Nutrition for the pediatric surgical patient: approach in the peri-operative period

Falcão, Mário Cícero; Tannuri, Uenis

doi:10.1590/s0041-87812002000600010

Cited by 15 publications

(22 citation statements)

References 35 publications

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“…Undernutrition in this group may have far more implications owing to the associated biological stresses of growth and development and the rapid changes that occur during the functional maturation of organs and systems 27 . Furthermore, they have a proportionately smaller nutritional reserve compared with adults.…”

Section: Discussionmentioning

confidence: 99%

The impact of nutritional status on the outcome of Indian patients undergoing neurosurgical shunt surgery

et al. 2007

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Undernutrition is common in surgical patients, is frequently unrecognised and is strongly associated with adverse outcomes such as high rates of complications and mortality, worsening functional status and prolonged hospitalisation. Owing to the associated infection and symptoms such as repeated vomiting, a high prevalence of undernutrition is expected in hydrocephalus patients, which may contribute to their poor surgical outcomes. The aim of this study was to evaluate the influence of preoperative nutritional status on the outcome of Indian patients with hydrocephalus undergoing neurosurgical shunt surgery. One hundred and twenty-four consecutive patients undergoing scheduled hydrocephalus shunt surgery were studied prospectively. All patients underwent nutritional screening according to different parameters prior to surgery. The patients were classified into normally nourished and undernourished groups. The undernourished group was further subdivided into moderately and severely undernourished. The surgical outcome was compared between these groups. A high prevalence (53 %) of undernutrition was observed in these patients. Postoperative complications such as shunt infection (P¼0·0023), shunt revision (P¼ 0·0074) and mortality (P¼ 0·0003) were significantly more common in undernourished patients compared with normally nourished patients. Serum albumin emerged as the most significant independent predictor of postoperative mortality. The present study demonstrated a high prevalence of undernutrition in hydrocephalus patients in India and its adverse influence on the outcome of shunt surgery. Early preoperative nutritional status screening and its optimisation may decrease the morbidity and mortality of shunt surgery for hydrocephalus. Nutritional status: Hydrocephalus: Neurosurgical shunt surgeryThe influence of nutritional status on the course of an illness was already known to Hippocrates when he stated that well-fed patients would recover more quickly 1 . Since then, numerous studies have widely acknowledged the deleterious effects of impaired nutritional status on clinical outcome 2 -4 and hospital costs 5 . Undernutrition, however continues to be a significant problem in surgical patients, with up to 40 % of patients being undernourished on admission to hospital, and about 78 % of the undernourished patients who stay longer in hospital losing further weight 6 -8 .This deterioration of nutritional status in the patient undergoing surgery may result in reduced systemic immunity, an exaggerated stress response, organ system dysfunction, poor wound healing and delayed functional recovery 7,9 -14 . Therefore, careful preoperative nutritional assessment followed by the initiation of appropriate nutritional therapies has been proposed to improve outcomes 12 . Hydrocephalus is a clinical condition marked by the excessive accumulation of cerebrospinal fluid within the cerebral ventricles. It is more frequent in children and results from congenital or acquired disease processes including developmental anomalies, neop...

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Section: Discussionmentioning

confidence: 99%

The impact of nutritional status on the outcome of Indian patients undergoing neurosurgical shunt surgery

et al. 2007

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Section: Defining Malnutritionmentioning

confidence: 99%

“…For children, all measurements should be compared with standardized growth curves 6 . Other anthropometric measurements that can be used in nutrition assessment include arm circumference and arm muscle circumference 6 , 7 . Nutrition assessments should include clinical history, gastrointestinal (GI) symptoms, appetite changes, clinical examination, anthropometric data, weight trends, growth velocity, and biochemical evaluation 6 .…”

Section: Defining Malnutritionmentioning

confidence: 99%

Optimizing Perioperative Nutrition in Pediatric Populations

et al. 2015

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Nutrition status prior to surgery and nutrition rehabilitation after surgery can affect the morbidity and mortality of pediatric patients. A comprehensive approach to nutrition in pediatric surgical patients is important and includes preoperative assessment, perioperative nutrition considerations, and postoperative recovery. A thorough nutrition assessment to identify patients who are at nutrition risk prior to surgery is important so that the nutrition status can be optimized prior to the procedure to minimize suboptimal outcomes. Preoperative malnutrition is associated with increased complications and mean hospital days following surgery. Enteral and parenteral nutrition can be used in cases where food intake is inadequate to maintain and possibly improve nutrition status, especially in the 7-10 days prior to surgery. In the perioperative period, fasting should be limited to restricting solid foods and non-human milk 6 hours prior to the procedure and allowing clear liquids until 2 hours prior to the procedure. Postoperatively, early feeding has been shown to resolve postoperative ileus earlier, decrease infection rates, promote wound healing, and reduce length of hospital stay. If nutrition cannot be provided orally, then nutrition through either enteral or parenteral means should be initiated within 24-48 hours of surgery. Practitioners should identify those patients who are at the highest nutrition risk for postsurgical complications and provide guidance for optimal nutrition during the perioperative and postoperative period.

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“…The pre-transplant daily nutritional support, equal to 130-150% of the basal energy expenditure (Alonso, 2008;Greer, Lehnert, Lewindon, Cleghorn, & Shepherd, 2003;Novy, & Schwarz, 1997;Shepherd, 1996;Ramaccioni, Soriano, Arumugam, & Klish, 2000;Heubi, Helman, Melvin, & Shulman, 2002;Campos, Matias, & Coelho 2002;Falcão & Tannuri, 2002), consisted of the supply of a lipid emulsion of long-chain triglyceride/medium-chain triglyceride in a ratio of 3:2, liposoluble vitamins, and micronutrients (Johnson, Young, Cotter, Lin, & Rowe, 1990;Lai & Chen, 2000;Marchesini, Fabbri, Bianchi, Brizi, & Zoli, 1996). Oral intake was the administration route of preference.…”

Section:  mentioning

confidence: 99%

Therapeutic Effectiveness of Nutrition Therapy in Pediatric Patients with Chronic Liver Diseases Awaiting Liver Transplantation

Giammanco¹,

Bavetta²,

Greco³

et al. 2013

JFR

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It is important to prevent protein/calorie malnutrition in children with end stage liver diseases prior to transplantation. This study involved 34 patients between the ages of 10 and 156 months (mean value 25.69 months  32.2) (13 females and 21 males) on the liver transplant waiting list. Data collected as of three months before transplant and up to ten months after the procedure concerned gender, age, weight, height, Pediatric End Stage Liver Disease Score, baseline pathology, type of nutrition, type of transplant, immunosuppression, pulse steroid therapy, length of stay, and post transplant complications. Linear regression analysis showed that the length of hospital stay was 24.5 days more for females than for males, but also that intensive nutrition therapy shortens this stay for both female patients (P = 0.085) and younger patients (P = 0.023). The study population was divided into two groups according to the different nutritional therapies adopted. The Student's t-test and Mann-Whitney test evidenced that the group receiving intensive nutrition therapy grew taller compared with the group following an oral diet (mean -1.37 and Prob = 0.043); that females grew taller compared to males (mean -1.65 +/-0.56); and that there was an increase in height among the children in the group receiving intensive nutrition therapy despite the presence (-1.37 +/-0.56) or absence (-14.8 +/-5.44 and Prob = 0.035) of complications, and despite the administration (-1.03 +/-0.33) or non administration (-1.48 +/-0.55 and Prob = 0.019) of steroids. Intensive nutrition therapy enhances the velocity of growth in height and shortens the length of hospital stay, thus optimizing the final prognosis of the baseline pathology.

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Nutrition for the pediatric surgical patient: approach in the peri-operative period

Cited by 15 publications

References 35 publications

The impact of nutritional status on the outcome of Indian patients undergoing neurosurgical shunt surgery

The impact of nutritional status on the outcome of Indian patients undergoing neurosurgical shunt surgery

Optimizing Perioperative Nutrition in Pediatric Populations

Therapeutic Effectiveness of Nutrition Therapy in Pediatric Patients with Chronic Liver Diseases Awaiting Liver Transplantation

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