ABSTRACT
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 α-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 α-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 α-adrenergic drugs, those who are malnourished, and those with longer fasting periods. These prescriptions engender costs higher than those associated with standard polymeric formula.
Subject(s)
Enteral Nutrition , Food, Formulated/analysis , Intensive Care Units, Pediatric , Adrenergic Agents/therapeutic use , Child, Preschool , Costs and Cost Analysis , Enteral Nutrition/economics , Female , Food, Formulated/economics , Humans , Infant , Length of Stay , Male , Malnutrition/therapy , Prospective Studies , Shock, Septic , Treatment OutcomeABSTRACT
Objetivo: Avaliar as evidências acerca da eficácia do hormônio de crescimento recombinante humano (GH) em crianças com insuficiência renal crônica, comparando-o com o uso de placebo ou ausência de tratamento.Métodos: A partir da base de dados Pub Med, utilizando-se os unitermos "kidney failure, chronic" e "growth hormone", selecionamos seis estudos clínicos randomizados e controlados, publicados entre 1990 e 2004, na faixa etária de 0 a 18 anos. Selecionamos apenas os estudos que avaliaram o escore Z da velocidade de crescimento ou o escore Z do delta da estatura para a idade.Resultados: A análise dos estudos, compreendendo 278 pacientes (175 em uso de GH e 103 em uso de placebo ou sem tratamento), mostrou que o uso de GH teve uma eficácia superior ao placebo ou ausência de tratamento, no sentido de acelerar a velocidade de crescimento e/ou a estatura de crianças com insuficiência renal crônica.Conclusão: O uso de GH é efetivo para aumentar a estatura de crianças com insuficiência renal crônica.
