PATRICIA ZAMBERLAN DOS SANTOS
Projetos de Pesquisa
Unidades Organizacionais
Instituto da Criança, Hospital das Clínicas, Faculdade de Medicina
5 resultados
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Agora exibindo 1 - 5 de 5
- Body composition in pediatric patients(2023) ZAMBERLAN, Patricia; MAZZONI, Beatriz P.; BONFIM, Maria A. C.; VIEIRA, Rafaela R.; TUMAS, Rosana; DELGADO, Artur F.Undernutrition is highly prevalent in children who are critically ill and is associated with increased morbidity and mortality, including a higher risk of infection due to transitory immunological disorders, inadequate wound healing, reduced gut function, longer dependency on mechanical ventilation, and longer hospital stays compared with eutrophic children who are critically ill. Nutrition care studies have proposed that early interventions targeting nutrition assessment can prevent or minimize the complications of undernutrition. Stress promotes an acute inflammatory response mediated by cytokines, resulting in increased basal metabolism and nitrogen excretion and leading to muscle loss and changes in body composition. Therefore, the inclusion of body composition assessment is important in the evaluation of these patients because, in addition to the nutrition aspect, body composition seems to predict clinical prognosis. Several techniques can be used to assess body composition, such as arm measurements, calf circumference, grip strength, bioelectrical impedance analysis, and imaging examinations, including computed tomography and dual-energy x-ray absorptiometry. This review of available evidence suggests that arm measurements seem to be well-established in assessing body composition in children who are critically ill, and that bioelectrical impedance analysis with phase angle, handgrip strength, calf circumference and ultrasound seem to be promising in this evaluation. However, further robust studies based on scientific evidence are necessary.
- 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.
- 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
- Response to ""Comment on 'Bioelectrical Impedance Phase Angle and Morbidity and Mortality in Critically Ill Children'""(2019) ZAMBERLAN, Patricia; CARVALHO, Werther Brunow de; DELGADO, Artur Figueiredo