PATRICIA ZAMBERLAN DOS SANTOS
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Instituto da Criança, Hospital das Clínicas, Faculdade de Medicina
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- The Latin American and Spanish Survey on Nutrition in Pediatric Intensive Care (ELAN-CIP2)(2019) CAMPOS-MINO, Santiago; CID, Jesus Lopez-Herce; DELGADO, Artur Figueiredo; BENAVIDES, Eliana Munoz; COSS-BU, Jorge A.; VILLAVICENCIO, Pedro Mestre; IRAMAIN, Ricardo; VILLARUEL, Sayani Valdez; NIEVA, Ana; VARGAS, Ana; LOPEZ, Pilar Arias; FERNANDEZ, Analia; SILVESTRE, Andrea; BOTTA, Priscila; TORRES, Silvio Fabio; COSTA, Caroline Abud Drumond; GARCIA, Pedro Celiny Ramos; PIVA, Jefferson; CABEDO, Maria Thereza De Cordes; LUGLIO, Michele; ZAMBERLAN, Patricia; GUZMAN, Gustavo; LOBOGUERRERO, Fanny Garcia; FERNANDEZ, Mauricio; CASSALETT, Gabriel; PEREZ, German; MONTES, Miguel Ruz; VELASQUEZ, Rocio Porras; PEREZ, Victor; CASTRO, Santiago Ramirez; VILLAVICENCIO, Pedro Mestre; WEGNER, Adriana; ORDENES, Nadia; DESSAUER, Bettina Von; CORS, Carolina; GONZALES, Marcos; BENAVIDES, Eliana Munoz; QUIROZ, Miguel Angel Saavedra; PERALTA, Felipe Verscheure; ROQUE, Jorge; ROSICH, Patricia Del Rosario; CAMPOS-MINO, Santiago; MONTALVO, Erika; PESANTES, Xavier Paez; BARQUIN, Luis Augusto Moya; RIVAS, Ricardo Alfredo Mack; ROMAN, Carlos; ORTIZ, Cesar Antonio Ramos; MONSREAL, Miguel Ignacio Flores; VILLARUEL, Sayani Valdez; GONZALEZ, Sonia Vargas; JIMENEZ, Hassel Jimmy; BRACHO, Carlos; SAMUDIO, Lissa; PALPAN, Beatriz Atachagua; PALOMO, Patricia; ESCALANTE-KANASHIRO, Raffo; ARANA, Rosa; NUNEZ, Antonio Rodriguez; CID, Jesus Lopez-Herce; FERNANDEZ, Yolanda Lopez; MENCHACA, Amanda; LOPEZ, Claudia MadridObjective: To characterize the practices of nutritional support in Latin American and Spanish PICUs. Design: Survey with a questionnaire sent to Latin American Society of Pediatric Intensive Care members. Setting: PICUs of participant hospitals. Patients: Critically ill children between 1 month and 18 years old. Interventions: None. Measurements and Main Results: Forty-seven surveys from 17 countries were analyzed. Sixty-seven percent of PICUs were from university-affiliated hospitals, with a median of 380 admissions/yr. Sixty-eight percent and 48.9% had a nutritional support team and nutritional support protocol, respectively. Seventy-five percent completed nutritional evaluations, with 34.2% at admission. PICUs with high-volume admissions were likely to have a nutritional support team (p < 0.005), and university-affiliated hospitals showed a trend of having a nutritional support team (p = 0.056). Measured, estimated, and ideal weights were used in 75%, 14.6%, and 10.4%, respectively. Energy requirements were calculated using Holliday & Segar and Schofield equations in 90% of the PICUs; 43% used correction factors. Only three PICUs had indirect calorimetry. At day 3 of initiation of nutritional support, 57.3% of PICUs provided at least 50% of the calculated energy requirement, and 91.5% at day 5. Protein needs were estimated according to American Society for Parenteral and Enteral Nutrition and European Society for Clinical Nutrition and Metabolism/European Society for Paediatric Gastroenterology Hepatology and Nutrition guidelines in 55.3% and 40.4%, respectively. Enteral nutrition was the preferred feeding method, initiated in 97.7% at 48 hours. The feeding route was gastric (82.9%), by bolus (42.5%) or continuous (57.4%). Monitoring methods included gastric residual measurement in 55.3%. Enteral nutrition was discontinued in 82.8% when gastric residual was 50% of the volume. Prokinetics were used in 68%. More than half of PICUs used parenteral nutrition, with 95.8% of them within 72 hours. Parenteral nutrition was administered by central vein in 93.6%. Undernourished children received parenteral nutrition sooner, whether or not enteral nutrition intolerance was present. When enteral nutrition was not tolerated beyond 72 hours, parenteral nutrition was started in 57.4%. Parenteral nutrition was initiated when enteral nutrition delivered less than 50% in 97%. Conclusions: Nutritional practices are heterogeneous in Latin American PICUs, but the majority use nutritional support strategies consistent with international guidelines.
- Malnutrition and Nutrition Support in Latin American PICUs: The Nutrition in PICU (NutriPIC) Study(2023) CAMPOS-MINO, Santiago; FIGUEIREDO-DELGADO, Artur; ZARATE, Patricia; ZAMBERLAN, Patricia; MUNOZ-BENAVIDES, Eliana; COSS-BU, Jorge A.OBJECTIVES: To characterize the nutritional status of children admitted to Latin American (LA) PICUs and to describe the adequacy of nutrition support in reference to contemporary international recommendations. DESIGN: The Nutrition in PICU (NutriPIC) study was a combined point-prevalence study of malnutrition carried out on 1 day in 2021 (Monday 8 November) and a retrospective cohort study of adequacy of nutritional support in the week preceding. SETTING: Four-one PICUs in 13 LA countries. PATIENTS: Patients already admitted to the PICU of 1 month to 18 years old on the study day were included in the point-prevalence study. For the retrospective arm, we included patients receiving nutritional support on the study day and with a PICU length of stay (LOS) greater than or equal to 72 hours. Exclusion criteria were being a neonate, conditions that precluded accurate anthropometric measurements, and PICU LOS greater than 14 days. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Of 316 patients screened, 5 did not meet age criteria. There were 191 of 311 patients who were included in the point-prevalence study and underwent anthropometric evaluation. Underweight and length for age less than -2 z scores were present in 42 of 88 children (47.7%) and 41 of 88 children (46.6%) less than 24 months old, and 14 of 103 (13.6%) and (23/103) 22.3% of 103 children greater than or equal to 24 months, respectively. Evidence of obesity (body mass index > 2 z score) was present in 7 of 88 children (5.7%) less than 24 months old and 13 of 103 children (12.6%) greater than or equal to 24 months. In the 115 of 311 patients meeting criteria for the retrospective arm, a total of 98 patients reported complete nutritional data. The 7-day median (interquartile range) adequacy for delivered versus recommended enteral energy and protein requirement was 114% (75, 154) and 99% (60, 133), respectively. CONCLUSIONS: The NutriPIC study found that in 2021 malnutrition was highly prevalent especially in PICU admissions of less than 24 months old. Retrospectively, the 7-day median nutritional support appears to meet both energy and protein requirements.
conferenceObject MALNUTRITION AND OBESITY PREVALENCE IN CRITICALLY ILL LATIN AMERICAN CHILDREN: A PRELIMINARY REPORT OF THE NUTRIPIC STUDY(2022) MINO, S. Campos; DELGADO, A. Figueiredo; ZARATE, P.; ZAMBERLAN, P.; BENAVIDES, E. Munoz; BU, J. A. CossconferenceObject ADEQUACY OF ENERGY AND PROTEIN ADMINISTRATION DURING NUTRITIONAL SUPPORT IN LATIN AMERICAN CRITICALLY ILL CHILDREN: A PRELIMINARY REPORT OF THE NUTRIPIC STUDY(2022) MINO, S. Campos; DELGADO, A. Figueiredo; ZARATE, P.; ZAMBERLAN, P.; BENAVIDES, E. Munoz; BU, J. Coss