The effects of hospitalization on the nutritional status of children.

OBJECTIVE: To evaluate the nutritional status of children at hospital admission and again at hospital discharge and to investigate factors associated with the onset and/or exacerbation of malnutrition. METHOD: An observational study of 203 children under 5 years old admitted to a hospital in the city of Fortaleza between August and December 2003. Nutritional status, expressed in z-scores for weight/age, stature/age and weight/stature, was compared at the time of admission and on hospital discharge and broken down by sex, age, condition responsible for hospitalization and length of hospital stay. RESULTS: On admission prevalence rates for moderate and/or severe malnutrition (z-score < -2) were 18.7, 18.2 and 6.9%, for weight/age, stature/age and weight/stature, respectively. During their stay in hospital 51.6% of the 186 children who completed the study lost weight, with most weight being lost by those with prolonged hospital stays and pneumonia as the disease responsible for their hospitalization. Children who had malnutrition on admission were still malnourished at hospital discharge and 10 (9.17%) well-nourished children developed mild malnutrition while hospitalized. CONCLUSIONS: The prevalence of malnutrition at the time of admission was elevated and remained unchanged by discharge. Prolonged hospitalization and pneumonia were linked with weight loss in hospital.

The effects of hospitalization on the nutritional status of children

OBJECTIVE: To evaluate the nutritional status of children at hospital admission and again at hospital discharge and to investigate factors associated with the onset and/or exacerbation of malnutrition. METHOD: An observational study of 203 children under 5 years old admitted to a hospital in the city of Fortaleza between August and December 2003. Nutritional status, expressed in z-scores for weight/age, stature/age and weight/stature, was compared at the time of admission and on hospital discharge and broken down by sex, age, condition responsible for hospitalization and length of hospital stay. RESULTS: On admission prevalence rates for moderate and/or severe malnutrition (z-score < -2) were 18.7, 18.2 and 6.9%, for weight/age, stature/age and weight/stature, respectively. During their stay in hospital 51.6% of the 186 children who completed the study lost weight, with most weight being lost by those with prolonged hospital stays and pneumonia as the disease responsible for their hospitalization. Children who had malnutrition on admission were still malnourished at hospital discharge and 10 (9.17%) well-nourished children developed mild malnutrition while hospitalized. CONCLUSIONS: The prevalence of malnutrition at the time of admission was elevated and remained unchanged by discharge. Prolonged hospitalization and pneumonia were linked with weight loss in hospital.

Comparison between normal saline and a polyelectrolyte solution for fluid resuscitation in severely dehydrated infants with acute diarrhoea.

UNLABELLED: The optimal intravenous solution for rehydration of infants and children with severe dehydration is debated. AIM: The aim was to compare the efficacy of a polyelectrolyte solution (group PS) with sodium chloride 0.9% solution (group NS) in rapid parenteral rehydration of severely dehydrated infants with acute diarrhoea. METHODS: Primary outcomes were volume and time to hydration. Secondary outcomes were urea, creatinine, electrolytes, glucose, arterial pH and bicarbonate levels. Patients were assigned randomly and openly to one of the two treatment groups. Severe dehydration was defined as one or more of the following associated with any other sign of dehydration: depressed consciousness, a weak or absent pulse or capillary refill time > 10 sec. Peripheral blood samples for chemical pathology were collected before and after rapid fluid therapy. The mean age of the 36 enrolled infants was 9.1 mths. All had depressed consciousness or severe hypotension/shock. The fluid infusion rate was 50 ml/kg/hr until haemodynamic stability was restored (absence of severe hypotension and two urine emissions). Fluid volume, time to rehydration and weight before and after rehydration were recorded. RESULTS: All infants recovered full pulse within 1 hr; most had a better level of consciousness or capillary refill <3 sec. Group NS (15 infants) showed (before and after treatment, respectively) a decrease of plasma potassium (3.4 to 3.1 mmol/L, p=0.07), bicarbonate (13.3 to 12.2 mmol/L, p=0.01) and glucose (8.2 to 5.8 mmol/L, p<0.01). Group PS (21 infants) showed a decrease of potassium (4.4 to 3.2 mmol/L, p<0.01) but an increase in bicarbonate (11.6 to 13.3 mmol/L, p<0.01) and glucose (11.4 to 14.8 mmol/L, p=0.08). CONCLUSION: Polyelectrolyte solution was as effective as normal saline on volume expansion and better for correcting acidosis.

American visceral leishmaniasis (kala-azar) in hospitalized children from an endemic area.

OBJECTIVE: To study epidemiological and clinical aspects of American visceral leishmaniasis in hospitalized children in Ceará, Brazil. METHODS: A retrospective and observational study was carried out with children suffering from American visceral leishmaniasis admitted to Hospital Infantil Albert Sabin in Fortaleza. Medical records were reviewed consistently. Inclusion criteria were children with amastigote-positive smears in bone marrow or in splenic aspirates, or a positive Leishmania sp immunofluorescence assay. RESULTS: From January 1995 to December 2002, 450 children with American visceral leishmaniasis were identified, accounting for 9 to 27% of all reported cases in Ceará in that period, with peak hospitalization rates in 1995 and 2000. The mean age was 4.4 years (12% < 1 year and 65% < 5 years of age). The overall male: female ratio was 1.1 and 1.48 in children > 5 year (p = 0.04). Urban patients infected by American visceral leishmaniasis increased steadily over an 8-year period (chi2 p = 0.01). The main clinical complaints on admission were fever (96%), pallor (90%) and abdominal swelling (75%). Clinical cure was defined as the absence of fever, regression of splenic and hepatic enlargement and of pancytopenia. Overall mortality was 9.2% and 21.2% in patients younger than one year. Malnutrition, edema, bleeding, jaundice, and concomitant infections were related to higher mortality. CONCLUSIONS: Cases of American visceral leishmaniasis spiked with a 5-year interval, and affected most under-five urban children. Mortality was related to low age, signs of severe disease and concomitant infection.

American visceral leishmaniasis (kala-azar) in hospitalized children from an endemic area

OBJETIVOS: Estudar os aspectos epidemiológicos e clínicos da leishmaniose visceral americana em crianças hospitalizadas do Ceará. MÉTODOS: Estudo retrospectivo e observacional de crianças com leishmaniose visceral americana admitidas no Hospital Infantil Albert Sabin, em Fortaleza. Os prontuários foram revistos sistematicamente. Os critérios de inclusão foram crianças com esfregaços positivos para Leishmania em aspirado de medula óssea ou de baço, ou teste de imunoensaio positivo para Leishmania sp. RESULTADOS: Entre janeiro de 1995 e dezembro de 2002, foram identificados 450 pacientes, perfazendo 9 a 27 por cento dos casos de leishmaniose visceral americana notificados no Ceará no período, com picos de admissão em 1995 e 2000. A idade média foi de 4,4 anos (12 por cento < 1 ano e 65 por cento < 5 anos de idade). A relação masculino:feminino foi de 1,1 em geral e de 1,48 em < 5 anos (p = 0,04). Os pacientes urbanos aumentaram regularmente no período de 8 anos (X², p = 0,01). As principais queixas foram febre (90 por cento), palidez (90 por cento) e aumento abdominal (75 por cento). A cura clínica foi constatada por ausência de febre, regressão da hepato-esplenomegalia e da pancitopenia. A letalidade geral foi de 9,2 por cento, e 21,2 por cento em lactentes < 1 ano. Desnutrição, edema, sangramento, icterícia e infecção intercorrentes foram fatores relacionados com maior letalidade. CONCLUSÕES: Casos hospitalizados de leishmaniose visceral americana apresentaram picos a cada 5 anos e afetaram crianças urbanas < 5 anos. A mortalidade esteve associada à baixa idade, sinais de gravidade e infecção concomitante.

Intestinal barrier function and weight gain in malnourished children taking glutamine supplemented enteral formula.

OBJECTIVE: We examined the effect of standard formula and glutamine or glycine supplemented enteral formula on intestinal permeability and weight gain in children with malnutrition. METHODS: 80 children aged 2 to 60 months with a weight-for-age z-score less than -- 2 were studied. From December 1996 to April 1999, 27 study patients received nonsupplemented formula. From June 2001 to June 2002 an additional 53 patients were randomly assigned to receive formula supplemented with glutamine or glycine (isosmolar concentrations) for 10 days. Lactulose/mannitol excretion ratio was used as a measure of intestinal permeability and was performed before and after 10 days of nutritional rehabilitation. Weight was measured before and after treatment. RESULTS: Patients were similar on admission with regard to age, sex, nutritional status and lactulose/mannitol ratio. The lactulose/mannitol ratio significantly improved (decreased) in children receiving formula supplemented with glutamine for 10 days but not in those receiving glycine or nonsupplemented formula. Weight gain occurred during therapy in all groups and was not statistically different among groups. CONCLUSION: Formula supplemented with glutamine improves intestinal barrier function compared with nonsupplemented formula but does not augment weight gain.

Uma concepçäo popular sobre a esquistossomose mansonica: os modos de transmissäo e prevençäo na perspectiva de gênero / A popular concept of schistosomiais mansoni: modes of transmission and prevention in the perspectives of gender differences

Estudo sobre as concepçoes e práticas populares acerca da transmissäo e prevençäo das parasitoses, com ênfase para a esquistossomose mansônica. Explora a existência de um sistema popular de cuidados de saúde que mescla elementos da biomedicina e da medicina tradicional como forma de compreender e manejar os fenômenos de saúde/doença. Descreve as diferenças entre sexo e morbidade e sexo/gênero na concepçäo dos sujeitos entrevistados. Apresenta o discurso popular sobre as parasitoses, discutindo as dificuldades das açoes de controle. Considera as contradiçoes entre hábitos e valores culturais e as medidas de controle conhecidas, criticando a imprecisäo das açoes educativas nos programas oficiais de intervençäo.