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https://www.arca.fiocruz.br/handle/icict/3610
PRÁTICAS NUTRICIONAIS NOS RECÉM-NASCIDOS COM MENOS DE 1500 GRAMAS
Gianini, Nicole Oliveira Mota | Date Issued:
2001
Advisor
Affilliation
Fundação Oswaldo Cruz. Instituto Fernandes Figueira. Departamento de Ensino. Programa de Pós-Graduação em Saúde da Criança. Rio de Janeiro, RJ, Brasil
Abstract in Portuguese
Com o objetivo de conhecer as práticas nutricionais nas unidades neonatais do Rio de Janeiro fizemos um estudo descritivo, näo intervencionista, sobre as práticas nutricionais nas maiores unidades neonatais do município do Rio de Janeiro, de uma coorte de recém-nascidos com menos de 1.500g de peso ao nascer, admitidos de novembro de 1999 a abril de 2000. Analisamos 416 prontuários. Dos recém-nascidos acompanhados, 60,4 por cento sobreviveram. O peso médio do grupo populacional foi de 1140g mais ou menos 270. O suporte nutricional parenteral foi instituído em 55,28 por cento dos recém-nascidos, com início em torno do quarto dia.O suporte parenteral total ou parcial durou em média nove dias. A primeira dieta foi ofertada em média no quarto dia de vida, predominando o uso do leite humano (materno e/ou pool de doadoras), em 89,8 por cento. A dieta plena foi atingida em média após 12 dias da sua introduçäo e foi suspensa em 52,4 por cento dos casos, predominando a "piora clínica" como motivo principal da suspensäo. O intervalo entre uma alprescriçäo de oferta de 2/2 horas até 6/6 horas. Predominantemente a dieta foi ofertada em gavagem simples. A recuperaçäo do peso de nascimento foi em média com 17 dias, sendo que os recém-nascidos que receberam dieta enteral mais cedo atingiram o peso de nascimento mais precocemente. Encontramos treze casos de enterocollite necrosante, sem relaçäo com Apgar, escore de risco e/ou introduçäo precoce da dieta. Dos treze casos, oito faleceram. Em que pese toda a importância que o leite materno possui para essa populaçäo, a alta em aleitamento materno ocorreu em 33,75 por cento. Concluímos que diferentes práticas nutricionais säo utilizadas no grupo estudado,variando inclusive dentro da mesma unidade.Näo há uma rotina estabelecida e as condutas traçadas estäo aquém das preconizadas na literatura.
Abstract
The higher survival rate of underweight neonate in the latest years has brought a
new challenge: the nutrition issue. A theme that is much controversy.
With the objective of knowing the nutritional practices in neonatal units in Rio
de Janeiro, a descriptive, non-intervening work has been undertaken on the nourishing
practices in major neonatal units in the city of Rio de Janeiro, comprehending a cohort
of newborns weighing under 1500g at birth, admitted from November 1999 to April
2000.
Four hundred sixteen medical records were analyzed and a questionnaire filled
out with demographic data of the population, the different kinds of therapy used, the
results obtained, and the variation in procedures among the centers. CDC Epi-info (Epi
– 6.04) software was used for data analysis. Variance analysis and Kruskal-Wallis nonparametric
tests were used for analyzing the continuous variables and chi-square for the
categorical variables. Also, Pearson correlation coefficient was used for correlating
continuous data.
Of those newborn, 60.4% survived. Life span was longer for newborns
weighing over 1000g and born after a gestation period of over 30 weeks. Average
weight of the population was 1140g±270.
Parenteral nutrition support was applied to 55,28% of the newborns, starting
around the fourth day. Initial aliquot were around 2g/kg/day (amino acid and/or lipid).
Total or partial parenteral support has been applied for nine days in average.
The first diet was offered in the fourth day of life in average, predominantly
human milk (from mother and/or a pool of donors), for 89,8%. In average, full diet was
attained twelve days after its introduction, and it was suspended in 52,4% of the cases,
the main motive for suspension being “general clinical picture”, generally sometime
before completing fifteen days from its introduction (77,5%). The interim between one
aliquot and the other diet varied, prescription for the offer being from every two hours
every six hours. Predominantly the diet was offered by plain gavage (99,2%). Recovery
of birth weight was attained in about seventeen days, the newborns that received enteral
diet having attained their birth weight earlier. Thirteen cases of necrotizing enterocolitis
were found, without relation with Apgar, risk score and/or premature introduction of
diet. Of the 13 cases, eight died (61,5%). Notwithstanding the importance of maternal
milk for this population, halting of maternal milk nourishing occurred in 33,75%.
The conclusion was that there are different nutritional practices in use within the
group focused, such practices varying included within the same unit. There insn’t a
guideline of nutrition and the conducts are not in papers found in the literature.
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