Intervención nutricional precoz en ancianos con neumonía adquirida en la comunidad / Precocious nutritional intervention in elder people with community-acquired pneumonia

RESUMEN Introducción: la nutrición tiene importancia capital en la evolución de los pacientes ingresados. La prevalencia de malnutrición oscila entre 30% y 60% de los enfermos hospitalizados. Objetivo: evaluar impacto en la mortalidad y complicaciones a corto plazo de una intervención nutricional precoz. Material y método: se realizó un estudio caso control con todos los pacientes que ingresaron en la Unidad de Cuidados intensivos emergentes con el diagnóstico de neumonía adquirida en la comunidad asociada a desnutrición en Hospital Militar Dr. Carlos J. Finlay, de noviembre de 2017 hasta mayo del 2018. Resultados: la media de la edad del estudio fue de 80,73 ± 9,01 años. El 46 % fueron mujeres. La mortalidad global estuvo en el 26 %. El 69 % de los pacientes presento alguna complicación. Existió una mayor sobrevida en el grupo de estudio (7 fallecidos y 29 vivos), que en el grupo de control donde hubo 12 fallecidos y 24 vivos x2 = 0,18. En la tabla 2 se evidencia que existe diferencia entre los grupos según las complicaciones aparecidas. Fue marcada la diferencia entre los grupos en relación a la cantidad de pacientes con diarreas. La incidencia fue mayor tanto en el subgrupo de vivos(8) como en el de fallecidos(3) del grupo control. Por otro lado la hiperglucemia fue mucho mayor en el grupo de estudio(11) y sin embargo, no hubo impacto en la mortalidad x2 = 0,03. En la tabla 3 se evidencia una fuerte evidencia que relaciona al estado nutricional deficiente con una peor evolución. Entre los fallecidos solo 1 tenía un estado nutricional catalogado como desnutrido ligero, sin embargo entre los 22 fallecidos 14 presentaron desnutrición severa. Conclusiones: el estado nutricional al ingreso impacta negativamente en la mortalidad a corto plazo y la estrategia nutricional mixta precoz no reduce ese aspecto sin embargo si reduce el número de complicaciones aunque se asoció a mayor incidencia de hiperglucemia sin impactar en la mortalidad (AU).

SUMMARY Introduction: nutrition has a capital importance in the evolution of in-patients. Malnutrition prevalence ranges from 30 % to 60 % of the admitted patients. Objective: to evaluate the impact on mortality and the short time complications of the precocious nutritional intervention. Material and Method: a case control study was carried out with all patients who entered the Emergency Intensive Care Unit with the diagnosis of community-acquired pneumonia associated to malnutrition in the Military Hospital "Dr, Carlos J. Finlay" from November 2017 to May 2018. Results: the average age was 80.73 ± 9.01 years. 46 % were female patients. Global mortality was 26 %. 69 % of patients had complications. The group of study showed a higher survival (7 deads and 29 survivors) than the control one where there were 12 deads and 24 survivors (2=0.18). Table 2 shows that there are differences between groups according to the complications found. The difference between groups was remarkable in relation to the quantity of patients with diarrhea. The incidence was higher both in the group of survivors(8) and in the group of dead peoples(3) of the control group. On the other hand, hyperglycemia was much higher in the group of study(11) but without striking on mortality (2= 0.03). Table 3 shows strong evidence relating deficient nutritional status to a worth evolution. Among the deceased patients only 1 had a nutritional status classified as slightly malnutrition, but among the 22 deceased, 14 had severe malnutrition. Conclusions: the nutritional status at admission negatively strikes on short term mortality, and mixed precocious nutritional strategy does not reduce that aspect. However it does reduce the number of complications, though it was associated to a higher incidence of hyperglycemia without striking on mortality (AU).

Perfil bioquímico en sangre de cordón en prematuros extremos y crecimiento fetal / Intrauterine growth and biochemical levels in cord blood samples in infants less than 31 weeks gestation

Introducción: Con mayor aporte de proteínas y energía en la primera semana se ha observado hipofosfemia en prematuros extremos. Los menores niveles de fósforo se han presentado en prematuros con antecedentes de restricción de crecimiento intrauterino. Objetivos: Caracterizar los niveles plasmáticos bioquímicos en el cordón de prematuros extremos, nacidos adecuados (AEG) y pequeños para edad gestacional (PEG) y la relación con calcemia y fosfemia en la primera semana de vida. Pacientes y método: Estudio clínico realizado en Neonatología del Hospital Doctor Sótero del Río, en los años 2013 y 2014. Se analiza el perfil bioquímico en el cordón y la calcemia y fosfemia en los primeros 7 días de vida, registrados en la ficha clínica según fueran AEG o PEG, según las curvas de Alarcón-Pittaluga. Análisis con significación de p < 0,05. Resultados: Los niveles de colesterol, transaminasas, albúmina y creatinina fueron similares para los PEG y AEG. Los niveles de pH, fósforo, calcio, y fosfatasas alcalinas fueron menores en los PEG. El nitrógeno ureico, el ácido úrico y los triglicéridos fueron mayores en los PEG. Los PEG muestran marcada reducción de fosfemia en la primera semana, la calcemia tiende a subir proporcionalmente al descenso de la fosfemia. Conclusiones: En prematuros extremos la desnutrición intrauterina se expresa en modificación de los niveles plasmáticos de calcio, fósforo, fosfatasas alcalinas, nitrógeno ureico, ácido úrico y triglicéridos. Posnatalmente, al recibir aporte nutricional, se manifiesta una disminución de la fosfemia y un aumento de calcemia, concordante con aportes insuficientes de fósforo durante el período.

Introduction: The use of greater amounts of protein and energy during the first week of life is associated with hypophosphataemia in extreme preterm babies. The lowest phosphorus levels are described in intrauterine growth restricted (IUGR) babies. Objectives: To describe biochemistry levels in cord blood plasma in extreme premature, adequate and small for gestational age babies (AGA/SGA) and their relationship with plasma calcium and phosphorus levels during the first week of life. Patients and method: A descriptive clinical study was performed in the Neonatology Service at Hospital Dr. Sótero del Río during 2013 and 2014. A biochemical analysis of cord blood was performed on 43 premature babies, as well as plasma calcium and phosphorus levels during the first week. The adequacy for gestational age was obtained using Alarcón- Pittaluga growth curves. Statistical significance was P < .05. Results: Cholesterol, transaminases, albumin and creatinine levels were similar for both AGA and SGA babies. Levels of pH, phosphorus, calcium and alkaline phosphatase were significantly lower in SGA babies. Urea nitrogen, uric acid and triglycerides levels were higher in SGA. The analysis during the first week showed a strong reduction in phosphorus levels, as well as an increase in calcium levels in proportion to the decrease in phosphorus in the SGA sub- group. Conclusions: Intrauterine malnutrition in preterm babies is expressed in the modulation of plasma levels of calcium, phosphorus, alkaline phosphatase, urea nitrogen, uric acid and triglycerides. During post-natal life, when nutritional intake begins, a decrease in phosphorus and an increase in calcium levels appear, consistent with insufficient phosphorus intake during this period.

[Intrauterine growth and biochemical levels in cord blood samples in infants less than 31 weeks gestation]. / Perfil bioquímico en sangre de cordón en prematuros extremos y crecimiento fetal.

INTRODUCTION: The use of greater amounts of protein and energy during the first week of life is associated with hypophosphataemia in extreme preterm babies. The lowest phosphorus levels are described in intrauterine growth restricted (IUGR) babies. OBJECTIVES: To describe biochemistry levels in cord blood plasma in extreme premature, adequate and small for gestational age babies (AGA/SGA) and their relationship with plasma calcium and phosphorus levels during the first week of life. PATIENTS AND METHOD: A descriptive clinical study was performed in the Neonatology Service at Hospital Dr. Sótero del Río during 2013 and 2014. A biochemical analysis of cord blood was performed on 43 premature babies, as well as plasma calcium and phosphorus levels during the first week. The adequacy for gestational age was obtained using Alarcón- Pittaluga growth curves. Statistical significance was P<.05. RESULTS: Cholesterol, transaminases, albumin and creatinine levels were similar for both AGA and SGA babies. Levels of pH, phosphorus, calcium and alkaline phosphatase were significantly lower in SGA babies. Urea nitrogen, uric acid and triglycerides levels were higher in SGA. The analysis during the first week showed a strong reduction in phosphorus levels, as well as an increase in calcium levels in proportion to the decrease in phosphorus in the SGA sub- group. CONCLUSIONS: Intrauterine malnutrition in preterm babies is expressed in the modulation of plasma levels of calcium, phosphorus, alkaline phosphatase, urea nitrogen, uric acid and triglycerides. During post-natal life, when nutritional intake begins, a decrease in phosphorus and an increase in calcium levels appear, consistent with insufficient phosphorus intake during this period.