RESUMO
ABSTRACT Objective: To report the experience of the training in home parenteral nutrition (PN) directed to family members of children and adolescents participating in a multidisciplinary intestinal rehabilitation program of a tertiary public hospital. Methods: Cross-sectional descriptive study with family caregivers of patients from the Intestinal Rehabilitation Program of Hospital de Clínicas de Porto Alegre, RS, Brazil, from July/2014 to January/2017. Inclusion criteria: family members of children aged 30 days to 17 years and estimated PN use ≥8 weeks; and family members motivated to care for the child. The training covered: hand washing and disinfection; infusion pump handling; and central venous catheter (CVC) and PN care. Outcomes assessed: catheter-related bloodstream infection (CRBSI) rate, accidental CVC exit, end of PN infusion with more than 60minutes of delay or advance compared to the time predicted, mechanical obstruction, bleeding in the CVC insertion site, and death. Results: Twenty-seven family members of 17 children were trained. Their median age was 28 (18-60) years, and 63% were mothers. The mean CRBSI rate was 1.7/1,000 days of CVC use, and 29.4% of patients had at least one episode of accidental CVC exit. There were no complications related to PN infusion, bleeding, or death. Conclusions: The training of family caregivers allowed the safe implementation of home PN, with the active participation of families, making the procedure feasible in the public health system in Brazil.
RESUMO Objetivo: Apresentar a experiência da capacitação de familiares de crianças e adolescentes participantes de um programa multiprofissional de reabilitação intestinal de um hospital público terciário para uso de nutrição parenteral (NP) no domicílio. Métodos: Estudo descritivo transversal com familiares cuidadores de pacientes do Programa de Reabilitação Intestinal do Hospital de Clínicas de Porto Alegre, RS, Brasil, entre julho/2014 e janeiro/2017. Critérios de inclusão: familiares das crianças com idades entre 30dias e 17 anos e previsão de uso de NP≥8 semanas; e familiares que demonstrassem motivação para os cuidados da criança. Acapacitação contemplou: lavagem e higienização das mãos; manuseio da bomba de infusão; cuidados com cateter venoso central (CVC) e com solução de NP. Desfechos avaliados foram: taxa de infecção de corrente sanguínea relacionada ao CVC (ICSRC), saída acidental do CVC, término da infusão da NP com atraso ou adiantamento maior que 60minutos em comparação ao previsto, obstrução mecânica, sangramento do sítio de inserção do CVC e óbito. Resultados: Foram capacitados 27 familiares de 17 crianças, com mediana de idade de 28 (18-60) anos, dos quais 63% eram mães. A taxa média de ICSRC observada foi 1,7/1.000 dias de uso de CVC, e a saída acidental do CVC ocorreu em 29,4% dos pacientes. Não foram observadas complicações referentes à infusão da NP, a sangramento ou a óbito. Conclusões: A capacitação de familiares cuidadores possibilitou a execução de maneira segura da NP no domicílio com participação ativa das famílias, tornando o procedimento viável no sistema público de saúde no Brasil.
Assuntos
Humanos , Masculino , Feminino , Lactente , Pré-Escolar , Criança , Adolescente , Adulto , Adulto Jovem , Família , Educação em Saúde/métodos , Cuidadores/educação , Nutrição Parenteral no Domicílio , Brasil , Estudos Transversais , Avaliação de Resultados em Cuidados de Saúde , Pessoa de Meia-IdadeRESUMO
OBJECTIVE: To report the experience of the training in home parenteral nutrition (PN) directed to family members of children and adolescents participating in a multidisciplinary intestinal rehabilitation program of a tertiary public hospital. METHODS: Cross-sectional descriptive study with family caregivers of patients from the Intestinal Rehabilitation Program of Hospital de Clínicas de Porto Alegre, RS, Brazil, from July/2014 to January/2017. Inclusion criteria: family members of children aged 30 days to 17 years and estimated PN use ≥8 weeks; and family members motivated to care for the child. The training covered: hand washing and disinfection; infusion pump handling; and central venous catheter (CVC) and PN care. Outcomes assessed: catheter-related bloodstream infection (CRBSI) rate, accidental CVC exit, end of PN infusion with more than 60minutes of delay or advance compared to the time predicted, mechanical obstruction, bleeding in the CVC insertion site, and death. RESULTS: Twenty-seven family members of 17 children were trained. Their median age was 28 (18-60) years, and 63% were mothers. The mean CRBSI rate was 1.7/1,000 days of CVC use, and 29.4% of patients had at least one episode of accidental CVC exit. There were no complications related to PN infusion, bleeding, or death. CONCLUSIONS: The training of family caregivers allowed the safe implementation of home PN, with the active participation of families, making the procedure feasible in the public health system in Brazil.
Assuntos
Cuidadores/educação , Família , Educação em Saúde/métodos , Nutrição Parenteral no Domicílio , Adolescente , Adulto , Brasil , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde , Adulto JovemRESUMO
The associations of Cesarean delivery with offspring metabolic and immune-mediated diseases are believed to derive from lack of mother-to-newborn transmission of specific microbes at birth. Bifidobacterium spp., in particular, has been hypothesized to play a health-promoting role, yet little is known about how delivery mode modifies colonization of the newborn by this group of microbes. The aim of this research was to examine the presence of Bifidobacterium in meconium and in the transitional stool, and to assess cytokine levels and hematological parameters in the venous cord blood of infants born by elective, pre-labor Cesarean section vs. vaginal delivery in Southern Brazil. We recruited 89 mother-newborn pairs (23 vaginal delivery and 66 elective cesarean delivery), obtained demographic information from a structured questionnaire and clinical information from medical records. We obtained umbilical cord venous blood and meconium samples following delivery and the transitional stool (the first defecation after meconium) before discharge. We determined plasma levels of IL-1ß, IL-10, IL-6, GM-CSF, IL-5, IFN-γ, TNF-α, IL-2, IL-4 and IL-8 in the cord blood, and presence of stool Bifidobacterium by real time PCR. Compared to vaginally-delivered neonates, Cesarean-delivered neonates had a lower leukocyte count (p = 0.037), lower hemoglobin (p = 0.04), and lower levels of the cytokine GM-CSF (p = 0.009) in the cord blood. Moreover, Bifidobacterium was detected less often in the transitional stool of Cesarean-delivered neonates compared to vaginally-delivered neonates (p = 0.001). The results indicate that pre-labor Cesarean birth may be associated with microbial and hematological alterations in the neonate. The clinical significance of these findings remains to be determined in larger prospective birth cohort studies.
Assuntos
Bifidobacterium/fisiologia , Citocinas/sangue , Parto Obstétrico , Sangue Fetal/metabolismo , Intestinos/microbiologia , Leucócitos/metabolismo , Cesárea , DNA/metabolismo , Fezes/microbiologia , Humanos , Recém-Nascido , Mecônio/metabolismoAssuntos
Humanos , Masculino , Feminino , Recém-Nascido , Lactente , Deglutição , Fonoaudiologia , Transtornos de DeglutiçãoRESUMO
Introdução: A cirrose caracteriza-se por uma alteração crônica do parênquima hepático que frequentemente leva à desnutrição em crianças e adolescentes. A intervenção nutricional deve ser feita precocemente, o que requer um cuidadoso acompanhamento desses pacientes. Objetivos: Comparar os resultados da avaliação nutricional de crianças e adolescentes cirróticos realizada em dois períodos de tempo distintos. Métodos: Foram utilizados bancos de dados oriundos de duas pesquisas conduzidas com pacientes pediátricos com cirrose. Após a aplicação de critérios de inclusão e exclusão, 67 crianças e adolescentes foram avaliados em duas séries com intervalo de aproximadamente uma década entre elas. As duas séries tiveram as variáveis antropométricas estatura para idade (E/I) e dobra cutânea tricipital para idade (DCT/I) avaliadas de acordo com os padrões da Organização Mundial de Saúde. A gravidade da doença foi avaliada pelos modelos Pediatric End-stage Liver Disease (PELD)/ Model for End-stage Liver Disease (MELD) e pelo escore Child-Pugh. O nível de significância foi estabelecido em 5%. Resultados: Os resultados da avaliação do estado nutricional dos pacientes nas duas séries não mostraram diferença estatisticamente significativa. Na série 1, 22,6% dos pacientes apresentaram desnutrição, e 27,8% na série 2 (p = 0,955). Conclusões: Podemos concluir que nas duas séries avaliadas, separadas por aproximadamente uma década, o percentual de desnutrição e a gravidade da cirrose se mantiveram estáveis (AU)
Introduction: Cirrhosis is characterized by a chronic alteration of the liver parenchyma that often leads to malnutrition in children and adolescents. Nutritional intervention should be performed early, requiring careful follow-up of these patients. Objectives: To compare the nutritional assessment of cirrhotic pediatric patients performed in two separate periods of time. Methods: This research used two different databases originated from studies conducted with pediatric patients with cirrhosis. After applying inclusion and exclusion criteria, 67 children and adolescents were assessed in two series of tests performed within a time range of approximately a decade. Both series had standard deviation score for height-for-age (SDS-H/A), standard deviation score for triceps skinfold-for-age and (SDS-TSF/A), calculated according to the standards established by the World Health Organization. Disease severity was evaluated by the Pediatric End-stage Liver Disease (PELD)/Model for End-stage Liver Disease (MELD) and by the Child-Pugh score. Results were considered significant at p < 0.05. Results: The present study did not find any statistically significant difference for the nutritional status of the researched subjects in any of the series. In the first series, 22.6% of patients were undernourished, compared to 27.8% in the second one (p = 0.955). Conclusions: We can conclude that in both series of tests conducted with an interval of about a decade from each other the percentage of malnutrition and the severity of cirrhosis remained stable (AU)
Assuntos
Humanos , Pré-Escolar , Criança , Adolescente , Cirrose Hepática , Estado Nutricional , Desnutrição , Avaliação NutricionalRESUMO
AIM: To evaluate the nutritional status and its association with proinflammatory cytokines in children with chronic liver disease. METHODS: We performed a cross-sectional study with 43 children and adolescents, aged 0 to 17 years, diagnosed with chronic liver disease. All patients regularly attended the Pediatric Hepatology Unit and were under nutritional follow up. The exclusion criteria were fever from any etiology at the time of enrollment, inborn errors of the metabolism and any chronic illness. The severity of liver disease was assessed by Child-Pugh, Model for End-stage Liver Disease (MELD) and Pediatric End Stage Liver Disease (PELD) scores. Anthropometric parameters were height/age, body mass index/age and triceps skinfold/age according to World Health Organization standards. The cutoff points for nutritional status were risk of malnutrition (Z-score < -1.00) and malnutrition (Z-score < -2.00). Interleukin-1ß (IL-1ß), IL-6 and tumor necrosis factor-α levels were assessed by commercial ELISA kits. For multivariate analysis, linear regression was applied to assess the association between cytokine levels, disease severity and nutritional status. RESULTS: The median (25(th)-75(th) centile) age of the study population was 60 (17-116)-mo-old, and 53.5% were female. Biliary atresia was the main cause of chronic liver disease (72%). With respect to Child-Pugh score, cirrhotic patients were distributed as follows: 57.1% Child-Pugh A, a mild presentation of the disease, 34.3% Child-Pugh B, a moderate stage of cirrhosis and 8.6% Child-Pugh C, were considered severe cases. PELD and MELD scores were only above the cutoff point in 5 cases. IL-6 values ââwere increased in patients at nutritional risk (34.9%) compared with those who were well-nourished [7.12 (0.58-34.23) pg/mL vs 1.63 (0.53-3.43) pg/mL; P = 0.02], correlating inversely with triceps skinfold-for-age z-score (rs = -0.61; P < 0.001). IL-6 levels were associated with liver disease severity assessed by Child-Pugh score (P = 0.001). This association remained significant after adjusting for nutritional status in a linear regression model. CONCLUSION: High IL-6 levels were found in children with chronic liver disease at nutritional risk. Inflammatory activity may be related to nutritional status deterioration in these patients.
Assuntos
Citocinas/sangue , Mediadores da Inflamação/sangue , Hepatopatias/diagnóstico , Desnutrição/etiologia , Estado Nutricional , Adolescente , Fatores Etários , Biomarcadores/sangue , Distribuição de Qui-Quadrado , Criança , Fenômenos Fisiológicos da Nutrição Infantil , Pré-Escolar , Doença Crônica , Estudos Transversais , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Lactente , Interleucina-6/sangue , Modelos Lineares , Hepatopatias/sangue , Hepatopatias/etiologia , Hepatopatias/imunologia , Hepatopatias/fisiopatologia , Masculino , Desnutrição/sangue , Desnutrição/diagnóstico , Desnutrição/imunologia , Desnutrição/fisiopatologia , Análise Multivariada , Avaliação Nutricional , Estudos Prospectivos , Fatores de Risco , Índice de Gravidade de Doença , Regulação para CimaRESUMO
OBJECTIVE: To validate the Subjective Global Nutritional Assessment (SGNA) questionnaire for Brazilian children and adolescents. METHODS: A cross-sectional study with 242 patients, aged 30 days to 13 years, treated in pediatric units of a tertiary hospital with acute illness and minimum hospitalization of 24h. After permission from the authors of the original study, the following criteria were observed to obtain the validation of SGNA instruments: translation and backtranslation, concurrent validity, predictive validity, and inter-observer reliability. The variables studied were age, sex, weight and length at birth, prematurity, and anthropometry (weight, height, body mass index, upper arm circumference, triceps skinfold, and subscapular skinfold). The primary outcome was considered as the need for admission/readmission within 30 days after hospital discharge. Statistical tests used included ANOVA, Kruskal-Wallis, Mann-Whitney, chi-square, and Kappa coefficient. RESULTS: According to SGNA score, 80% of patients were considered as well nourished, 14.5% moderately malnourished, and 5.4% severely malnourished. Concurrent validity showed a weak correlation between the SGNA and anthropometric measurements (p<0.001). Regarding predictive power, the main outcome associated with SGNA was length of admission/readmission. Secondary outcomes associated included the following: length of stay at the unit after SGNA, weight and length at birth, and prematurity (p<0.05). The interobserver reliability showed good agreement among examiners (Kappa=0.74). CONCLUSION: This study validated the SGNA in this group of hospitalized pediatric patients, ensuring its use in the clinical setting and for research purposes in the Brazilian population.
Assuntos
Avaliação Nutricional , Desnutrição Proteico-Calórica/diagnóstico , Inquéritos e Questionários , Adolescente , Brasil , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Estado Nutricional , Variações Dependentes do Observador , Reprodutibilidade dos Testes , Índice de Gravidade de DoençaRESUMO
BACKGROUND: Cesarean delivery (CD) perturbs the assembly of the neonatal gut microbiome and has been associated with child and adult obesity. However, it is still unknown whether CD is associated with metabolic risk factors in young adults. OBJECTIVE: We investigated the association of CD and metabolic risk factors in young adults in a cohort study who were 23-25 y of age at follow-up. DESIGN: We used data from a cohort study in Ribeirão Preto, Brazil. Baseline data on 6827 singleton pregnancies were collected in 1978-1979, and a sample of 2063 subjects were followed up 23-25 y later (2002-2004). Information on the type of delivery, birth weight, maternal age, parity, maternal schooling, and maternal smoking was obtained after birth. Anthropometric data, biochemical measurements, and information on participant schooling and smoking history were collected at 23-25 y of age. A linear regression was performed to assess the association between CD and biochemical measurements in early adulthood, controlling for a minimum set of confounders that were identified in a directed acyclic graph. RESULTS: The mean ± SD age of the subjects was 23.9 ± 0.71 y, and 51.8% of the sample were women. The CD rate was 32.0% and was more common in older (P < 0.001) and more educated mothers (P < 0.001). Compared with vaginal delivery, CD was associated with higher body mass index (BMI) after multivariable adjustment (P < 0.001) but not with glucose, homeostasis model assessment of insulin resistance, the quantitative insulin-sensitivity check index, total cholesterol, LDL cholesterol, HDL cholesterol, or triglycerides (all P > 0.05). CONCLUSION: In our sample of Brazilian adults, CD was associated with higher BMI but not with other metabolic risk factors.
Assuntos
Cesárea/efeitos adversos , Síndrome Metabólica/etiologia , Adulto , Índice de Massa Corporal , Brasil/epidemiologia , Estudos de Coortes , Feminino , Seguimentos , Humanos , Hiperlipidemias/sangue , Hiperlipidemias/epidemiologia , Hiperlipidemias/etiologia , Hiperlipidemias/metabolismo , Resistência à Insulina , Modelos Lineares , Masculino , Síndrome Metabólica/sangue , Síndrome Metabólica/epidemiologia , Síndrome Metabólica/metabolismo , Sobrepeso/sangue , Sobrepeso/epidemiologia , Sobrepeso/etiologia , Sobrepeso/metabolismo , Estudos Prospectivos , Fatores de Risco , Adulto JovemRESUMO
BACKGROUND: Recent studies have raised controversy regarding the association between cesarean section and later obesity in the offspring. The purpose of this study was to assess the association of cesarean section with increased body mass index (BMI) and obesity in school children from two Brazilian cities with distinct socioeconomic backgrounds. METHODS: Two birth cohorts respectively born in 1994 in Ribeirao Preto, a wealthy city in Southeast, and in 1997/98 in Sao Luis, a less wealthy city in Northeast of Brasil, were evaluated. After birth, 2,846 pairs of mothers-newborns were evaluated in Ribeirao Preto and 2,542 in Sao Luis. In 2004/05, 790 children aged 10/11 years were randomly reassessed in Ribeirao Preto and 673 at 7/9 years in Sao Luis. Information on type of delivery, maternal and child characteristics, socioeconomic position and anthropometric measurements were collected after birth and at school age. Obesity was defined as BMI ≥ 95th percentile at school age. RESULTS: Obesity rate was 13.0% in Ribeirao Preto and 2.1% in Sao Luis. Cesarean section was associated with obesity and remained significant after adjustment only in Ribeirao Preto [OR = 1.74 (95% CI: 1.04; 2.92)]. The association between cesarean section and BMI remained significant after adjustment for maternal schooling, maternal smoking during pregnancy, duration of breastfeeding, gender, birth weight and gestational age, type of school and, only in Sao Luis, pre-pregnancy maternal weight. In Ribeirao Preto children born by cesarean section had BMI 0.31 kg/m2 (95% CI: 0.11; 0.51) higher than those born by vaginal delivery. In Sao Luis BMI of children born by cesarean section was 0.28 kg/m2 higher (95% CI: 0.08; 0.49) than those born by vaginal delivery. CONCLUSION: A positive association between cesarean section and increased BMI z-score was demonstrated in areas with different socioeconomic status in a middle-income country.