastos com a não administração da dieta somam 41,4% do valor despendido para esse serviço. Conclusão: Este estudo contribui para a atuação e desempenho do nutricionista em conjunto com a Equipe Multidisciplinar em Terapia Nutricional visando a melhora do paciente.

Objetivo: Evaluar el volumen prescrito de la alimentación enteral en comparación con el volumen infundido, la identificación de la dieta para la interrupción y gastos generados por estas interrupciones. Métodos: Estudio observacional con pacientes adultos y ancianos que reciben nutrición enteral en un hospital privado de Sao Paulo. La recolección de datos se realizó por medio de registros médicos electrónicos. Resultados: El volumen infundido fue significativamente menor que la cantidad prescrita en los cinco días de monitoreo en toda la muestra. La complicación principal de la dieta experimental fue la diarrea. El gasto en cantidad de administración no dietética al 41,4% de la cantidad gastada por este servicio. Conclusión: Este estudio contribuye al rendimiento y desempeño en nutrición en conjunto con el equipo multidisciplinario en el tratamiento nutricional destinado a la mejora del paciente.

Qualidade da terapia nutricional enteral em unidades de terapia intensiva / Quality of enteral nutritional therapy in intensive care units

Introdução: O monitoramento da qualidade da terapia nutricional é de extrema importância para a identificação de não conformidades em relação às metas nutricionais e à real oferta enérgico-proteica, e, consequentemente, proporcionar melhorias na assistência ao paciente grave. Objetivo: Avaliar a adequação da nutrição enteral (NE) por meio da aplicação de indicadores de qualidade da terapia nutricional em Unidades de Terapia Intensiva. Método: Foi avaliada a adequação de calorias e proteínas calculadas, prescritas e ofertadas. Também foram aplicados indicadores de qualidade da terapia nutricional enteral propostos pelo International Life Sciences Institute Brasil. Resultados: Foram avaliados 53 pacientes, com idade média de 59,3±17,64 anos; 56,6% eram do sexo masculino. A adequação entre o prescrito e o calculado foi 72,15% para caloria e 57,58% para proteína, entre prescrito e infundido foi de 71,67% tanto para caloria e proteína, e a razão entre o calculado e infundido foi de 53,36% e 40,7% de caloria e proteína, respectivamente. Foram observadas não conformidades em relação às metas pré-estabelecidas nos seguintes indicadores de qualidade: dias com oferta calórica administrada maior ou menor que 20% da oferta prescrita em pacientes em NE (25%), dias com aporte proteico insuficiente no total de dias (49,37%) e pacientes em jejum por mais de 24 horas (52,83%). Conclusão: Foram encontradas inadequações na prescrição e oferta da NE, principalmente proteica. Assim como, frequência elevada de jejuns inadequados e alta mortalidade no grupo estudado.(AU)

Background: Monitoring the quality of nutrition therapy is extremely important to identify non-conformities in relation to nutritional goals and the real energetic-protein supply, and consequently provide improvements in care for critically ill patients. Objectives: To assess the adequacy of enteral nutrition through the application of nutritional therapy quality indicators in Intensive Care Units. Methods: It was evaluated the adequacy of calories and proteins calculated, prescribed and offered. Also enteral nutrition therapy quality indicators were applied. Results: Fifty-three patients were evaluated,with a mean age of 59.3±17.64 years; 56.6% were male. The suitability of prescribed and calculated was 72.15% to calories and 57.58% protein, between prescribed and infused was 71.67% for both calories and protein, and the ratio between the calculated and infused was 53.36% and 40.7% of calorie and protein, respectively. It was observed non-conformities in relation to pre-established goals in the following quality indicators: days with higher administered energy intake or less than 20% of the prescribed offering in patients enteral nutrition therapy (25%), days with insufficient protein intake in total days (49.37%) and patients fasted for more than 24 hours (52.83%). Conclusion: Inadequacies were found in the prescription and supply of enteral nutrition, especially protein. As well as high frequency of inadequate fasts and high mortality in this group.(AU)

Quality control of enteral nutrition therapy in cancer patients at nutritional risk.

INTRODUCTION: Quality indicators in nutritional therapy (QINTs) allow for the practical assessment of quality in the management of enteral nutrition therapy (ENT) among hospitalized patients. OBJECTIVE: To control ENT quality in cancer patients at nutritional risk. METHODS: A prospective, observational study was performed with cancer patients over 19 years of age who had undergone exclusive ENT for at least 72 h. Nutritional Risk Screening was used to assess nutritional risk; in the presence of nutritional risk, the Subjective Global Assessment (SGA) was used. Six QINTs were applied. RESULTS: Our study included 211 patients (mean age: 59 ± 10 years, 67.3% men). Most common cancer diagnoses were head and neck (68.2%) and gastrointestinal (18%). Nutritional risk was identified in 93.3% (n = 197) of patients; SGA identified malnutrition in 84.2% of patients (n = 166). ENT was used for 9.7 ± 7 days, presenting a daily deficit of -243.1 ± 141 ml of dietary volume, -363.3 ± 214.1 kcal, and -14.2 ± 8.41 g of protein. Three of the six QINTs were in accordance with the proposed goal: frequency of SGA application, calculations of nutritional needs, and frequency of diarrhea. Three of the six QINTs were in disagreement with the proposed goal: ENT infused volume exceeding 70% of prescribed volume, frequency of digestive fasting exceeding 24 h, and frequency of constipation. Prescriptions for anticholinergic drugs (p = 0.023) and diuretics (p = 0.007) were associated with diarrhea. CONCLUSION: Nutritional risk and malnutrition are frequent among ENT cancer patients. Quality control in ENT was moderately impaired by episodes of fasting and intestinal motility disorders.

Protected time for nutrition support teams: What are the benefits?

BACKGROUND & AIMS: Nutrition support teams (NSTs) are important and unique entities in acute care hospitals. Despite their utility, NSTs are lacking in the majority of hospitals worldwide and where they exist, most members only spend a fraction of their time working within that role. We aim to evaluate the effect of protected time on NST performance by assessing the influence of structure and process in NST activities. METHODS: All large public hospitals (>250 beds) in the Brazilian Federal District were evaluated with a structured questionnaire designed to assess NST performance. The questionnaire was adapted to include the Donabedian quality processes comprising 54 questions split amongst 6 domains; mainly structure and processes. The percentage of questionnaire compliance (NST outcome) was utilized to assess differences regarding structure and process. Hospitals with protected time to NST activities (Group I) were compared to hospitals without NSTs protected times (Group II). RESULTS: Seven hospitals were assessed. Group I, n = 3, showed a significantly higher performance outcome than Group II, n = 4 (77.9 × 60.3; P = 0.004), and only Group I's score achieved the benchmark for quality standards (75% compliance). Significant differences between groups were also found in structure (P = 0.017) and process (P = 0.014). CONCLUSIONS: This study indicates that protected time for NST activities is paramount to increase NST performance and could positively influence Donabedian quality indicators. Our results highlight the importance of NSTs in large hospitals and is an advocate for public policies requiring dedicated time for NST work. Only a larger study can confirm our findings.

Nutritional Supplementation Is a Necessary Complement to Dietary Counseling among Tuberculosis and Tuberculosis-HIV Patients.

UNLABELLED: The Brazilian Ministry of Health and the World Health Organization recommend dietary counseling for patients with malnutrition during tuberculosis treatment. Patients under tuberculosis therapy (infected and not infected with HIV) were followed-up to evaluate the effectiveness of dietary counseling. OBJECTIVE: describe the nutritional status of patients with tuberculosis. METHODS: an observational follow-up study over a 180-day period of tuberculosis therapy in adults was conducted. Subjects were assessed for body composition (using BMI, TSF and MUAC parameters), serum biomarkers and offered dietary counseling. The data obtained at each visit (D15, D30, D60, D90, D120, D150, and D180) were analyzed, showing trajectories over time and central tendencies each time. RESULTS: at baseline, the mean age was 41.1 (± 13.4) years; they were predominantly male, with income lower than a local minimum wage and at least six years of schooling. Patients showed predominantly pulmonary tuberculosis. At baseline, all patients suffered from malnutrition. The overall energy malnutrition prevalence was of 70.6%. Anemia at baseline was observed in both groups (63.2%), however, it was significantly more pronounced in the HIV+. At the end, energy malnutrition was reduced to 57.1% (42.9% of HIV- and 71.4% of the HIV+). Micronutrients malnutrition was evident in 71.4% of the HIV- patients and 85.7% of HIV+ patients at the end of tuberculosis therapy. Using BMI (≤ 18.5 kg/m2cutoff) as an index of malnutrition, it was detected in 23.9% of the HIV- and 27.3% of the HIV+ patients at baseline, with no evident improvement over time; using TSF (≤ 11.4mm as cutoff) or MUAC (≤ 28.5cm as cutoff), malnutrition was detected in 70.1% and 85.3% of all patients, respectively. Nevertheless, combining all biomarkers, at the end of follow-up, all patients suffered from malnutrition. CONCLUSION: Although with a limited number of patients, the evidence does not support that dietary counseling is effective to recover from malnutrition in our population.

O impacto da introdução precoce de terapia nutricional enteral na redução da morbimortalidade na terapia intensiva pediátrica: uma revisão sistemática / Early enteral nutrition therapy and mortality in a pediatric intensive care unit

OBJETIVO: Avaliar o impacto da introdução precoce de terapia nutricional enteral na redução da morbimortalidade em unidades de terapia intensiva pediátrica. MÉTODOS: Pesquisa bibliográfica nas bases de dados PubMed, Lilacs e Embase dos últimos 10 anos, em língua inglesa e população-alvo de indivíduos de 1 mês de idade a 18 anos, internados em unidades de terapia intensiva pediátrica, usando as palavras-chave: Critical Care, Nutritional Support e Nutrition Disorders or Malnutrition. RESULTADOS: Apesar dos avanços na qualidade dos cuidados clínicos, a prevalência de desnutrição em crianças hospitalizadas permanece imutável nos últimos 20 anos (15-30%) e tem implicações no tempo de internação, curso da doença e morbidade. A desnutrição é comum e é com frequência pouco reconhecida e então, não tratada. A terapia nutricional é parte essencial no tratamento dos pacientes pediátricos gravemente doentes que apresentam estado de hipercatabolismo proteico, que pode ser minimizado com um plano terapêutico nutricional efetivo. Neste estudo, foram revisadas publicações que mostraram que ainda há uma escassez de pesquisas controladas e randomizadas com bom tratamento estatístico em relação à terapia nutricional enteral com desfecho relacionado à morbimortalidade. As diretrizes atuais para terapia nutricional desses pacientes são amplamente baseadas na opinião de experts e em dados extrapolados de estudos em adultos, bem como de estudos realizados em crianças saudáveis. CONCLUSÃO: A evidência científica na utilização de terapia nutricional enteral na melhora da evolução dos pacientes pediátricos gravemente doentes ainda é escassa e são necessários novos estudos focados nisso, além de diretrizes mais bem-formuladas.

OBJECTIVE: To assess the impact of early introduction of enteral nutrition therapy in reducing morbidity and mortality in pediatric intensive care unit. METHODS: Search in the literature of the last 10 years, in English and the target population of individuals aged 1 month to 18 years admitted to pediatric intensive care units in the databases PubMed, Lilacs and Embase using the keywords: Critical Care, Nutritional Support and Nutrition Disorders or Malnutrition. RESULTS: Despite advances in the quality of clinical care, the prevalence of malnutrition in hospitalized children remains unchanged in the last 20 years (15-30%) and has implications for the time of admission, course of illness and morbidity. Malnutrition is common and is often poorly recognized and therefore, untreated. Nutritional therapy is an essential part in the treatment of pediatric patients who have severely ill hypercatabolic state protein, which can be minimized with an effective nutritional treatment plan. In this study, we reviewed publications which have shown that there is still a paucity of randomized and controlled studies with good statistical treatment in relation to enteral nutritional therapy with outcomes related to morbidity and mortality. The current guidelines for nutritional therapy in these patients are largely based on expert opinion and data extrapolated from adult studies and studies in healthy children. CONCLUSION: The scientific evidence on the use of enteral nutrition therapy in improving the development of critically ill pediatric patients is still scarce and further studies are needed focusing on it, and better guidelines must be formulated.

Impact of early enteral nutrition therapy on morbimortality reduction in a pediatric intensive care unit: a systematic review.

OBJECTIVE: To assess the impact of early introduction of enteral nutrition therapy in reducing morbidity and mortality in pediatric intensive care unit. METHODS: Search in the literature of the last 10 years, in English and the target population of individuals aged 1 month to 18 years admitted to pediatric intensive care units in the databases PubMed, Lilacs and Embase using the keywords: Critical Care, Nutritional Support and Nutrition Disorders or Malnutrition. RESULTS: Despite advances in the quality of clinical care, the prevalence of malnutrition in hospitalized children remains unchanged in the last 20 years (15-30%) and has implications for the time of admission, course of illness and morbidity. Malnutrition is common and is often poorly recognized and therefore, untreated. Nutritional therapy is an essential part in the treatment of pediatric patients who have severely ill hypercatabolic state protein, which can be minimized with an effective nutritional treatment plan. In this study, we reviewed publications which have shown that there is still a paucity of randomized and controlled studies with good statistical treatment in relation to enteral nutritional therapy with outcomes related to morbidity and mortality. The current guidelines for nutritional therapy in these patients are largely based on expert opinion and data extrapolated from adult studies and studies in healthy children. CONCLUSION: The scientific evidence on the use of enteral nutrition therapy in improving the development of critically ill pediatric patients is still scarce and further studies are needed focusing on it, and better guidelines must be formulated.

Valoración de la efectividad del soporte nutricional por sonda nasogástrica en sala general / Assessment of the efficacy of nasogastric nutritional support in a general ward / Valorização da efetividade do suportenutricional por sonda nasogástricaem enfermaría

La interrupción de la alimentación enteral conduce a un aporte calórico inadecuado, circunstancia que se agrava debido al estado catabólico que presentan los pacientes internados, contribuyendo ambas situaciones al deterioro de su estado nutricional. La malnutrición calóricoproteica se asocia con un mayor número de complicaciones, con un incremento de la estadía hospitalaria y, por lo tanto, con mayores costos. Objetivos. Evaluar la calidad del soporte nutricional por sonda y cuáles son los factores que influyeron en las diferencias entre la cantidad de nutrientes administrados, pautados y teóricamente requeridos. Material y métodos. Pacientes adultos a quienes se les prescribía nutrición enteral por sonda nasogastro/enteral. Se calcularon diariamente las calorías pautadas y las administradas, mientras que los requerimientos calóricos teóricos se calcularon según la ecuación de Harris-Benedict a la que se le aplicaba un factor de estrés y actividad. Asimismo, se evaluaron las causas por las que se interrumpió la nutrición enteral. Resultados. De un total de 40 pacientes consecutivos que recibieron soporte nutricional enteral un 95% presentó administración inadecuada. Hubo una inadecuación de la prescripción médica de la alimentación enteral en un 70% relacionado con el requerimiento calórico total. El bajo ratio de calorías administradas-pautadas afectaban a la Nutrición Enteral, debido a las causas más importantes de interrupción (que acumulan el 80% de las interrupciones):a) relacionadas al personal de enfermería (32.5%), b) incumplimiento en el horario de entrega del alimento (20%), c) problemas mecánicos (12.5%), d) procedimientos diagnósticos (10%) y e) disfunción gastrointestinal(10%). Conclusiones. En nuestra unidad se observó una diferencia importante entre los requerimientos calóricos teóricos y la cantidad efectivamente administrada. El conocimiento de esta situación permitirá ...

Background. The interruption of enteral feeding leads to inappropriate caloric intake, circumstance aggravated by the catabolic state of inpatients and both factors contributing to the deterioration of their nutritional status.Protein-energy malnutrition is associated with more complications, increased hospital stay, and therefore higher costs.Objective. To evaluate the quality of enteral nutritional support and the factors influencing the differences between the amounts of nutrients managed, scheduled and theoretically required.Materials y methods. Adult patients prescribed enteral nutrition by nasogastric/enteral tube. The calories administered and estimated were daily calculated, while theoretical caloric requirements were calculated according to the Harris-Benedict equation with an applied factor of stress and activity. The reasons leading to enteral nutrition cessationwere also evaluated.Results. Of the 40 consecutive patients who received enteral nutritional support, 95% reported inadequate administration. There was an inadequate medical prescription of enteral feeding by 70%, related to total caloric requirements. The low ratio of calories prescribed-administered affected enteral nutrition due to the following main causes of interruption (which accumulate 80% of interruptions): nurses/' work (32.5%), failure in the delivery of the scheduled food (20%), mechanical problems (12.5%), diagnostic procedures (10%) and gastrointestinal dysfunction (10%). Conclusions. In our unit we could observe an important difference between the theoretical energy requirements and the amounts effectively administered. Acknowledging...

A interrupção da alimentação enteral conduza uma contribuição calórica inadequada, circunstância que se agrava devido o estado catabólico que apresentamos pacientes internados, contribuindo ambas as situaçõespara a deterioração do seu estado nutricional. A má nutriçãocalórica-proteica é associada a um maior número decomplicações, com um incremento da estadia hospitalariae, portanto, com maiores custos.Objetivos. Avaliar a qualidade do suporte nutricional porsonda e quais são os fatores que influenciaram nas diferençasentre a quantidade de nutrientes administrados, determinadose teoricamente requeridos.Material e métodos. Pacientes adultos que recebiam prescriçãonutricional enteral por sonda nasogastroenteral. Foramcalculadas diariamente as calorias determinadas e asadministradas enquanto que os requerimentos calóricoseram calculados segundo a equação de Harris-Benedictna qual se aplicava um fator de estresse e atividade. Alémdisso, foram avaliadas as causas pelas quais a nutriçãoenteral foi interrompida.Resultados. De um total de 40 pacientes ...

Qualifying instrument for evaluation of food and nutritional care in hospital.

Establishing criteria for hospital nutrition care ensures that quality care is delivered to patients. The responsibility of the Hospital Food and Nutrition Service (HFNS) is not always well defined, despite efforts to establish guidelines for patient clinical nutrition practice. This study describes the elaboration of an Instrument for Evaluation of Food and Nutritional Care (IEFNC) aimed at directing the actions of the Hospital Food and Nutrition Service. This instrument was qualified by means of a comparative analysis of the categories related to hospital food and nutritional care, published in the literature. Elaboration of the IEFNC comprised the following stages: (a) a survey of databases and documents for selection of the categories to be used in nutrition care evaluation, (b) a study of the institutional procedures for nutrition practice at two Brazilian hospitals, in order to provide a description of the sequence of actions that should be taken by the HFNS as well as other services participating in nutrition care, (c) design of the IEFNC based on the categories published in the literature, adapted to the sequence of actions observed in the routines of the hospitals under study, (d) application of the questionnaire at two different hospitals that was mentioned in the item (b), in order to assess the time spent on its application, the difficulties in phrasing the questions, and the coverage of the instrument, and (e) finalization of the instrument. The IEFNC consists of 50 open and closed questions on two areas of food and nutritional care in hospital: inpatient nutritional care and food service quality. It deals with the characterization and structure of hospitals and their HFNS, the actions concerning the patients' nutritional evaluation and monitoring, the meal production system, and the hospital diets. "This questionnaire is a tool that can be seen as a portrait of the structure and characteristics of the HFNS and its performance in clinical and meal management dietitian activities."