PATRICIA ZAMBERLAN DOS SANTOS
Projetos de Pesquisa
Unidades Organizacionais
Instituto da Criança, Hospital das Clínicas, Faculdade de Medicina
4 resultados
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- Pediatric icu and nutritional assessments(2015) FEFERBAUM, R.; ZAMBERLAN, P.The nutritional assessment of children in the pediatric intensive care unit (PICU) is unique in view of the metabolic changes of the underlying disease. The presence of inflammatory activity leads to body composition changes (lean mass reduction) and undernutrition.Nutritional assessment is one of the main aspects of the pediatric intensive care patient and is the most important tool to avoid hospital undernutrition. It must prioritize anthropometric and laboratory markers that can differentiate body composition to detect specific macronutrient and micronutrient deficiencies and assessment of the inflammatory activity.There is currently no gold standard for nutritional assessment in the PICU. The results of anthropometric and laboratory markers must be jointly analyzed but individually interpreted according to disease and metabolic changes, in order to reach a correct diagnosis of the nutritional status and to plan and monitor the nutritional treatment. © Springer Science+Business Media New York 2015.
- Bioelectrical Impedance Phase Angle and Morbidity and Mortality in Critically Ill Children(2019) ZAMBERLAN, Patricia; FEFERBAUM, Rubens; DORIA FILHO, Ulysses; CARVALHO, Werther Brunow de; DELGADO, Artur FigueiredoBackgroundNutrition markers may be useful for diagnosis and monitoring and, also, as additional indicators of estimating death risk. We tested the association of body composition indicators (mid-upper arm circumference and phase angle) with pediatric intensive care unit (PICU) length of stay and mortality in critically ill pediatric patients. MethodsData from children aged 2 months-18 years were collected, and bioelectrical impedance was performed to obtain phase angle. Severity was evaluated by scoring the Pediatric Index of Mortality. Descriptive statistics were reported for nominal variables. Receiver operating characteristic curve was used to analyze the association of phase angle with 30-day mortality and to find the best cutoff. Survival probabilities and PICU length of stay were estimated using the Kaplan-Meier method. ResultsWe evaluated 247 children with a median age of 4.8 years whose main cause of admission was sepsis. Survival curves showed higher survival in patients with phase angle >2.8 degrees compared with patients with phase angle 2.8 degrees (P<.0001). Kaplan-Meier time-to-event analysis showed that children with lower phase angle values were more likely to remain in the PICU (hazard ratio, 1.84; P=.003). Lower survival was also observed in patients who presented mid-upper arm circumference values 5th percentile (P<.03). ConclusionsMid-upper arm circumference and phase angle were associated with mortality and morbidity in critically ill children, suggesting that these parameters may be useful not only for nutrition diagnosis and monitoring, but also as an additional indicator in estimating prognosis.
- Bioelectrical impedance phase angle and morbidity and mortality in critically ill children (vol 34, pg 163, 2019)(2020) ZAMBERLAN, Patricia; FEFERBAUM, Rubens; DORIA FILHO, Ulysses; CARVALHO, Werther Brunow de; DELGADO, Artur Figueiredo
- Nutrition Therapy in a Pediatric Intensive Care Unit: Indications, Monitoring, and Complications(2011) ZAMBERLAN, Patricia; DELGADO, Artur Figueiredo; LEONE, Claudio; FEFERBAUM, Rubens; OKAY, Thelma SuelyBackground: Nutrition therapy (NT) is essential for the care of critically ill children. Inadequate feeding leads to malnutrition and may increase the patient's risk of morbidity and mortality. The aim of this study was to describe the NT used in a tertiary pediatric intensive care unit (PICU). Methods: The authors evaluated NT administered to 90 consecutive patients who were hospitalized for 7 days in the PICU of Instituto da Crianca, Hospital das Clinicas, Universidade de Sao Paulo, Brazil. NT was established according to the protocol provided by the institution's NT team. NT provided a balance of fluids and nutrients and was monitored with a weekly anthropometric nutrition assessment and an evaluation of complications. Results: NT was initiated, on average, within 72 hours of hospitalization. Most children (80%) received enteral nutrition (EN) therapy; of these, 35% were fed orally and the rest via nasogastric or postpyloric tube. There were gastrointestinal complications in patients (5%) who needed a postpyloric tube. Parenteral nutrition (PN) was used in only 10% of the cases, and the remaining 10% received mixed NT (EN + PN). The average calorie and protein intake was 82 kcal/kg and 2.7 g/kg per day. Arm circumference and triceps skinfold thickness decreased. Conclusions: The use of EN was prevalent in the tertiary PICU, and few clinical complications occurred. There was no statistically significant change in most anthropometric indicators evaluated during hospitalization, which suggests that NT probably helped patients maintain their nutrition status. (JPEN J Parenter Enteral Nutr. 2011;35:523-529)