PATRICIA ZAMBERLAN DOS SANTOS
Projetos de Pesquisa
Unidades Organizacionais
Instituto da Criança, Hospital das Clínicas, Faculdade de Medicina
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- Can calf circumference be a viable option for nutritional assessment in the PICU?(2021) VIEIRA, Rafaela Rodrigues; CAMPOS, Marina Morgado Simoes de; ZAMBERLAN, Patricia; VIANI, KarinaBackground: Children admitted to paediatric intensive care units (PICUs) often need specialised nutri-tional intervention. Nutritional assessments provide specific data to support such interventions. Body composition measures, such as mid-upper arm circumference (MUAC), can complement nutritional assessment. However, MUAC has limitations. Calf circumference (CC) is an easy and common measure of muscle loss in the elderly; however, there are still very few studies on CC in children. Aims: To evaluate the viability of using CC for nutritional monitoring of children under intensive care, compared with MUAC and weight. Methods: Patients aged 2-10 years admitted to the PICU between December 2018 and August 2019 were included in the study. Two MUAC, CC, and weight measurements were performed: one in the first 24 h after PICU admission and another after 7 days. As there are no reference values for CC in children, this measure was used solely to observe the patient's individual progress. The nutritional status, both ac-cording to body mass index and MUAC, was used to characterise samples. Percentage changes in these measures were compared using the Wilcoxon signed-rank test for comparison between medians and Spearman's correlation test. Information from medical records regarding hospitalisation was also collected and analysed. Results: Thirty patients were included in the study. During hospitalisation week 1, CC decreased significantly (p = 0.001), whereas MUAC (p = 0.427) and weight (p = 0.315) did not change significantly. Percentage changes in CC and MUAC were statistically different (p = 0.0449), with a positive correlation between the changes in both measures (p = 0.0333; r = 0.3896); conversely, although the percentage changes in CC and weight significantly differed (p = 0.0066), no correlation was found between them (p = 0.9382; r = 0.0148). The percentage changes in MUAC and weight were not different (p = 0.1880) or correlated (p = 0.1691; r = 0.2577). No statistically significant relationship was found between per-centage changes in CC and clinical outcomes (length of stay, fasting time, and mechanical ventilation time). Conclusions: CC appears to be a viable measure for use in PICUs. Although positively correlated with MUAC, a measure proven useful in critically ill children, CC decreased significantly in the first week of intensive care, whereas MUAC remained unchanged, indicating that CC may show signs of depletion earlier than MUAC in these patients. Our study reinforces the importance of alternative measures for anthropometric assessment of critically ill children.
- Increased nutrition risk at admission is associated with longer hospitalization in children and adolescents with COVID-19(2022) ZAMBERLAN, Patricia; CARLOTTI, Ana Paula de Carvalho Panzeri; VIANI, Karina Helena Canton; RODRIGUEZ, Isadora Souza; SIMAS, Josiane de Carvalho; SILVERIO, Ariadne Beatriz; VOLPON, Leila Costa; CARVALHO, Werther Brunow de; DELGADO, Artur FigueiredoBackground We investigated the association of nutritional risk and inflammatory marker level with length of stay (LOS) in children and adolescents hospitalized for COVID-19 infection in two pediatric teaching hospitals in a developing country. Methods This was a cross-sectional analytical retrospective study performed in two pediatric hospitals. We included the data from all children and adolescents who were hospitalized with a SARS-CoV-2 infection between March and December 2020. Demographic, anthropometric, clinical, and laboratory data were extracted from electronic medical records. Nutritional risk was assessed according to the STRONGkids tool within 24 hours of admission and was categorized into two levels: >= 4 (high risk) and <4 (moderate or low risk). Means or medians were compared between nutritional risk groups using the t test and Mann-Whitney U test, respectively. The association of nutritional risk and inflammatory markers with LOS was estimated using the Kaplan-Meier method and log-rank test. Cox proportional-hazard and linear regression models were performed, and adjusted for sex, age, and respiratory symptoms. Results From a total of 73 patients, 20 (27.4%) had a STRONGkids score >= 4 at admission, which was associated with a longer LOS even after adjusting (beta = 12.30; 1.74-22.9 95% CI; P = 0.023). The same association was observed between LOS and all laboratory markers except for D-dimer. Conclusion Among children and adolescents with COVID-19, a STRONGkids score >= 4 at admission, lower values of albumin, lymphocytes, and hemoglobin, and higher CRP values were associated with longer LOS.
conferenceObject Nutritional Status Deterioration of Children with Cancer in the First Week of Intensive Care and Relation to Clinical Outcomes(2018) VIANI, K.; RAFAEL, M. Neto; PUGLIESE, C.; MIGUEL, G. Bouchabki; MANZOLI, B. Stachissini; ZAMBERLAN, P.