Submitted by Setor de Tratamento da Informa??o - BC/PUCRS (tede2@pucrs.br) on 2015-08-13T19:35:39Z No. of bitstreams: 1 473454 - Texto Parcial.pdf: 755327 bytes, checksum: 9e3264a8362ab0aeb4b4514a2de60490 (MD5) / Made available in DSpace on 2015-08-13T19:35:40Z (GMT). No. of bitstreams: 1 473454 - Texto Parcial.pdf: 755327 bytes, checksum: 9e3264a8362ab0aeb4b4514a2de60490 (MD5) Previous issue date: 2015-07-02 / Objective: To compare the effectiveness of single-dose intramuscular bromopride, metoclopramide, and ondansetron for the treatment of vomiting in a pediatric emergency for the treatment of vomiting in a pediatric emergency for the treatment of vomiting in a pediatric emergency for the treatment of vomiting in a pediatric emergency for the treatment of vomiting in a pediatric emergency for the treatment of vomiting in a pediatric emergency for the treatment of vomiting in a pediatric emergency for the treatment of vomiting in a pediatric emergency for the treatment of vomiting in a pediatric emergency for the treatment of vomiting in a pediatric emergency for the treatment of vomiting in a pediatric emergency for the treatment of vomiting in a pediatric emergency for the treatment of vomiting in a pediatric emergency for the treatment of vomiting in a pediatric emergency for the treatment of vomiting in a pediatric emergency for the treatment of vomiting in a pediatric emergency for the treatment of vomiting in a pediatric emergency for the treatment of vomiting in a pediatric emergency for the treatment of vomiting in a pediatric emergency for the treatment of vomiting in a pediatric emergency for the treatment of vomiting in a pediatric emergency for the treatment of vomiting in a pediatric emergency for the treatment of vomiting in a pediatric emergency for the treatment of vomiting in a pediatric emergency for the treatment of vomiting in a pediatric emergency department setting. department setting. department setting. department setting. department setting. department setting.department setting. Methods: Randomized controlled trial of children who presented with vomiting due to gastroenteritis at the pediatric emergency department of Hospital Universit?rio de Santa Maria from August 2013 to June 2014. Children aged 1 to 12 years were randomized to receive a single intramuscular dose of bromopride or metoclopramide (up to 10 mg) or ondansetron (up to 8 mg) 0.15 mg/kg. After administration of the antiemetic drug, children remained under observation for at least 1 hour. Children who were discharged after the observation period were subsequently monitored by their parents or caregivers at home for 24 hours and contacted via telephone for assessment of the results of antiemetic therapy. The following parameters were compared across treatment groups: time to cessation of vomiting within 1, 6, and 24 hours; acceptance of oral rehydration therapy; intravenous fluid replacement; return to hospital; and adverse effects attributable to the antiemetic. All parents or caregivers were given information on the antiemetic treatment that would be provided and signed an informed consent form authorizing the child's participation in the study. Results: Of 180 children randomized, 175 completed the trial. Within 1 hour of antiemetic administration, cessation of vomiting had been achieved in 96.6% of children given bromopride, 94.8% of those given metoclopramide, and 100% of those given ondansetron (p=0.312). Six hours after administration, bromopride was found to cease vomiting in 216?114 minutes, metoclopramide in 150?168 minutes, and ondansetron in 72?54 minutes (p=0.011). Cessation of vomiting at 24 hours was achieved in 67.8% of children given bromopride, 67.2% of those given metoclopramide, and 96.6% of those given ondansetron (p=0.002). Children in the ondansetron group accepted more fluid replenishment orally (200 ml) than those given bromopride or metoclopramide (150 ml and 100 ml respectively) (p=0.034). Eleven children ultimately required intravenous fluids: five in the bromopride group and six in the metoclopramide group. Within 1 hour of antiemetic administration, only 24.1% of children in the ondansetron group reported adverse effects (somnolence, diarrhea, fatigue, restlessness, feeling hot) fatigue, restlessness, feeling hot) fatigue, restlessness, feeling hot)fatigue, restlessness, feeling hot)fatigue, restlessness, feeling hot)fatigue, restlessness, feeling hot) fatigue, restlessness, feeling hot) fatigue, restlessness, feeling hot) fatigue, restlessness, feeling hot)fatigue, restlessness, feeling hot) fatigue, restlessness, feeling hot) fatigue, restlessness, feeling hot)fatigue, restlessness, feeling hot)fatigue, restlessness, feeling hot) fatigue, restlessness, feeling hot)fatigue, restlessness, feeling hot) , whereas 42.4% and 44.8% of children in the bromopride and metoclopramide groups respectively reported somnolence (p=0.034). At 24 hours, there were no significant differences in adverse effects across the three groups (p=0.357). Conclusion: In a pediatric emergency department setting, ondansetron is superior to bromopride and metoclopramide for treatment of vomiting. Ondansetron was associated with cessation or reduction of vomiting both within 1 hour of administration and at 6 and 24 hours. Bromopride and metoclopramide were both effective, but were associated with somnolence, an adverse effect that can prolong observation time in the emergency department and thus increase hospital costs. / Objetivo: Avaliar os resultados dos antiem?ticos aplicados via intramuscular, bromoprida, metoclopramida e ondansetron em dose ?nica para o em dose ?nica para o em dose ?nica para o em dose ?nica para o em dose ?nica para o em dose ?nica para o em dose ?nica para o em dose ?nica para o em dose ?nica para o em dose ?nica para o tratamento de v?mitos em um pronto tratamento de v?mitos em um pronto tratamento de v?mitos em um pronto tratamento de v?mitos em um pronto tratamento de v?mitos em um pronto tratamento de v?mitos em um pronto tratamento de v?mitos em um pronto tratamento de v?mitos em um pronto tratamento de v?mitos em um pronto tratamento de v?mitos em um pronto tratamento de v?mitos em um pronto tratamento de v?mitos em um pronto tratamento de v?mitos em um pronto tratamento de v?mitos em um pronto socorro socorro socorro pedi?trico. pedi?trico. pedi?trico. pedi?trico. M?todos: Ensaio cl?nico randomizado e controlado, envolvendo crian?as que consultaram por v?mitos, devido ? gastroenterite, no servi?o de Emerg?ncia Pedi?trica no Hospital Universit?rio de Santa Maria, no per?odo de agosto de 2013 a junho de 2014. Foram randomizadas crian?as com idades entre 1 a 12 anos, para receber dose ?nica de bromoprida via intramuscular ou metoclopramida via intramuscular (m?ximo 10mg); ou ondansetron (m?ximo 8mg) na dose de 0,15mg/kg via intramuscular. A crian?a ap?s receber o antiem?tico permanecia em observa??o por no m?mimo 1 hora. Ap?s a reavaliac?o cl?nica as crian?as que recebiam alta eram monitorizadas pelo familiar no domic?lio durante 24 horas, e contactados por via telef?nica para avaliar o resultado do tratamento antiem?tico recebido. Os grupos foram comparados em rela??o a tempo para cessar os v?mitos dentro de 1, 6 e 24 horas; aceita??o de l?quidos orais; reidrata??o endovenosa; retorno ao hospital e efeitos colaterais relacionados aos antiem?ticos. Os familiares ap?s devidamente informados sobre o tratamento antiem?tico que a crian?a seria submetida, assinaram o Termo de Consentimento Livre e Esclarecido, permitindo a participa??o do filho no estudo. Resultados: Das 180 crian?as randomizadas, 175 completaram o estudo. Na primeira hora ap?s medicar, a bromoprida teve 96,6% de efic?cia na cessa??o dos v?mitos, a metoclopramida, 94,8% e o ondansetron 100%, (p= 0,312). Em 6 horas, ? bromoprida cessou o v?mito em 216?114 minutos, ? metoclopramida em 150?168 minutos e o ondansetron 72?54 minutos, (p=0,011). Em 24 horas, a cessa??o dos v?mitos ocorreu em 67,8% com bromoprida, 67,2% com metoclopramida e 96,6% com ondansetron (p=0,002). O grupo ondansetron aceitou melhor os l?quidos orais, 200 ml, comparado ? bromoprida, 150 ml e ? metoclopramida, 100 ml (p=0,034). Onze crian?as necessitaram de hidrata??o endovenosa: 5 no grupo bromoprida e 6 no metoclopramida. Sessenta minutos ap?s medicar, apenas 24,1% do grupo ondansetron apresentaram efeitos colaterais (sonol?ncia, diarreia, cansa?o, cansa?o, cansa?o, cansa?o, cansa?o, cansa?o, cansa?o, cansa?o, inquieta??o, sensa??o de calor) inquieta??o, sensa??o de calor)inquieta??o, sensa??o de calor) inquieta??o, sensa??o de calor)inquieta??o, sensa??o de calor) inquieta??o, sensa??o de calor)inquieta??o, sensa??o de calor)inquieta??o, sensa??o de calor) inquieta??o, sensa??o de calor)inquieta??o, sensa??o de calor)inquieta??o, sensa??o de calor) inquieta??o, sensa??o de calor)inquieta??o, sensa??o de calor)inquieta??o, sensa??o de calor)inquieta??o, sensa??o de calor)inquieta??o, sensa??o de calor)inquieta??o, sensa??o de calor) inquieta??o, sensa??o de calor) , enquanto que os grupos bromoprida e metoclopramida apresentaram associa??o com sonol?ncia, 42,4% e 44,8%, respectivamente, p=0,034. Os efeitos colaterais em 24hs n?o apresentaram diferen?a estat?stica significativa entre os tr?s grupos, p=0,357. Conclus?o: Existem benef?cios nos resultados para tratamento de v?mito em pronto socorro pedi?trico com o uso do ondansetron em rela??o ? bromoprida e ? metoclopramida. O ondansetron mostrou-se associado na cessa??o ou redu??o dos v?mitos ap?s medicar tanto na primeira hora, quanto nas pr?ximas 6 e 24 horas. A bromoprida e a metoclopramida foram consideradas eficazes, mas apresentava associa??o com sonol?ncia, efeito colateral que pode determinar um maior tempo de observa??o em sala de emerg?ncia e aumentar os custos hospitalares.

Submitted by Caroline Xavier (caroline.xavier@pucrs.br) on 2017-06-30T18:12:27Z No. of bitstreams: 1 DIS_ALINE_CARLA_HENNEMANN_PARCIAL.pdf: 366885 bytes, checksum: 6ba089ef0367b97f213ea850621ee052 (MD5) / Approved for entry into archive by Caroline Xavier (caroline.xavier@pucrs.br) on 2017-06-30T18:12:36Z (GMT) No. of bitstreams: 1 DIS_ALINE_CARLA_HENNEMANN_PARCIAL.pdf: 366885 bytes, checksum: 6ba089ef0367b97f213ea850621ee052 (MD5) / Made available in DSpace on 2017-06-30T18:12:43Z (GMT). No. of bitstreams: 1 DIS_ALINE_CARLA_HENNEMANN_PARCIAL.pdf: 366885 bytes, checksum: 6ba089ef0367b97f213ea850621ee052 (MD5) Previous issue date: 2015-08-31 / Conselho Nacional de Pesquisa e Desenvolvimento Cient?fico e Tecnol?gico - CNPq / Introduction: Breast milk is the best food for infants; however, in some situations, especially when delivery was by cesarean section, it is necessary to complement the newborn feeding in the first days of life. There are doubts whether the use of complementary formula to breast milk in the first days of life could be associated with the onset of gastrointestinal symptoms in infants. Objectives: To investigate the association of dietary supplements in the first 10 days of life for term neonates born by elective cesarean section with the mother's report about infantile colic and vomiting/regurgitation in the first three months of life and the diagnosis of cow's milk allergy and gastroesophageal reflux in the first six months of life. Methods: A cohort study included term neonates delivered by cesarean section at Moinhos de Vento Hospital, a private hospital located in Porto Alegre, Rio Grande do Sul, Brazil, from October 2011 to April 2013. Initial data were obtained from medical records and interviews with the mothers in the recovery room. Follow-up was done by telephone contact with the mothers at the end of the second week, at three months and at six months after birth. The factors under study were breastfeeding, prescription and use of food supplements, and type of prescribed formula. These variables were obtained for the first 48 hours of life, the first 10 days of life and for the first three month of life. The study outcomes were the occurrence of colic and vomiting/regurgitation reported by mothers in the first three months of life, as well as diagnosis of cow's milk allergy and gastroesophageal reflux in the first six months of life. Data were analyzed with the chi-square or Fisher's exact test using SPSS version 17.0. To control confounding factors, the Poisson multivariate regression was used. The significance level was 5% (p ? 0.05). Results: Nine hundred and sixty-four infants were studied, of whom 657 (68.1%) were exclusively breastfeeding, 215 (22.3%) had mixed feeding and 92 (9.5%) were fed only formula at the age of three months. Three hundred and seventy infants (38.4%) had frequent vomiting/regurgitation and 741 (76.9%) had colic, of which 382 (39.7%) were of medium/high intensity. The use of complementary formula in the first 10 days of life was not significantly associated with the studied outcomes. However, the type of feeding by three months of life was associated with some of these outcomes: infants not breastfed at all within the three months had fewer reports of vomiting, relative risk (RR) 0.63; confidence interval (CI) 0.45 to 0.89 95% (p = 0.009), and less colic, RR 0.65; 95% CI 0.46 to 0.94 (p = 0.022). Among these infants, a higher proportion was fed anti-regurgitation formulas. Partially breastfed babies had more maternal reports of colic, RR 1.22; 95% CI 1.03 to 1.45 (p = 0.024). At six months of life, 2.0% of the infants had diagnosis of cow's milk allergy and 3.1% had gastroesophageal reflux, outcomes that were associated with the type of feeding at three months but not at 10 days of life. Conclusions: In this population of infants born at term by cesarean section, there was no association between the use of formula supplements in the first 10 days of life, or the type of formula used in this period, and the incidence of colic and vomiting/regurgitation in the first three months of life, or the diagnosis of cow's milk allergy or gastroesophageal reflux in the first six months of life. However, the type of infant feeding at the end of the third month of life was associated with some of the study outcomes. / Introdu??o: O leite materno ? o melhor alimento para lactentes; entretanto, em algumas situa??es, principalmente quando o parto ocorre por cesariana, ? necess?rio complementar a alimenta??o do rec?m-nascido nos primeiros dias de vida. Questiona-se se o uso de f?rmulas complementares ao leite materno nos primeiros dias de vida poderiam estar associadas ao surgimento de sintomas gastrointestinais nos lactentes. Objetivos: Verificar a associa??o entre uso de complemento alimentar nos primeiros 10 dias de vida, em rec?m-nascidos a termo de parto ces?reo, com o relato materno de c?licas e v?mitos/regurgita??o nos tr?s primeiros meses de vida e no diagn?stico de alergia ao leite de vaca e de refluxo gastroesof?gico nos primeiros seis meses de vida. M?todos: Um estudo de coorte incluiu rec?m-nascidos a termo por cesariana eletiva no Hospital Moinhos de Vento, um hospital particular localizado em Porto Alegre, Rio Grande do Sul, no per?odo de outubro de 2011 a abril de 2013. Os dados iniciais foram obtidos dos prontu?rios e de entrevistas com as m?es na sala de recupera??o. O seguimento foi feito por contato telef?nico com as m?es, ao final da segunda semana, aos tr?s meses e aos seis meses ap?s o nascimento. Os fatores em estudo foram aleitamento materno, prescri??o e utiliza??o de complemento alimentar e tipo de f?rmula prescrita. Estas vari?veis foram obtidas em rela??o ?s primeiras 48 horas de vida, aos primeiros 10 dias de vida e aos primeiros tr?s meses de vida. Os desfechos em estudo foram ocorr?ncia de c?lica e v?mitos/regurgita??es relatados pelas m?es nos tr?s primeiros meses de vida, assim como diagn?stico de alergia ao leite de vaca e de refluxo gastroesof?gico nos seis primeiros meses de vida. Os dados foram analisados com os testes qui-quadrado ou exato de Fisher utilizando o aux?lio do programa SPSS vers?o 17.0. Para controle de fatores confundidores, foi utilizada a an?lise multivariada de Regress?o de Poisson. O n?vel de signific?ncia adotado foi de 5% (p?0,05). Resultados: Foram estudados 964 lactentes, sendo que 657 (68,1%) mantinham a amamenta??o exclusiva aos 3 meses, 215 (22,3%) estavam com aleitamento misto e 92 (9,5%) mamavam apenas f?rmula. Trezentos e setenta lactentes (38,4%) apresentaram v?mitos/regurgita??es frequentes e 741 (76,9%) apresentaram c?licas, sendo 382 (39,7%) de m?dia/alta intensidade. O uso de complemento nos primeiros 10 dias de vida n?o se associou significativamente com os desfechos estudados. Entretanto o tipo de alimenta??o aos tr?s meses de vida associou-se com alguns desses desfechos: os lactentes que n?o mamavam mais ao seio aos tr?s meses tinham menos relatos de v?mitos, risco relativo (RR) 0,63; intervalo de confian?a (IC)95% 0,45-0,89 (p = 0,009) e de c?licas, RR 0,65; IC95% 0,46-0,94 (p = 0,022). Entre esses lactentes, uma propor??o maior utilizava f?rmulas anti-regurgita??o. Os beb?s que mamavam parcialmente aos seio tinham mais relatos maternos de c?licas, RR 1,22; IC95% 1,03-1,45 (p = 0,024). Aos seis meses, 2,0% dos lactentes tiveram diagn?stico de alergia ao leite de vaca e 3.1% apresentavam refluxo gastroesof?gico, desfechos que foram associados ao tipo de alimenta??o aos tr?s meses mas n?o aos 10 dias de vida. Conclus?es: Nesta popula??o de lactentes nascidos a termo, por cesariana eletiva, n?o houve associa??o do uso de complemento alimentar nos primeiros 10 dias de vida, ou do tipo de f?rmula utilizada nesse per?odo, com a incid?ncia de c?lica e de v?mitos/regurgita??o nos tr?s primeiros meses de vida, e nem com o diagn?stico de alergia ao leite de vaca ou refluxo gastroesof?gico nos primeiros seis meses de vida. Entretanto, o tipo de alimenta??o do lactente ao final do terceiro m?s de vida associou-se a alguns dos desfechos estudados.