ABSTRACT
OBJECTIVE: To correlate the nutritional status with variables associated to the type of diet and feeding route of children and adolescents with spastic quadriplegic cerebral palsy (CP). METHODS: This cross-sectional study included 28 patients aged ≤13 years old who presented a diagnosis of spastic quadriplegic CP and were followed by the nutrition team of the Outpatient Clinic for Special Patients of Hospital de Clínicas de Uberlândia - Universidade Federal de Uberlândia (HC-UFU), between July/2016 and January/2017. Consent forms were signed by the legal guardians. The nutritional status was evaluated and data on dietary complications food route and type of diet were collected. For the description of data, average and median values were used. Correlation was tested with Spearman's index. Significance was set at p<0.05. RESULTS: 75% of patients used alternative feeding routes (nasoenteral, catheter or gastrostomy), 57% were eutrophic. The most frequent complications were oropharyngeal dysphagia, reflux and intestinal constipation. No correlation was found between the occurrence of complications and the nutritional status. There was a positive correlation between the diet received and the patient's nutritional status (0.48; p=0.01), i.e. individuals with adequate caloric and macronutrients intake had a better nutritional status. CONCLUSIONS: The results reinforce the need for continued nutritional guidance for the children's parents/caregivers, as well as the choice of an adequate rout of feeding to each child by the multi-professional team, in order to contribute to improved nutritional status and adequate dietary intake.
Subject(s)
Cerebral Palsy/complications , Energy Intake , Nutritional Status , Child , Cross-Sectional Studies , Enteral Nutrition/adverse effects , Feeding Behavior , Female , Humans , Male , Malnutrition/etiology , Parents/education , Severity of Illness IndexABSTRACT
ABSTRACT Objective: To correlate the nutritional status with variables associated to the type of diet and feeding route of children and adolescents with spastic quadriplegic cerebral palsy (CP). Methods: This cross-sectional study included 28 patients aged ≤13 years old who presented a diagnosis of spastic quadriplegic CP and were followed by the nutrition team of the Outpatient Clinic for Special Patients of Hospital de Clínicas de Uberlândia - Universidade Federal de Uberlândia (HC-UFU), between July/2016 and January/2017. Consent forms were signed by the legal guardians. The nutritional status was evaluated and data on dietary complications food route and type of diet were collected. For the description of data, average and median values were used. Correlation was tested with Spearman's index. Significance was set at p<0.05. Results: 75% of patients used alternative feeding routes (nasoenteral, catheter or gastrostomy), 57% were eutrophic. The most frequent complications were oropharyngeal dysphagia, reflux and intestinal constipation. No correlation was found between the occurrence of complications and the nutritional status. There was a positive correlation between the diet received and the patient's nutritional status (0.48; p=0.01), i.e. individuals with adequate caloric and macronutrients intake had a better nutritional status. Conclusions: The results reinforce the need for continued nutritional guidance for the children's parents/caregivers, as well as the choice of an adequate rout of feeding to each child by the multi-professional team, in order to contribute to improved nutritional status and adequate dietary intake.
RESUMO Objetivo: Correlacionar o estado nutricional com variáveis associadas ao tipo de dieta e via de alimentação de crianças e adolescentes com paralisia cerebral (PC) tetraparética espástica. Métodos: Estudo de corte transversal com 28 pacientes com idade ≤13 anos, atendidos pela equipe de nutrição do Ambulatório de Pacientes Especiais do Hospital de Clínicas de Uberlândia da Universidade Federal de Uberlândia (HC-UFU), entre julho de 2016 e janeiro de 2017, que apresentavam diagnóstico de PC tetraparética espástica. Os pacientes incluídos tiveram o termo de consentimento assinado pelo responsável legal. Avaliou-se o estado nutricional e coletaram-se dados sobre complicações alimentares, via de alimentação e tipo de dieta. Para descrição desses dados, foram utilizadas média e mediana; para análises de correlação, correlação de Spearman, sendo significante p<0,05. Resultados: Neste estudo, 75% dos pacientes utilizavam via alternativa para alimentação (sonda nasoenteral ou gastrostomia) e 57% eram eutróficos. As complicações mais frequentes foram disfagia orofaríngea, refluxo e obstipação intestinal. Não houve correlação entre ocorrência de complicações e estado nutricional. Observou-se correlação positiva entre dieta recebida e estado nutricional dos pacientes (0,48; p=0,01), sendo que indivíduos com adequada ingestão calórica e de macronutrientes apresentaram melhor classificação do estado nutricional. Conclusões: Os resultados obtidos reforçam a necessidade de orientações nutricionais contínuas para os pais/cuidadores das crianças do estudo, bem como a escolha de uma via de alimentação adequada a cada uma delas pela equipe multiprofissional, a fim de contribuir para a melhora do estado nutricional e da ingestão alimentar.
Subject(s)
Energy Intake , Cerebral Palsy/complications , Nutritional Status , Parents/education , Severity of Illness Index , Cross-Sectional Studies , Enteral Nutrition/adverse effects , Malnutrition/etiology , Feeding BehaviorABSTRACT
O atendimento ao paciente pediátrico com atraso no desenvolvimento neuromotor (ADNM), em particular aqueles com diagnóstico de paralisia cerebral (PC), é um grande desafio para os serviços públicos de saúde em todo o mundo. A complexidade do manejo clínico torna relevante uma abordagem integrada e interdisciplinar. O objetivo deste estudo foi conhecer o perfil epidemiológico e as principais comorbidades dos pacientes com ADNM, particularmente com PC, atendidos em um serviço interdisciplinar de referência com 10 anos de experiência no manejo desses pacientes. Estudo transversal descritivo e retrospectivo por meio de análise de prontuários dos pacientes do Ambulatório de Pacientes Especiais do Hospital de Clínicas de Uberlândia no período de 2010 a 2012. Foram analisados 136 prontuários, 79 (58,1%) do sexo masculino e 70 (51,5%) procedentes de Uberlândia. O diagnóstico frequente foi PC 113 (83,1%). A obstipação intestinal (OI) e a doença do refluxo gastroesofágico (DRGE) foram as comorbidades mais frequentes, respectivamente, 85 (62,5%) e 80 (58,8%). Alimentação por via alternativa foi observada em 71 (52,2%), sendo 61 (44,8%) por gastrostomia e 10 (7,3%) por sonda nasoenteral. Doenças respiratórias ocorreram em 59 (43,3%) pacientes e foram responsáveis por internação em 22 (16,1%); 98 (72,0%) pacientes realizavam fisioterapia, 62 (45,6%) fonoterapia e 46 (33,8%) terapia ocupacional. Acompanhamento odontológico foi observadoem 49 (36,0%) deles. O reconhecimento do perfil epidemiológico, comorbidades e complicações mais prevalentes auxiliam a equipe interdisciplinar especializada a desenvolver estratégias para melhor assistência e cuidados aos pacientes com ADNM.
Care rendered to pediatric patients with neuromotor delay, particularly those diagnosed with Cerebral Palsy (CP), is a major challenge to public health services worldwide. The complexity of clinical management makes an integrated and multidisciplinary approach relevant. The aim of this study was to get to know the epidemiological profile and the main co- morbidities of patients with neuromotor delay, who are attended in a multidisciplinary referral service which has 10 years experience in the management of these patients. This study was carried out through cross descriptive and retrospective analysis of medical records of patients at the Special Patient Clinic at the University Hospital of Uberlândia, during the period of 2010-2012. One hundred and thirty six (136) records were analyzed, 79 (58.1%) were male and 70 (51.5 %) coming of Uberlândia. The more frequent diagnosis is CP in 113 (83.1%) Intestinal Constipation (IC) and gastro-esophageal reflux disease (GERD) were the most frequent co-morbidities, 85 (62.5%) and 80 (58.8%) respectively. Feeding by way of alternative means was observed in 71 (52.2%), with 61 (44.8%) gastrostomy and 10 (7.3%) through a nasogastric tube. Respiratory disorders occurred in 59 (43.3%) patients and were responsible for hospitalization in 22 (16.1%) cases. 98 (72.0%) patients underwent physical therapy, 62 (45.6%) speech therapy and 46 (33.8%) occupational therapy. Dental care was observed in 49 (36.0%) patients. Recognition of the epidemiological profile, comorbidities and more prevalent complications assist the specialized interdisciplinary team in developing strategies to best support and care for patients with neuromotor delay
Subject(s)
Humans , Male , Infant, Newborn , Infant , Child, Preschool , Cerebral Palsy/complications , Morbidity , Health Strategies , Failure to Thrive/epidemiology , Health Profile , Occupational Therapy , Physical Therapy Modalities , DiagnosisABSTRACT
BACKGROUND: To understand the clinical characteristics and the diagnostic procedures in pediatric patients with eosinophilic esophagitis and to evaluate the sensitivity of the patients to food and inhalant allergens. A cross-sectional study was performed in 35 children with eosinophilic esophagitis during the time period from January 2010 to January 2011. The clinical and epidemiological data were obtained using a questionnaire and medical chart analysis. The body mass index for age was used for the nutritional evaluation (via the Z score). The sensitivity to foods and inhalants was evaluated by performing a skin prick test and atopy patch test. RESULTS: Patients (35 in total, median age 10 years) with a diagnosis of eosinophilic esophagitis were evaluated. The most prevalent symptoms in the patients were vomiting (71.4%) and abdominal pain (51.4%). Endoscopic alterations were observed in 97.2% of the patients. A good nutritional state was observed in 82.8% of the children. The tests demonstrated the presence of food sensitivities and/or aeroallergens in 27 (77.1%) patients, whereas 8 (22.9%) patients did not test positive in any of the tests performed. Among the patients with positive tests, 24 (68.5%) exhibited sensitivity to aeroallergens and 16 (45.7%) were sensitive to foods. The comparison between the sensitive and insensitive groups displayed statistically significant results with respect to sex, symptom prevalence, and 24-hour esophageal pH monitoring. CONCLUSIONS: The patients evaluated in this study displayed clinical characteristics of eosinophilic esophagitis similar to those reported in the literature. The sensitivity to foods determined by the tests was less than that observed in prior studies; however, a marked sensitivity to aeroallergens was observed. The different allergen sensitivity profiles observed in this study suggests that, similar to asthma, the eosinophiic esophagitis disease may exhibit several phenotypes.
