Net Promoter Score (NPS) as a tool to assess parental satisfaction in pediatric intensive care units

Abstract Objective To verify the performance of the Net Promoter Score (NPS) as a tool to assess parental satisfaction in pediatric intensive care units (PICUs). Methods The authors conducted an observational cross-sectional multicenter study in the PICUs of 5 hospitals in Brazil. Eligible participants were all parents or legal guardians of PICU-admitted children, aged 18 years or over. The NPS was administered together with the EMpowerment of PArents in THe Intensive Care (EMPATHIC-30), used as the gold standard, and a sociodemographic questionnaire. For analysis, the results were dichotomized into values greater than or equal to the median of the tests. The associations between the 2 tools were evaluated and the distribution of their results was compared. Results The parents or legal guardians of 78 PICU-admitted children were interviewed. Of the respondents, 85% were women and 62% were in a private hospital. The median NPS was 10 (IQR, 10-10), and the median EMPATHIC-30 score was 5.7 (IQR, 5.4-5.9). Compared with the gold standard, the NPS had a sensitivity of 100% at all cutoff points, except at cutoff 10, where the sensitivity was slightly lower (97.5%). As for specificity, NPS performance was poorer, with values ranging from 0% (NPS ≥ 5) to 47.4% (NPS = 10). Conclusions NPS proved to be a sensitive tool to assess parental satisfaction, but with poor ability to identify dissatisfied users in the sample.

Net Promoter Score (NPS) as a tool to assess parental satisfaction in pediatric intensive care units.

OBJECTIVE: To verify the performance of the Net Promoter Score (NPS) as a tool to assess parental satisfaction in pediatric intensive care units (PICUs). METHODS: The authors conducted an observational cross-sectional multicenter study in the PICUs of 5 hospitals in Brazil. Eligible participants were all parents or legal guardians of PICU-admitted children, aged 18 years or over. The NPS was administered together with the EMpowerment of PArents in THe Intensive Care (EMPATHIC-30), used as the gold standard, and a sociodemographic questionnaire. For analysis, the results were dichotomized into values greater than or equal to the median of the tests. The associations between the 2 tools were evaluated and the distribution of their results was compared. RESULTS: The parents or legal guardians of 78 PICU-admitted children were interviewed. Of the respondents, 85% were women and 62% were in a private hospital. The median NPS was 10 (IQR, 10-10), and the median EMPATHIC-30 score was 5.7 (IQR, 5.4-5.9). Compared with the gold standard, the NPS had a sensitivity of 100% at all cutoff points, except at cutoff 10, where the sensitivity was slightly lower (97.5%). As for specificity, NPS performance was poorer, with values ranging from 0% (NPS ≥ 5) to 47.4% (NPS = 10). CONCLUSIONS: NPS proved to be a sensitive tool to assess parental satisfaction, but with poor ability to identify dissatisfied users in the sample.

Prevalence and functional status of children with complex chronic conditions in Brazilian PICUs during the COVID-19 pandemic

Abstract Objective The proportion of children with complex chronic conditions is increasing in PICUs around the world. We determined the prevalence and functional status of children with complex chronic conditions in Brazilian PICUs during the COVID-19 pandemic. Methods The authors conducted a point prevalence cross-sectional study among fifteen Brazilian PICUs during the COVID-19 pandemic. The authors enrolled all children admitted to the participating PICUs with complex chronic conditions on three different days, four weeks apart, starting on April 4th, 2020. The authors recorded the patient's characteristics and functional status at admission and discharge days. Results During the 3 study days from March to June 2020, the authors enrolled 248 patients admitted to the 15 PICUs; 148 had CCC (prevalence of 59.7%). Patients had a median of 1 acute diagnosis and 2 chronic diagnoses. The use of resources/devices was extensive. The main mode of respiratory support was conventional mechanical ventilation. Most patients had a peripherally inserted central catheter (63.1%), followed by a central venous line (52.5%), and 33.3% had gastrostomy or/and tracheostomy. The functional status score was significantly better at discharge compared to admission day due to the respiratory status improvement. Conclusions The prevalence of children with CCC admitted to the Brazilian PICUs represented 59.7% of patients during the COVID-19 pandemic. The functional status of these children improved during hospitalization, mainly due to the respiratory component.

Impact of the COVID-19 Pandemic on Patient- and Family-Centered Care and on the Mental Health of Health Care Workers, Patients, and Families.

During the COVID-19 pandemic, hospitals around the world were forced to reorganize their processes in an attempt to contain the spread of the virus while still providing adequate care to patients. In the Pediatric Intensive Care Unit (PICU) setting, changes in family visitation protocols and restrictions on parent chaperones during hospitalization, as well as other changes, interfered with care. Based on a narrative review of the literature, supported by the authors' observations in practice, we aimed to describe the impact of the pandemic on patient and family-centered care (PFCC) in the PICU environment, especially regarding the presence of family members, family support, and communication with patients and their families, as well as the effects of changes in these practices on the mental health of those involved. In this context, several strategies were used to sustain PFCC, and, despite many challenges, attempts were made to achieve the bare-minimum goals of humanized care for patients, families, and providers alike.

Parents' satisfaction with care in pediatric intensive care units.

OBJECTIVE: To verify the parents' satisfaction in relation to the care provided to their child admitted to the pediatric intensive care unit and associated clinical factors. METHOD: Exploratory, cross-sectional study, with a total of 84 parents, in a private hospital in Sao Paulo, Brazil. Data collection took place from March 2019 to January 2020, in the post-discharge period. Data were analyzed using descriptive statistics and Spearman's Correlation Coefficient. RESULTS: Mean satisfaction was high (5.75) (SD=0.35). There was no correlation between parents' satisfaction and length of hospital stay, severity and illness. CONCLUSION: Parents showed high levels of satisfaction with the care received in pediatric intensive care, regardless of disease classification, length of hospital stay or severity. Greater satisfaction was observed in the domains of professional attitude, care and cure, information and parents' participation.

Prevalence and functional status of children with complex chronic conditions in Brazilian PICUs during the COVID-19 pandemic.

OBJECTIVE: The proportion of children with complex chronic conditions is increasing in PICUs around the world. We determined the prevalence and functional status of children with complex chronic conditions in Brazilian PICUs during the COVID-19 pandemic. METHODS: The authors conducted a point prevalence cross-sectional study among fifteen Brazilian PICUs during the COVID-19 pandemic. The authors enrolled all children admitted to the participating PICUs with complex chronic conditions on three different days, four weeks apart, starting on April 4th, 2020. The authors recorded the patient's characteristics and functional status at admission and discharge days. RESULTS: During the 3 study days from March to June 2020, the authors enrolled 248 patients admitted to the 15 PICUs; 148 had CCC (prevalence of 59.7%). Patients had a median of 1 acute diagnosis and 2 chronic diagnoses. The use of resources/devices was extensive. The main mode of respiratory support was conventional mechanical ventilation. Most patients had a peripherally inserted central catheter (63.1%), followed by a central venous line (52.5%), and 33.3% had gastrostomy or/and tracheostomy. The functional status score was significantly better at discharge compared to admission day due to the respiratory status improvement. CONCLUSIONS: The prevalence of children with CCC admitted to the Brazilian PICUs represented 59.7% of patients during the COVID-19 pandemic. The functional status of these children improved during hospitalization, mainly due to the respiratory component.

Parents' satisfaction with care in pediatric intensive care units / Satisfacción de los padres respecto a la atención en una unidad de cuidados intensivos pediátricos / Satisfação dos pais em relação ao cuidado em unidade de terapia intensiva pediátrica

ABSTRACT Objective: To verify the parents' satisfaction in relation to the care provided to their child admitted to the pediatric intensive care unit and associated clinical factors. Method: Exploratory, cross-sectional study, with a total of 84 parents, in a private hospital in Sao Paulo, Brazil. Data collection took place from March 2019 to January 2020, in the post-discharge period. Data were analyzed using descriptive statistics and Spearman's Correlation Coefficient. Results: Mean satisfaction was high (5.75) (SD=0.35). There was no correlation between parents' satisfaction and length of hospital stay, severity and illness. Conclusion: Parents showed high levels of satisfaction with the care received in pediatric intensive care, regardless of disease classification, length of hospital stay or severity. Greater satisfaction was observed in the domains of professional attitude, care and cure, information and parents' participation.

RESUMEN Objetivo: Verificar la satisfacción de los padres en relación con la atención brindada al niño ingresado en la unidad de cuidados intensivos pediátricos y los factores clínicos asociados. Método: Es una investigación exploratoria y transversal, realizada entre 84 padres en un hospital privado de São Paulo, Brasil. Los datos se recogieron entre marzo de 2019 y enero de 2020, después del alta y se analizaron mediante estadística descriptiva y el Coeficiente de Correlación de Spearman. Resultados: La media de satisfacción fue alta (5,75) (DP=0,35). No hubo correlación de la satisfacción de los padres con la duración de la estancia, la enfermedad y la gravedad. Conclusión: Los padres mostraron altos niveles de satisfacción con la atención recibida en cuidados intensivos pediátricos, independientemente del período de la hospitalización, de la clasificación de la enfermedad o de la gravedad de la misma. Se observó mayor satisfacción en los dominios de actitud profesional, cuidado y curación, información y participación de los padres.

RESUMO Objetivo: Verificar a satisfação dos pais em relação ao cuidado prestado ao filho internado na unidade de terapia intensiva pediátrica e fatores clínicos associados. Método: Pesquisa exploratória, transversal, com 84 pais, em hospital privado de São Paulo, Brasil. A coleta de dados ocorreu de março de 2019 a janeiro de 2020, no pós-alta. Os dados foram analisados por estatística descritiva e Coeficiente de Correlação de Spearman. Resultados: A média de satisfação foi alta (5,75) (DP=0,35). Não houve correlação da satisfação dos pais com tempo de internação, gravidade e doença. Conclusão: Os pais apresentaram altos níveis de satisfação com o cuidado recebido na terapia intensiva pediátrica, independentemente da classificação da doença, tempo de internação ou gravidade. Observou-se maior satisfação nos domínios atitude profissional, cuidado e cura, informação e participação dos pais.

End-of-life practices in patients admitted to pediatric intensive care units in Brazil: A retrospective study

Abstract Objective: To determine the prevalence of life support limitation (LSL) in patients who died after at least 24 h of a pediatric intensive care unit (PICU) stay, parent participation and to describe how this type of care is delivered. Methods: Retrospective cohort study in a tertiary PICU at a university hospital in Brazil. All patients aged 1 month to 18 years who died were eligible for inclusion. The exclusion criteria were those brain death and death within 24 h of admission. Results: 53 patients were included in the study. The prevalence of a LSL report was 45.3%. Out of 24 patients with a report of LSL on their medical records only 1 did not have a donot-resuscitate order. Half of the patients with a report of LSL had life support withdrawn. The length of their PICU stay, age, presence of parents at the time of death, and severity on admission, calculated by the Pediatric Index of Mortality 2, were higher in patients with a report of LSL. Compared with other historical cohorts, there was a clear increase in the prevalence of LSL and, most importantly, a change in how limitations are carried out, with a high prevalence of parental participation and an increase in withdrawal of life support. Conclusions: LSLs were associated with older and more severely ill patients, with a high prevalence of family participation in this process. The historical comparison showed an increase in LSL and in the withdrawal of life support.

Comparison of nursing workload in a Pediatric Intensive Care Unit estimated by three instruments.

OBJECTIVE: To compare the nursing workload using the Nursing Activities Score (NAS), Therapeutic Intervention Scoring System-28 (TISS-28) and Nine Equivalents of Nursing Manpower Use Score (NEMS) instruments in children admitted to a Pediatric Intensive Care Unit in a university hospital. METHOD: A prospective cohort study performed in a Pediatric Intensive Care Unit, with a sample formed of all children hospitalized during the study period. Nursing workload was evaluated using the TISS-28, NEMS and NAS instruments, and further divided into two groups: Group 1 forming a category of basic activities items and Group 2 forming a category of other support and intervention activities. RESULTS: The sample consisted of 490 Pediatric Intensive Care Unit admissions, totaling 4617 observations. NAS presented the best estimate of total working hours. TISS-28 and NEMS showed better agreement and the results showed strong correlations between NAS and TISS-28 and between NEMS and TISS-28. In Group 1 (basic activities), NAS(1) and TISS-28(1) showed moderate correlation, in Group 2 (specialized activities) the three instruments showed strong correlations. CONCLUSION: NAS stood out in the evaluation of nursing workload and showed good correlation and agreement with the TISS-28.

Accuracy of cerebrospinal fluid ferritin for purulent meningitis.

OBJECTIVE: To evaluate the use of cerebrospinal fluid (CSF) ferritin levels in the diagnosis of purulent meningitis (PM). METHOD: We studied 81 children between 28 days and 12 years of age who presented with clinical suspicion of meningitis to the emergency department. CSF ferritin levels were measured and compared between diagnostic groups (PM, aseptic meningitis (AM) and no meningitis). RESULTS: The median age was 24 (IQR 8-69) months. There were 32 patients with AM (39%), 23 with PM (28%) and 26 with no meningitis (32%). Median CSF ferritin was 4.2 ng/mL (IQR 3.0-6.5), 52.9 ng/mL (IQR 30.7-103 ng/mL) and 2.4 ng/mL (IQR 2-4), respectively. CSF ferritin was higher in children with PM compared with AM (p<0.001) or no meningitis (p<0.001). There was no difference between AM and no meningitis. CONCLUSION: CSF ferritin may be a useful biomarker to discriminate PM in children with clinical symptoms of this disease.

Clinical Outcomes in Critically Ill Children With Excess Weight: A Retrospective Cohort Study.

BACKGROUND: Because of its high prevalence and negative impact on quality of life and longevity, overweight in childhood and adolescence is a major public health concern. The objective of the present study was to determine whether excess weight is associated with clinical outcomes in critically ill children and adolescents admitted to the pediatric intensive care unit (PICU). METHOD: This retrospective cohort study was performed with children and adolescents admitted to a PICU over 3 years. Nutrition status was classified based on the body mass index z-score for age, following World Health Organization (WHO) criteria. The following outcomes were assessed: mortality, need for mechanical ventilation, length of admission, and multiple organ dysfunction syndrome. RESULTS: Of 1468 patients admitted during the study period, 1407 were included in the study: 956 (68.0%) had adequate weight, 228 (16.2%) were overweight, and 223 (15.8%) were underweight. Associations were detected between most variables and all nutrition categories (underweight, adequate weight, and overweight). In the descriptive analysis, mortality was more prevalent in nutrition status extremes (extremely underweight or overweight). An independent association between nutrition status and mortality was not detected in any category. CONCLUSION: Nutrition status was not independently associated with poor outcomes. However, overweight should be considered a potential risk factor for adverse clinical outcomes in PICU admissions.

Performance of prognostic markers in pediatric sepsis.

OBJECTIVE: To evaluate the prognostic performance of the Pediatric Index of Mortality 2 (PIM2), ferritin, lactate, C-reactive protein (CRP), and leukocytes, alone and in combination, in pediatric patients with sepsis admitted to the pediatric intensive care unit (PICU). METHODS: A retrospective study was conducted in a PICU in Brazil. All patients aged 6 months to 18 years admitted with a diagnosis of sepsis were eligible for inclusion. Those with ferritin and C-reactive protein measured within 48h and lactate and leukocytes within 24h of admission were included in the prognostic performance analysis. RESULTS: Of 350 eligible patients with sepsis, 294 had undergone all measurements required for analysis and were included in the study. PIM2, ferritin, lactate, and CRP had good discriminatory power for mortality, with PIM2 and ferritin being superior to CRP. The cutoff values for PIM2 (> 14%), ferritin (> 135ng/mL), lactate (> 1.7mmol/L), and CRP (> 6.7mg/mL) were associated with mortality. The combination of ferritin, lactate, and CRP had a positive predictive value of 43% for mortality, similar to that of PIM2 alone (38.6%). The combined use of the three biomarkers plus PIM2 increased the positive predictive value to 76% and accuracy to 0.945. CONCLUSIONS: PIM2, ferritin, lactate, and CRP alone showed good prognostic performance for mortality in pediatric patients older than 6 months with sepsis. When combined, they were able to predict death in three-fourths of the patients with sepsis. Total leukocyte count was not useful as a prognostic marker.

End-of-life practices in patients admitted to pediatric intensive care units in Brazil: A retrospective study.

OBJECTIVE: To determine the prevalence of life support limitation (LSL) in patients who died after at least 24h of a pediatric intensive care unit (PICU) stay, parent participation and to describe how this type of care is delivered. METHODS: Retrospective cohort study in a tertiary PICU at a university hospital in Brazil. All patients aged 1 month to 18 years who died were eligible for inclusion. The exclusion criteria were those brain death and death within 24h of admission. RESULTS: 53 patients were included in the study. The prevalence of a LSL report was 45.3%. Out of 24 patients with a report of LSL on their medical records only 1 did not have a do-not-resuscitate order. Half of the patients with a report of LSL had life support withdrawn. The length of their PICU stay, age, presence of parents at the time of death, and severity on admission, calculated by the Pediatric Index of Mortality 2, were higher in patients with a report of LSL. Compared with other historical cohorts, there was a clear increase in the prevalence of LSL and, most importantly, a change in how limitations are carried out, with a high prevalence of parental participation and an increase in withdrawal of life support. CONCLUSIONS: LSLs were associated with older and more severely ill patients, with a high prevalence of family participation in this process. The historical comparison showed an increase in LSL and in the withdrawal of life support.

Comparison of nursing workload in a Pediatric Intensive Care Unit estimated by three instruments / Comparação da carga de trabalho de enfermagem em Unidade de Terapia Intensiva Pediátrica estimada por três instrumentos / Comparación de la carga de trabajo de enfermería en Unidad de Cuidados Intensivos Pediátrica estimada por tres instrumentos

ABSTRACT Objective: To compare the nursing workload using the Nursing Activities Score (NAS), Therapeutic Intervention Scoring System-28 (TISS-28) and Nine Equivalents of Nursing Manpower Use Score (NEMS) instruments in children admitted to a Pediatric Intensive Care Unit in a university hospital. Method: A prospective cohort study performed in a Pediatric Intensive Care Unit, with a sample formed of all children hospitalized during the study period. Nursing workload was evaluated using the TISS-28, NEMS and NAS instruments, and further divided into two groups: Group 1 forming a category of basic activities items and Group 2 forming a category of other support and intervention activities. Results: The sample consisted of 490 Pediatric Intensive Care Unit admissions, totaling 4617 observations. NAS presented the best estimate of total working hours. TISS-28 and NEMS showed better agreement and the results showed strong correlations between NAS and TISS-28 and between NEMS and TISS-28. In Group 1 (basic activities), NAS(1) and TISS-28(1) showed moderate correlation, in Group 2 (specialized activities) the three instruments showed strong correlations. Conclusion: NAS stood out in the evaluation of nursing workload and showed good correlation and agreement with the TISS-28.

RESUMO Objetivo: Comparar a carga de trabalho de enfermagem por meio dos instrumentos Nursing Activities Score (NAS), Therapeutic Intervention Scoring System-28 (TISS-28) e Nine Equivalents of Nursing Manpower Use Score (NEMS) em crianças internadas em Unidade de Terapia Intensiva Pediátrica de um hospital universitário. Método: Estudo de coorte prospectivo realizado em Unidade de Terapia Intensiva Pediátrica, com amostra constituída por todas as crianças internadas durante o período do estudo. A carga de trabalho de enfermagem foi avaliada por meio dos instrumentos TISS-28, NEMS e NAS, e posteriormente dividida em dois grupos: Grupo 1 formando uma categoria de itens de atividades básicas; Grupo 2 formando uma categoria de outras atividades de apoio e intervenção. Resultados: A amostra foi composta por 490 internações em Unidade de Terapia Intensiva Pediátrica, totalizando 4617 observações. O NAS apresentou a melhor estimativa do total de horas de trabalho. O TISS-28 e o NEMS apresentaram melhor concordância e os resultados apresentaram fortes correlações entre NAS e TISS-28 e entre NEMS e TISS-28. No Grupo 1 (atividades básicas), o NAS(1) e o TISS-28(1) apresentaram correlação moderada, no Grupo 2 (atividades especializadas) os três instrumentos apresentaram correlações fortes. Conclusão: O NAS destacou-se na avaliação da carga de trabalho de enfermagem e apresentou boa correlação e concordância com o TISS-28.

RESUMEN Objetivo: Comparar la carga de trabajo de enfermería a través de los instrumentos Nursing Activities Score (NAS), Therapeutic Intervention Scoring System-28 (TISS-28) y Nine Equivalents of Nursing Manpower Use Score (NEMS) en niños ingresados en Unidad de Cuidados Intensivos Pediátrica de un hospital universitario. Método: Estudio de cohorte prospectivo realizado en Unidad de Cuidados Intensivos Pediátrica, con muestra constituida por todos los niños ingresados durante el período de estudio. La carga de trabajo de enfermería fue evaluada a través de los instrumentos TISS-28, NEMS y NAS y, posteriormente dividida en dos grupos: Grupo 1 formando una categoría de ítems de actividades básicas; Grupo 2 formando una categoría de otras actividades de apoyo e intervención. Resultados: La muestra fue compuesta por 490 ingresos en Unidad de Cuidados Intensivos Pediátrica, en un total de 4617 observaciones. El NAS presentó la mejor estimativa del total de horas trabajadas. El TISS-28 y el NEMS presentaron mejor concordancia y los resultados demostraron fuertes correlaciones entre NAS y TISS-28 y entre NEMS y TISS-28. En el grupo 1 (actividades básicas), el NAS(1) y el TISS-28(1) presentaron correlación moderada, en el Grupo 2 (actividades especializadas) los tres instrumentos presentaron correlaciones fuertes. Consideraciones Finales: El NAS se destacó en la evaluación de la carga de trabajo de enfermería y presentó buena correlación y concordancia con el TISS-28.

Septic shock in pediatrics: the state-of-the-art.

OBJECTIVE: Review the main aspects of the definition, diagnosis, and management of pediatric patients with sepsis and septic shock. SOURCE OF DATA: A search was carried out in the MEDLINE and Embase databases. The articles were chosen according to the authors' interest, prioritizing those published in the last five years. SYNTHESIS OF DATA: Sepsis remains a major cause of mortality in pediatric patients. The variability of clinical presentations makes it difficult to attain a precise definition in pediatrics. Airway stabilization with adequate oxygenation and ventilation if necessary, initial volume resuscitation, antibiotic administration, and cardiovascular support are the basis of sepsis treatment. In resource-poor settings, attention should be paid to the risks of fluid overload when administrating fluids. Administration of vasoactive drugs such as epinephrine or norepinephrine is necessary in the absence of volume response within the first hour. Follow-up of shock treatment should adhere to targets such as restoring vital and clinical signs of shock and controlling the focus of infection. A multimodal evaluation with bedside ultrasound for management after the first hours is recommended. In refractory shock, attention should be given to situations such as cardiac tamponade, hypothyroidism, adrenal insufficiency, abdominal catastrophe, and focus of uncontrolled infection. CONCLUSIONS: The implementation of protocols and advanced technologies have reduced sepsis mortality. In resource-poor settings, good practices such as early sepsis identification, antibiotic administration, and careful fluid infusion are the cornerstones of sepsis management.

Rapid diagnosis of respiratory distress syndrome by oral aspirate in premature newborns / Diagnóstico rápido da síndrome do desconforto respiratório por aspirado bucal em recém-nascidos prematuros

Abstract Objective: The stable microbubble test on gastric aspirate and on amniotic fluid has been used for the diagnosis of respiratory distress syndrome in the newborn. However, no study has performed this test on oral aspirates from premature infants. The objective of this study was to evaluate the performance of the stable microbubble test on oral aspirates from preterm newborns to predict respiratory distress syndrome. Method: This study included infants with gestational age <34 weeks. Oral fluids were obtained immediately after birth and gastric fluids were collected within the first 30 minutes of life. The samples were frozen and tested within 72 hours. Results: The sample was composed of paired aspirates from 64 newborns, who were divided into two groups: respiratory distress syndrome group (n = 21) and control group (n = 43). The median (interquartile range) of the stable microbubble count in the oral samples of infants with respiratory distress syndrome was significantly lower than that of infants who did not develop respiratory symptoms: respiratory distress syndrome group = 12 (8 -22) stable microbubbles/mm2; control group = 100 (48 -230) microbubbles/mm2 (p < 0.001). The correlation between microbubble count in gastric and oral aspirates was 0.90 (95% confidence interval = 0.85 -0.95; p < 0.001). Considering a cut-off point of 25 microbubbles/mm2, the sensitivity and the specificity of the stable microbubble test were 81.4% and 85.7%, respectively. Conclusion: The study suggests that the stable microbubble test performed on oral aspirate is a reliable alternative to that performed on gastric fluid for the prediction of respiratory distress syndrome in the newborn.

Resumo Objetivo: O teste das microbolhas estáveis no aspirado gástrico e no líquido amniótico foi usado no diagnóstico da síndrome do desconforto respiratório do recém-nascido. Contudo, nenhum estudo fez esse teste nos aspirados bucais de neonatos prematuros. O objetivo deste estudo foi avaliar o desempenho do teste das microbolhas estáveis em aspirados bucais de recém-nascidos prematuros para prever síndrome do desconforto respiratório. Método: Este estudo incluiu neonatos com idade gestacional < 34 semanas. Os fluidos orais foram obtidos imediatamente após o nascimento e os fluidos gástricos foram coletados nos primeiros 30 minutos de vida. As amostras foram congeladas e testadas em 72 horas. Resultados: A amostra foi composta de aspirados pareados de 64 recém-nascidos, divididos em dois grupos: grupo de síndrome do desconforto respiratório (n = 21) e grupo de controle (n = 43). A mediana (intervalo interquartil) da contagem das microbolhas estáveis nas amostras de fluido oral dos neonatos com síndrome do desconforto respiratório foi significativamente menor que a dos neonatos que não desenvolveram sintomas respiratórios: grupo de síndrome do desconforto respiratório = 12 (8-22) microbolhas estáveis/mm2; grupo de controle = 100 (48-230) microbolhas/mm2 (p < 0,001). A correlação entre a contagem das microbolhas nos aspirados gástricos e bucais foi 0,90 (intervalo de confiança de 95% = 0,85-0,95; p < 0,001). Considerando um ponto de corte de 25 microbolhas/mm2, a sensibilidade e a especificidade do teste das microbolhas estáveis foram 81,4% e 85,7%, respectivamente. Conclusão: O estudo sugere que o teste das microbolhas estáveis feito no aspirado bucal é uma opção confiável ao fluido gástrico para a predição da síndrome do desconforto respiratório do recém-nascido.

Rapid diagnosis of respiratory distress syndrome by oral aspirate in premature newborns.

OBJECTIVE: The stable microbubble test on gastric aspirate and on amniotic fluid has been used for the diagnosis of respiratory distress syndrome in the newborn. However, no study has performed this test on oral aspirates from premature infants. The objective of this study was to evaluate the performance of the stable microbubble test on oral aspirates from preterm newborns to predict respiratory distress syndrome. METHOD: This study included infants with gestational age <34 weeks. Oral fluids were obtained immediately after birth and gastric fluids were collected within the first 30 minutes of life. The samples were frozen and tested within 72 hours. RESULTS: The sample was composed of paired aspirates from 64 newborns, who were divided into two groups: respiratory distress syndrome group (n=21) and control group (n=43). The median (interquartile range) of the stable microbubble count in the oral samples of infants with respiratory distress syndrome was significantly lower than that of infants who did not develop respiratory symptoms: respiratory distress syndrome group=12 (8-22) stable microbubbles/mm2; control group=100 (48-230)microbubbles/mm2 (p<0.001). The correlation between microbubble count in gastric and oral aspirates was 0.90 (95% confidence interval=0.85-0.95; p<0.001). Considering a cut-off point of 25microbubbles/mm2, the sensitivity and the specificity of the stable microbubble test were 81.4% and 85.7%, respectively. CONCLUSION: The study suggests that the stable microbubble test performed on oral aspirate is a reliable alternative to that performed on gastric fluid for the prediction of respiratory distress syndrome in the newborn.

Reducing malnutrition in critically ill pediatric patients. / Redução da desnutrição em pacientes pediátricos gravemente enfermos.

OBJECTIVE: To compare the prevalence of malnutrition during two time periods in a pediatric intensive care unit. METHODS: This was a retrospective cross-sectional study of patients admitted to the pediatric intensive care unit of a university hospital during two one-year periods with an interval of four years between them. Nutritional evaluation was conducted based on weight and height measured at admission. The body mass index-for-age was the parameter chosen to evaluate nutritional status, as classified according to the World Health Organization, according to age group. RESULTS: The total sample size was 881 (406 in the contemporary sample and 475 in the historical sample). There was a significant reduction in malnutrition in the contemporary sample (p = 0.03). Malnourishment in patients in the historical sample was significantly associated with mortality and length of stay, while malnourishment in patients in the contemporary sample was not associated with worse outcomes. CONCLUSION: There was a significant reduction in malnutrition among patients in the same pediatric intensive care unit when comparing the two time periods. Our findings of a change in nutritional profile in critically ill patients corroborate the nutritional status data of children and adolescents worldwide.

OBJETIVO: Comparar a prevalência de desnutrição em dois momentos de uma unidade de terapia intensiva pediátrica. MÉTODOS: Estudo transversal retrospectivo, com pacientes internados na unidade de terapia intensiva pediátrica de um hospital universitário em dois períodos de 1 ano com intervalo de 4 anos. A avaliação nutricional foi realizada a partir do peso e da estatura aferidos no momento da internação. O índice de massa corporal para idade foi o parâmetro escolhido para avaliação do estado nutricional classificado de acordo com a Organização Mundial de Saúde, conforme faixa etária. RESULTADOS: A amostra total de pacientes foi de 881 (406 da amostra contemporânea e 475 da amostra histórica). Houve redução significativa da desnutrição na amostra contemporânea (p = 0,03). Os pacientes desnutridos da amostra histórica tiveram associação significativa com mortalidade e tempo de internação, enquanto que os desnutridos da amostra contemporânea não apresentaram piores desfechos. CONCLUSÃO: Houve redução significativa da desnutrição entre os pacientes da mesma unidade de terapia intensiva pediátrica quando comparamos dois momentos. Nossos achados de modificação de perfil nutricional em pacientes gravemente enfermos corroboram dados de estado nutricional de crianças e adolescentes a nível mundial.

Redução da desnutrição em pacientes pediátricos gravemente enfermos / Reducing malnutrition in critically ill pediatric patients

RESUMO Objetivo: Comparar a prevalência de desnutrição em dois momentos de uma unidade de terapia intensiva pediátrica. Métodos: Estudo transversal retrospectivo, com pacientes internados na unidade de terapia intensiva pediátrica de um hospital universitário em dois períodos de 1 ano com intervalo de 4 anos. A avaliação nutricional foi realizada a partir do peso e da estatura aferidos no momento da internação. O índice de massa corporal para idade foi o parâmetro escolhido para avaliação do estado nutricional classificado de acordo com a Organização Mundial de Saúde, conforme faixa etária. Resultados: A amostra total de pacientes foi de 881 (406 da amostra contemporânea e 475 da amostra histórica). Houve redução significativa da desnutrição na amostra contemporânea (p = 0,03). Os pacientes desnutridos da amostra histórica tiveram associação significativa com mortalidade e tempo de internação, enquanto que os desnutridos da amostra contemporânea não apresentaram piores desfechos. Conclusão: Houve redução significativa da desnutrição entre os pacientes da mesma unidade de terapia intensiva pediátrica quando comparamos dois momentos. Nossos achados de modificação de perfil nutricional em pacientes gravemente enfermos corroboram dados de estado nutricional de crianças e adolescentes a nível mundial.

ABSTRACT Objective: To compare the prevalence of malnutrition during two time periods in a pediatric intensive care unit. Methods: This was a retrospective cross-sectional study of patients admitted to the pediatric intensive care unit of a university hospital during two one-year periods with an interval of four years between them. Nutritional evaluation was conducted based on weight and height measured at admission. The body mass index-for-age was the parameter chosen to evaluate nutritional status, as classified according to the World Health Organization, according to age group. Results: The total sample size was 881 (406 in the contemporary sample and 475 in the historical sample). There was a significant reduction in malnutrition in the contemporary sample (p = 0.03). Malnourishment in patients in the historical sample was significantly associated with mortality and length of stay, while malnourishment in patients in the contemporary sample was not associated with worse outcomes. Conclusion: There was a significant reduction in malnutrition among patients in the same pediatric intensive care unit when comparing the two time periods. Our findings of a change in nutritional profile in critically ill patients corroborate the nutritional status data of children and adolescents worldwide.