Segurança alimentar e qualidade em terapia nutricional de recém-nascidos pré-termo em UTI Neonatal

The increasing prevalence of preterm infants’ birth and survival has challenged intensive care practitioners to develop and improve strategies to ensure the quality of nutritional therapy services and the nutritional security of these children. This study aimed to analyze which quality indicators of nutritional therapy can be implemented in a neonatal intensive care unit in order to monitor the service and prevent unwanted outcomes. A total of 81 preterm infants were divided into two groups according to their birth weight: Group 1, less than 1.500 grams and group 2, born with a weight equal to or greater than 1.500 grams. The quality indicators initially selected to be studied were: time to start nutritional therapy, time to meet energy needs, energy and protein adequacy, cumulative energy deficit, adequacy of nutritional formula, fasting periods, daily gastric residue and parenteral nutritional catheter infection. These indicators were correlated with the weight gain, the occurrence of necrotizing enterocolitis, mortality and the time of hospitalization of the unit. Statistical analysis was performed using the Skewness test (-1 to +1) and the Shapiro-Wilk test (> 0.05) and normality graphs. The parametric variables were compared between the groups by the T test and the non-parametric ones by the Mann Whitney test. Pearson's correlation tests were used when the distribution was normal and Spearman's correlation tests were used. The association of the categorized variables was evaluated by Fischer's exact test and the Odds Ratio was then calculated. It was observed significant differences between nutritional therapy and consequently nutritional status between groups 1 and 2 and the sensitivity of the indicators: time to onset of nutritional therapy, energy and protein adequacy, cumulative energy deficit, prolonged fasting, adequacy of the gastric residue and infection of the parenteral nutrition catheter with the outcomes of interest. We concluded by the recommendation of the immediate implantation of these indicators into the service in order to opportune the improvement of nutritional therapy quality and to reduce the prevalence of the unwanted outcomes, as well as the subsequent implantation of the other indicators that, although not related to the outcomes, still being important markers of nutritional safety of patients.A prevalência crescente do nascimento e da sobrevida de recém-nascidos prematuros tem desafiado os profissionais da área dos cuidados intensivos a desenvolverem e aperfeiçoarem estratégias que garantam a qualidade do serviço de terapia nutricional e a segurança alimentar e nutricional destas crianças. Este trabalho teve por objetivo analisar quais indicadores de qualidade em terapia nutricional podem ser implementados em uma unidade de terapia intensiva neonatal a fim de monitorar o serviço e prevenir desfechos indesejados. Para tanto, foram acompanhados 81 recémnascidos prematuros, divididos em dois grupos de acordo com o peso ao nascimento: Grupo 1- nascidos com peso inferior a 1.500 gramas e grupo 2- nascidos com peso igual ou superior a 1.500 gramas. Os indicadores de qualidade selecionados inicialmente para serem estudados foram: tempo para início da terapia nutricional, tempo para atingir as necessidades energéticas, adequação energética e proteica, déficit energético cumulativo, adequação da fórmula nutricional, períodos de jejum, resíduo gástrico diário e infecção no catéter utilizado para nutrição parenteral. Estes indicadores foram relacionados com o ganho de peso, a ocorrência de enterocolite necrosante, mortalidade e o tempo de internação da unidade. Para análise estatística considerou-se a normalidade dos dados pelo teste de Skewness (-1 a +1) e de Shapiro- Wilk (>0,05) e os gráficos de normalidade. As variáveis paramétricas foram confrontadas entre os grupos pelo teste T e as não paramétricas pelo teste de Mann Whitney. Foram utilizados os testes de correlação de Pearson quando a distribuição era normal e o de Spearman quando não. A associação das variáveis categorizadas foi avaliada pelo teste exato de Fischer e posteriormente calculouse a razão de chances (Odds Ratio). Observou-se como resultado diferenças significativas entre a terapia nutricional e consequentemente de estado nutricional entre os grupos 1 e 2; sensibilidade dos indicadores tempo para início da terapia nutricional, adequação energética e proteica, déficit energético cumulativo, jejum prolongado, adequação do resíduo gástrico e infecção do cateter da nutrição parenteral com os desfechos de interesse. Concluiu-se pela recomendação da implantação imediata destes no serviço a fim de oportunizar a melhoria da qualidade da terapia nutricional e diminuir a prevalência dos desfechos indesejados, bem como pela implantação posterior dos demais indicadores que, apesar de não terem se relacionado aos desfechos são importantes sinalizadores e marcadores de segurança alimentar dos pacientes

Indicadores de calidad en terapia nutricional en una unidad de terapia intensiva neonatal de Palmas

Os recém-nascidos internados em uma Unidade de Terapia Intensiva Neonatal (UTIN) são pacientes em risco nutricional e necessitam de acompanhamento intensivo. O serviço de terapia nutricional é responsável por manter/recuperar o estado nutricional daqueles que não respondem à conduta padrão. Este trabalho teve por objetivo implantar a monitorização de Indicadores de Qualidade em Terapia Nutricional, de interesse na UTIN, do Hospital e Maternidade Dona Regina, em Palmas, no Tocantins. Para tanto, foram acompanhados 12 recém-nascidos prematuros durante  o período de internação que variou de 5 a 40 dias. Os indicadores de qualidade monitorados foram: tempo para início da terapia nutricional, adequação energética e proteica, volume infundido, déficit energético, períodos de jejum, adequação do resíduo gástrico e infecção no cateter utilizado para nutrição parenteral. Foram observadas conformidades similares para os indicadores: adequação energético/proteica, volume infundido/prescrito, déficit energético e períodos de jejum prolongado. Os indicadores de resíduo gástrico e infecção por cateter central de infusão periférica não estão sendo monitorados diariamente na unidade em questão, o que os tornam não conformes. Destaca-se a necessidade de se padronizar a assistência, por meio da elaboração de protocolos e rotinas técnicas na unidade, e do treinamento periódico da equipe, com foco nas rotinas operacionais padronizas e supervisão do desempenho do profissional na sua execução.Newborns admitted to a neonatal intensive care unit (NICU) are patients at nutritional risk and require intensive follow-up. The nutritional therapy service is responsible for maintaining / recovering the nutritional status of those who do not respond to standard behavior. This study aimed to implement the monitoring of nutritional therapy quality indicators of interest in the Hospital and Maternity Dona Regina`s NICU, in Palmas, Tocantins. Twelve preterm infants were followed in the interval of hospitalization from 5 to 40 days. The quality indicators monitored were: time to start nutritional therapy, energy and protein adequacy, volume infused, energy deficit, fasting periods, adequacy of gastric residue, infection in the catheter used for parenteral nutrition. As a result, similar conformities were observed for the indicators of: energy / protein adequacy, infused / prescribed volume, energy deficit and periods of prolonged fasting. The indicators of gastric residual and infection by peripheric infusion central catheter are not being monitored daily in the unit in question. The need to standardize the assistance, through the elaboration of protocols and technical routines in the unit and the periodic training of the team, focusing on the standard operational routines and supervision of the professional performance in its execution.Los recién nacidos hospitalizados em Unidad de Terapia Intensiva Neonatal (UTIN) son pacientes con riesgo nutricional y necesitan un seguimiento intensivo. El servicio de terapia nutricional es responsable del mantenimiento/ recuperación del estado nutricional de aquellos que no responden al comportamiento estándar. El objetivo de este trabajo fue implementar el monitoreo de Indicadores de Calidad en Nutrición de Terapia (ICNT) de interés en la UTIN del Hospital y Maternidad de Doña Regina, en Palmas, Tocantins. Para ello, 12 recién nacidos prematuros fueron acompañados, en el intervalo de hospitalización y seguimiento de por lo menos 5 días y en un máximo de 40 días. Los indicadores de calidad monitoreados fueron: tiempo para el inicio de la terapia nutricional, adecuación de energía y proteína, volumen infundido, déficit de energía, períodos de ayuno, adecuación de residuos gástricos, infección en el catéter usado para parenteral nutrición. Se observó, como resultado, conformidades similares para los indicadores de: adecuación de energía / proteína, volumen infundido / prescrito, déficit de energía y períodos prolongados de ayuno. Los indicadores de residuos gástricos e infecciones por catéter central de infusión periférica no están siendo monitoreados diariamente en la unidad en cuestión. Es necesario estandarizar la asistencia, a través del desarrollo de protocolos y rutinas técnicas en la unidad y entrenamiento periódico del equipo, con foco en rutinas operacionales estandarizadas y supervisión del desempeño del profesional en su ejecución

Protein-energy adequacy and nutritional evolution of preterm infants in neonatal intensive care unit

<div><p>ABSTRACT Objective To evaluate the prescription of protein-calorie nutrition and its adequacy to the requirements of preterm newborns. Methods Prospective study with 30 preterm infants from a neonate intensive unit care. Anthropometric and nutritional therapy data were collected daily. Nutritional demands were defined according to the national guidelines. Protein-calorie nutritional support was considered adequate when it reached 70% of the calculated demand. The evolution of nutritional status was evaluated according to the growth curves of preterm infants. Statistical analyses were performed with the Statistical Package for Social Sciences 20.0, at a 5% significance level. Results The means of demand, prescription and infusion significantly differed from each other. The values of calories and proteins prescribed and infused were inadequate according to the calculated ones. There was no significant difference between the volume of prescribed and administered nutrition (p>0.05). At birth, 30% of the children were small, 66.7% were adequate, and 3.3% were large for gestational age. At discharge, the percentages were 33.3%; 63.3%; 3.3%, respectively. The values at birth significantly differed from those at discharge (p<0.01). Conclusion In the Unit of Neonatal Care studied, inadequate nutrient prescription and support is a factor that can compromise the nutritional status of the newborns at hospital discharge.</p></div

Implementation of a Brazilian Cardioprotective Nutritional (BALANCE) Program for improvement on quality of diet and secondary prevention of cardiovascular events: A randomized, multicenter trial

Background: Appropriate dietary recommendations represent a key part of secondary prevention in cardiovascular disease (CVD). We evaluated the effectiveness of the implementation of a nutritional program on quality of diet, cardiovascular events, and death in patients with established CVD. Methods: In this open-label, multicenter trial conducted in 35 sites in Brazil, we randomly assigned (1:1) patients aged 45 years or older to receive either the BALANCE Program (experimental group) or conventional nutrition advice (control group). The BALANCE Program included a unique nutritional education strategy to implement recommendations from guidelines, adapted to the use of affordable and regional foods. Adherence to diet was evaluated by the modified Alternative Healthy Eating Index. The primary end point was a composite of all-cause mortality, cardiovascular death, cardiac arrest, myocardial infarction, stroke, myocardial revascularization, amputation, or hospitalization for unstable angina. Secondary end points included biochemical and anthropometric data, and blood pressure levels. Results: From March 5, 2013, to Abril 7, 2015, a total of 2534 eligible patients were randomly assigned to either the BALANCE Program group (n = 1,266) or the control group (n = 1,268) and were followed up for a median of 3.5 years. In total, 235 (9.3%) participants had been lost to follow-up. After 3 years of follow-up, mean modified Alternative Healthy Eating Index (scale 0-70) was only slightly higher in the BALANCE group versus the control group (26.2 ± 8.4 vs 24.7 ± 8.6, P <.01), mainly due to a 0.5-serving/d greater intake of fruits and of vegetables in the BALANCE group. Primary end point events occurred in 236 participants (18.8%) in the BALANCE group and in 207 participants (16.4%) in the control group (hazard ratio, 1.15; 95% CI 0.95-1.38; P =.15). Secondary end points did not differ between groups after follow-up. Conclusions: The BALANCE Program only slightly improved adherence to a healthy diet in patients with established CVD and had no significant effect on the incidence of cardiovascular events or death. © 2019 The Author