Navegando por Palavras-chave "enteral nutrition"
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- ItemSomente MetadadadosAcute pancreatitis in pediatrics: a systematic review of the literature(Soc Brasil Pediatria, 2012-03-01) Mekitarian Filho, Eduardo [UNIFESP]; Carvalho, Werther Brunow de [UNIFESP]; Silva, Felipe Duarte; Universidade de São Paulo (USP); Universidade Federal de São Paulo (UNIFESP); Hosp Israelite Albert Einstein; Hosp Santa CatarinaObjective: To describe the main epidemiological, clinical, diagnostic and treatment aspects of children with acute pancreatitis.Sources: Systematic review of MEDLINE and SciELO databases in the last 5 years about acute pancreatitis in children, as well as consultation of relevant references on the texts obtained.Summary of the findings: Cases of acute pancreatitis in children have received growing attention in recent years, and an increase in the number of cases has been reported in several studies. the main etiologies in children involve biliary disease, drug-induced pancreatitis, recurrent hereditary pancreatitis and trauma, and up to 30% of cases have no defined etiology. the diagnosis is based on the combination of clinical and laboratory aspects with the increase of acinar enzymes and radiologic tests. Initial support treatment, with proper volume replacement and correction of the metabolic disturbances, besides specific nutritional therapy, are the fundamental points in the handling of acute conditions. Long term complications are unusual, and mortality rates are inferior to the rates for the adult population.Conclusions: the early diagnosis and the appropriate handling can contribute to a better outcome for the child with pancreatitis and to prevent the immediate and late complications related to the disease. More studies are required to better explain aspects related to the clinical and radiological diagnosis of pancreatitis in children, as well as aspects related to the nutritional therapy for this age group.
- ItemAcesso aberto (Open Access)Atuação da equipe multidisciplinar na terapia nutricional de pacientes sob cuidados intensivos(Pontifícia Universidade Católica de Campinas, 2005-12-01) Leite, Heitor Pons [UNIFESP]; Carvalho, Werther Brunow de [UNIFESP]; Santana e Meneses, Juliana Fernandez [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Hospitalized patients may have special nutrient requirements imposed by a combination of malnutrition and enhanced utilization of nutrients resulting from the disease process. Nutritional support, mainly during critical stages of disease, should be provided safely and effectively. Several studies have evaluated the paper of a multidisciplinary team in the administration of a nutritional therapy. Individually, the majority of these studies are underpowered to evaluate an effect on the quality of nutritional care. With the objective to identify problems inherent to the supply of nutritional support to hospitalized patients and verify the impact of the actions of a multidisciplinary team on the quality of these procedures, we analysed articles that have been published between 1980 and 2004 about the role of the action of multidisciplinary teams in the care and nutritional outcome of hospitalized patients, especially those undergoing intensive care. The terms used for the search were: multidisciplinary team, nutritional support, parenteral nutrition, enteral feeding, critically ill, intensive care unit, critically ill child. Of 130 studies, intially identified, just 24 were selected, of which 14 compared the standard of nutritional therapy with and without the presence of a multidisciplinary team. The inadequate supply of nutrients, infection and metabolic complications and the excessive use of parenteral nutrition were the main problems detected in the supply of nutritional support to hospitalized patients. In the comparative studies, the presence of the multidisciplinary team improved the pattern of nutritional support, and reduced the incidence of complications and the costs.
- ItemSomente MetadadadosDevelopment and evaluation of standardized protocol to prevent nasoenteral tube obstruction in cardiac patients requiring enteral nutrition with restricted fluid volumes(Blackwell Publishing, 2007-10-01) Matsuba, Claudia S. T.; De Gutierrez, Maria G. R.; Whitaker, Iveth Y.; Universidade Federal de São Paulo (UNIFESP)Aims and objectives. This study sought to assess the impact of a standardized protocol to maintain nasoenteral tube (NET) patency in patients requiring fluid restriction and identify factors associated with tube patency.Background. Nasoenteral tube obstruction may interrupt nutritional support and prohibit drug administration. Balancing NET patency in the context of fluid restriction can be a challenge.Design and methods. the impact of the standardized protocol was assessed by using a quasi-experimental design and an historical control.Results. Sixty patients receiving nasoenteral feeding as part of their clinical management were enrolled in the study. Nasoenteral obstruction was 8.3%, showing a reduction from the 17.4% observed in the baseline data collection. A key factor associated with tube obstruction was sounding of an infusion pump alarm reflecting the tube patency issues.Conclusions. While mindful of the limitations of probability sampling, the implementation of a standardized protocol accompanied by staff training reduced the rates of NET obstruction.Relevance to clinical practice. On the basis of these findings, we conclude that it is possible to maintain the patency of small bore tubes, even in the presence of fluid restriction, with a standardized protocol to guide clinical management.
- ItemAcesso aberto (Open Access)Diretrizes para terapia nutricional em crianças com câncer em situação crítica(Pontifícia Universidade Católica de Campinas, 2005-08-01) Garófolo, Adriana [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)This paper is a review of fundamental, up to date concepts of nutritional support for critically ill children with cancer. The aim of the text is to discuss the nutritional and metabolic changes caused by their condition, as well as indications and recommendations, contraindications and complications of nutritional support (enteral and parenteral nutrition) in cancer patients. The paper objectively shows the practical application of scientific knowledge and gives guidance to improve decisions about nutritional support in clinical practice. Finally, it is concluded there is a need to encourage research on support therapy, such as for the treatment of infections and for intensive nutritional and metabolic support, so as to increase the chances of curing children and adolescents with cancer.
- ItemSomente MetadadadosEarly Empiric Antibiotic Use Is Associated With Delayed Feeding Tolerance in Preterm Infants: A Retrospective Analysis(Lippincott Williams & Wilkins, 2017) Martinez, Francisco E; Ferri, Walusa A. G.| |Leone, Clea R.; Branco de Almeida, Maria Fernanda [UNIFESP]; Guinsburg, Ruth [UNIFESP]; Meneses, Jucille do Amaral; do Vale, Marynea Silva; Martins Marba, Sergio Tadeu; de Carvalho, Werther Brunow; Suppo de Souza Rugolo, Ligia Maria; de Andrade Lopes, Jose Maria; Ribeiro, Manoel A.; Procianoy, Renato S.; Muniz Bandeira Duarte, Jose Luiz; Ferrarez Bouzada, Maria Candida; de Lima Mota Ferreira, Daniela Marques; Alves Filho, Navantino; de Albuquerque Diniz, Edna Maria; Toledo Zanardi, Dulce Maria; Testoni, Daniela; dos Santos, Cristina Nunes; Conde Gomzalez, Maria Rafaela; Venzon, Paulyne Stadler; Belik, JaquesThe causative factors of neonatal feeding intolerance are poorly understood, but potentially related to clinical practices such as empiric antibiotic usage. The objective of this study was to evaluate whether early empiric antibiotic exposure negatively affects preterm infants' enteral feeding tolerance. Data from infants without risk factors for sepsis, 500 to 1499 g birth weight and 24 to 34 weeks gestational age were analyzed. The primary outcomes were the empiric antibiotic exposure effects on the infants' total parenteral nutrition usage duration and prevalence of necrotizing enterocolitis (NEC). Among the 901 infants included, 67 were exposed to early empiric antibiotic. A 50% increase in parenteral nutrition usage duration and a 4-fold greater prevalence of NEC was seen in the early empiric antibiotic-exposed neonates, when compared with control infants (P<0.01). Early empiric antibiotic exposure appears to negatively influence preterm infant feeding tolerance and possibly contributes to NEC.
- ItemSomente MetadadadosFactors Associated With Peptide-based Formula Prescription in a Pediatric Intensive Care Unit(Lippincott Williams & Wilkins, 2012-05-01) Vidigal, Maria V. M. [UNIFESP]; Leite, Heitor P. [UNIFESP]; Nogueira, Paulo C. K. [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Objectives: There is no evidence-based consensus on the use of peptide-based formulas for critically ill children. the present study aimed to identify the factors associated with the choice of peptide-based formulas in the first enteral nutrition prescription for critically ill children and to compare the direct costs of the enteral formulas used in a pediatric intensive care unit.Methods: in a prospective study, children admitted to the intensive care unit and receiving tube feeding for >= 48 hours were evaluated. the potential exposure variables for the use of peptide-based formulas as the first nutrition prescription were age, sex, malnutrition, sepsis/septic shock, fasting period >2 days, use of a-adrenergic drugs before initiating first diet, and the revised Pediatric Index of Mortality score. A direct cost comparison of prescribed formulas was performed.Results: of 291 patients included, 85 (29.2%) were given peptide-based formulas in the first nutrition prescription. This choice was independently associated with malnutrition (odds ratio [OR] 2.94; 95% confidence interval [CI] 1.60%-5.39%; P< 0.01), fasting period > 2 days (OR 3.46; 95% CI 1.93%-6.20%; P < 0.01), and use of a-adrenergic drugs (OR 2.32; 95% CI 1.24%-4.31%; P < 0.01). Peptide-based formula costs were up to 10 times higher than standard polymeric formula costs.Conclusions: the choice of peptide-based formula as the first enteral nutrition prescription is associated with the greater severity of patients' clinical status-patients receiving a-adrenergic drugs, those who are malnourished, and those with longer fasting periods. These prescriptions engender costs higher than those associated with standard polymeric formula.
- ItemAcesso aberto (Open Access)A suplementação de glutamina é benéfica em crianças com doenças graves?(Pontifícia Universidade Católica de Campinas, 2005-02-01) Pacífico, Stefânia Lucizani; Leite, Heitor Pons; Carvalho, Werther Brunow de [UNIFESP]; Hospital do Servidor Público Estadual Unidade de Terapia Intensiva; Universidade Federal de São Paulo (UNIFESP)Although there have been several randomized trials, conducted with critically ill adults, reporting the benefits of glutamine supplementation, there is scarce information on the role of glutamine in the treatment outcome of critically ill children. Our objective was to evaluate existing studies on the effect of glutamine supplementation, aiming at verifying the clinical benefits of such supplementation for critically ill children. A computerized search was conducted to select prospective, randomized, clinical trials of critically ill children, published between 1992 and 2003. Studies were included if, besides presenting the characteristics already mentioned, they evaluated the effects of parenteral and the enteral glutamine supplementing vs. those of standard care. The variables on clinical outcomes were: time to achieve full enteral nutrition, hospital length of stay, complication rates, and mortality. Three bibliographic databases were searched: Medline, LILACS and Cochrane Library. Search terms included: glutamine, critically ill, trauma, sepsis, burned, injured, bone marrow transplantation, intensive care, and mechanic ventilation. Initial screening resulted in 33 original articles; of these potentially eligible articles, only 7 fulfilled the inclusion criteria. Length of hospital stay, mortality rate, and hospital costs were not different for patients receiving glutamine-supplemented nutrition, when compared to those receiving non-supplemented diet. Glutamine was associated with reduction in the time necessary to achieve full enteral feeding and parenteral nutrition. There is no evidence to support the routine use of either parenteral or enteral glutamine supplement when treating critically ill children. The small number of patients, heterogeneity with respect to the studied groups, routes of administration, and confounding effects of concomitant diseases, all limit the inferences we can make from the results.