Evolução do estado nutricional de crianças submetidas à internação hospitalar

Abstract

Objective: to assess the evolution of nutritional status in children admitted to the Teaching Hospital of Universidade Federal de Alagoas.Methods: a retrospective study was performed on 52 children (0 -10yrs) whose length of hospital stay exceeded 10 days (from February to July/2001). We compared their nutritional status, expressed in terms of Z score of the weight-for-age ratio at the beginning (T1) and at the end of the hospitalization period (T2).Results: the predominant age range (44.2%) was less than 1 year (median=1.4yrs). The hospitalization period varied from 10 to 77 days (median=20 days). Although the prevalence rates of proteinenergy malnutrition (PEM) in T1 and T2 were, respectively, 71.2% and 69.2%, only 15.4% had this diagnosis on the medical records. These children diagnosed with protein-energy malnutrition presented extreme wasting and greater length of hospital stay than the others (PEM, n=8: -4.38±2.1, T=30 ± 4.5; undiagnosed PEM, n=13: -3.13±0.9, T=23±18; other conditions, n=31: -0.63±1.1, T=21±13). Among the 52 children analyzed, only 29 showed positive weight variation. However, the average magnitude of negative Z values was higher than that of positive values: -0.56 and 0.50. Children who remained in hospital for a longer period of time showed larger weight deficits, indicating that hospitalization did not contribute towards the improvement of their initial nutritional status.Conclusion: the prevalence of weight-for-age deficit among children at hospital admission was very high. This situation remained unchanged at hospital discharge.J Pediatr (Rio J) 2002;78(6):491-6: nutrition assessment, anthropometry, hospitalized child, nutritional status. ResumoObjetivo: analisar a evolução do estado nutricional de crianças internadas no Hospital Universitário da UFAL.Metodologia: estudo retrospectivo de 52 crianças (0 a 10 anos), que estiveram internadas no Hospital Universitário por mais de 10 dias (fevereiro a julho de 2002). Comparou-se o estado nutricional, expresso em escore z, do índice peso para idade (P/I) no momento da admissão (T 1 ) e da alta hospitalar (T 2 ). Resultados: a faixa etária predominante (44,2%) foi a de menor de um ano (mediana=16,4 meses). O tempo de internação variou de 10 a 77 dias (mediana= 20). A prevalência de desnutrição (DEP) emT 1 e T 2 foi, respectivamente, 71,2% e 69,2%, mas apenas 15,4% tinham esse diagnóstico no prontuário. Neste caso, as crianças se destacavam das demais pelo extremo grau de magreza e maior T (DEP, n=8: -4,38±2,1, T=30 ± 4,5; DEP não diagnosticado, n=13: -3,13±0,9, T=23±18; demais condições, n=31: -0,63±1,1, T=21±13). Das 52 crianças, 29 apresentaram variação de peso positiva, e 23 negativa. No entanto, a magnitude da média dos valores z negativos foi superior à dos valores positivos: -0,56 e 0,50. As crianças com maiores déficits ponderais foram as que permaneceram internadas por maior período de tempo, sem que isso tenha contribuído para melhorar sua condição nutricional inicial.Conclusão: a prevalência de déficit de peso para idade en...

Predisposing factors for peripheral intravenous puncture failure in children

“…Malnourishment, according to a Brazilian study, is prevalent on admission to hospital of children but is not diagnosed in them (16) . One can highlight capillary fragility and reduction in tissue turgor among the reasons which lead to PIP failure in malnourished children.…”

Avaliação antropométrica, fatores de risco para desnutrição e medidas de apoio nutricional em crianças internadas em hospitais de ensino no Brasil

“…[5][6][7] Unfortunately, nutritional assessment and follow up of children during hospitalization is not a routine in in-hospital treatment, which might hinder diagnosis and treatment of nutritional deficiencies. 8,9 Another issue concerns the fact that the diagnosis of malnutrition is not always documented in the child's medical record at hospital admission or death certificate, hindering a correct and comprehensive evaluation of the problem. A standard and pre-encoded questionnaire was used for data collection, which should be filled in within 48 hours of hospital admission and, at most, 48 hours before hospital discharge, taking into account discharges during weekends.…”

Hospitalização: efeito sobre o estado nutricional em crianças

“…When admitted they are not generally subjected to anthropometric assessment and do not, therefore, receive nutritional support. 8,10,12,13 Currently there is concern with the with the frequency of hospital malnutrition, however, there are problems with defining this and there are no studies on which to base the choice of a cutoff point for the percentage weight loss at which the term ought to be applied. 8,9,14 This work was undertaken with focus on the fact that children can fall into malnutrition or worsen a preexisting state of malnutrition while in hospital and that it is therefore of fundamental importance to perform nutritional assessments during the hospital stay.…”

“…In contrast, in countries like Brazil and Mexico, rates of up to 70 to 80% of malnutrition among hospitalized children, and furthermore the condition has been observed to worsen during the hospital stay. 10,15 The probable determinant factors of the elevated of the elevated prevalence of preexisting malnutrition that most stand out are: prematurity and low birth weight, lack of breastfeeding or early weaning and diarrhea. All of these factors, in isolation or conjunction, reflect the unfavorable socioeconomic living conditions of the children who seek care from public health services.…”

“…8,9 A study carried out in Alagoas state demonstrated an elevated prevalence of pre-hospitalization malnutrition and suggested that the dietary care provided to hospitalized children was not effective at improving their nutritional conditions. 10 The objective of this study is to assess the nutritional status of hospitalized children under 5 years old at the time of admission and again at discharge and to relate length of hospital stay and the disease responsible for admission with the presence and/or exacerbation of malnutrition.…”