Prevalence of thyroid dysfunction in neonates receiving parenteral nutrition in the intensive care unit

Abstract Objective: The use of parenteral nutrition (PN) formulations that do not contain iodine can contribute to the deficiency of this mineral, potentially leading to hypothyroidism and, ultimately, neurocognitive impairments. This study aimed to evaluate TSH alterations in newborns receiving PN. Methods: Retrospective study of neonatal intensive care unit patients receiving PN for > 15 days. Nutritional, anthropometric, and biochemical variables (TSH, T4, CRP) were analyzed. Hypothyroidism was defined by TSH > 10 mU/L. Results: Two hundred newborns were evaluated [156 (78%) preterm, 31±5 weeks of gestational age, 112 (56%) with very or extremely low birth weight]. The median (IQR) hospital stay was 68 (42-110) days, PN duration was 31 (21-47) days, and 188 (94%) patients also received enteral nutrition. Overall, 143 (71.5%) newborns underwent at least one TSH measurement. The prevalence of hypothyroidism was 10.5%. The Median PN duration in this group was 51 (34-109) days. Among those with hypothyroidism, 10 received Lugol's solution and six levothyroxine. Thirteen patients received prophylactic Lugol's solution with a median PN duration of 63 (48-197) days. TSH levels correlated positively with PN duration (r = 0.19, p = .02). Conclusions: The present data suggest that changes in TSH and T4 levels are present in neonates receiving PN for > 15 days, suggesting this population may be at risk for developing hypothyroid-ism. Therefore, the authors suggest that TSH and T4 measurements should be included as routine in neonatal patients receiving PN for > 15 days if PN formulations are not supplemented with iodine, and that iodine supplementation be provided as necessary.

Clinical impact of systematic nutritional care in adults submitted to allogeneic hematopoietic stem cell transplantation

BACKGROUND: The development of nutrition care programs for patients undergoing hematopoietic stem cell transplantation is necessity in view of the rapid and aggressive consequences frequently seen with this procedure. Patients require constant care to reduce complications and to contribute to the success of therapy. METHODS: In an attempt to ascertain the impact of systematic nutritional care on patients submitted to allogeneic hematopoietic stem cell transplantation, the present study assessed the nutritional and clinical status, use of parenteral nutrition, and complication and mortality rates in two groups of patients, who were submitted to transplantation between April 2003 and December 2004 (Non-intervention Group - NIG; n = 57) and between March 2006 and January 2008 (Intervention Group - IG; n = 34). RESULTS: There were no significant differences between groups in terms of clinical or nutritional profiles. Additionally, the length of hospital stay and complication and mortality rates were similar for both groups. However, time on parenteral nutrition during treatment was shorter for the IG [median 6.5 days (range: 1-28) for related donor recipients and 11 days (range: 1-21) for unrelated donor recipients] than for the NIG [median 20.5 days (range, 4-73) for patients submitted to myeloablative conditioning and 18.5 days (range: 11-59 days) for those submitted to nonablative conditioning]. CONCLUSION: The implementation of a nutritional follow-up and therapy protocol for adult patients submitted to hematopoietic stem cell transplantation shortens the duration of parenteral nutrition. It certainly has an impact on hospitalization costs and, potentially, on the rate of complications, even though this was not demonstrated in this study.

Avaliaçäo da funçäo tireoidiana no recém-nascido sob açäo do iodo aplicado no coto umbilical / Evaluation of the thyroid function in the newborn under the action of iodine applied to the umbilical stump

Estudos recentes têm demonstrado que a aplicaçäo de soluçöes iodadas na pele e mucosas em gestantes e recém-nascidos podem ser absorvidas, causando hipotireoidismo transitório e bócio. Näo havendo estudos comprovando que estas soluçöes utilizadas no coto umbilical possam provocar efeitos na funçai tireoidiana, oa autores realizaram um estudo prospectivo e randomizado em 104 recém-nascidos normais, com idade média de 10,8 ñ 2,7 dias no momento da coleta, dos quais 51 usaram álcool iodado a 1% no coto umbilical (grupo I) e 53 utilizaram álcool etílico a 70- gl (grupo II). As variáveis se distribuíram igualmente nos dois grupos. Dosou-se T4 e TSH por radioimunoensaio. O presente estudo demonstrou que o iodo é absorvido pelo coto umbilical, resultando em aumento do TSH (6,6 ñ 4,6 x 4,7 ñ 3,0; p < 0,02) e diminuiçäo da secreçäo de T4 (11,2 ñ 2,4 x 13,4 ñ 2,9; p < 0,0001), em relaçäo ao grupo-controle. Apesar da alteraçäo significativa da funçäo tireoidiana, näo foi observado nenhum caso com quadro clínico de hipotireoidismo ou bócio. Os autores recomendam a retirada de antissépticos iodados do coto umbilical do recém-nasdcido

Septicemia na UTI pediátrica: valor leucograma correlacionado com 2 outros testes hematológicos / Sepsis in a pediatric intensive care unit: the value of the white blood cell count and the correlation with 2 others haematologic tests

Neste trabalho foram analisadas as alteraçöes hematológicas de crianças internadas em Unidade de Terapaia Intensiva Pediátrica (UTIP) com septicemia comprovada por hemocultura positiva, com o objetivo de correlacioná-las. Dos 130 pacientes avaliados retrospectivamente, encontrou-se 244 situaçöes com hemoculturas positivas. Nesses casos, determinou-se critérios hematológicos considerados de alto risco para infecçäo, que foram comparados a positividade da hemocultura. Dos vários dados resultantes dessa observaçäo, dois foram os mais importantes. O primeiro é que a análise concomitante de mais de uma alteraçäo hematológica aumenta o valor do leucograma, VSG e plaquetas em predizer infecçäo. E a segunda, é de que somente 58,6% dos pacientes com hemocultura positiva tinham leucogramas de alto risco. Assim, o médico intensivista na UTIP deve valer-se de outros dados para diagnosticar e tratar um quadro séptico, mesmo sem a presença de leucograma de alto risco, já que esse fato ocorreu em 41,4% dos pacientes

Importância da hipertermia nas primeiras 24 horas de puerperio / The importance of fever in the first 24 hours de puerperium

Apresenta-se um estudo que analisa a presença de temperatura axilar >- 39-C nas primeiras 24 horas de puerpério - sua valorizaçäo clínica ou näo

Levantamento de bacteremias em hospital geral: HCPA, 1980-1983 / Survey of bacteremias in a general hospital: HCPA, 1980-1983

As hemoculturas positivas surgidas no HCPA durante um período de 40 meses consecutivos foram estudadas, constatando-se que ocorrem 4,7 hemoculturas positivas por mil pacientes por ano. Esses achados foram avaliados sob ponto de vista bacteriológico, terapêutico e prognóstico