Made available in DSpace on 2015-04-14T13:33:07Z (GMT). No. of bitstreams: 1 451397.pdf: 387615 bytes, checksum: 9ab7f900fdf963b0dd282f824f916d6a (MD5) Previous issue date: 2013-08-20 / Introduction: pain is a fairly recent topic in the field of neonatology, because until recently it was believed that the newborn was not able to feel pain. With the research progress we could not only to know that neonates feel pain, but also the important consequences arising from that. The aim of this study was to investigate how pain is assessed and treated in neonatal intensive care units in the city of Porto Alegre (RS). Methods: it is a descriptive study, done in the neonatal intensive care units of Porto Alegre (RS), from September/2012 to December/2012. The study was conducted in two phases: in the first, a structured interview was answered by the nurse coordinator of the neonatal intensive care unit to know if the neonatal pain is evaluated/treated and, if so, how the pain is managed; in a second moment observations were performed in loco to evaluate pain management to complement the data obtained through the interview. The observed procedures were venipuncture, gastric tube insertion, endotracheal tube aspiration, oral and nasal aspiration, heel stick and administration of medication subcutaneous/intramuscular. Results: were included in the study 9 of 10 neonatal intensive care units situated in the city of Porto Alegre (RS). Regarding the assessment of pain, 7 of 9 hospitals included in the study have established pain as the 5th vital sign, but only three have written protocol for evaluation of pain. The pain scale used by majority was the NIPS and the professionals who routinely perform pain assessment are the technical of nursing and/or nurse. Regarding pain management, of 269 procedures observed, only 31% was done with some form of analgesia. Conclusion: pain is undertreated during the procedures routinely performed by nursing staff of neonatal intensive care units of Porto Alegre. / Introdu??o: a dor ? um tema bastante recente na ?rea de neonatologia, pois at? bem pouco tempo acreditava-se que o rec?m-nascido n?o era capaz de sentir dor. Com o avan?o das pesquisas conseguiu-se n?o apenas saber que o neonato sente dor, como tamb?m, conhecer consequ?ncias importantes decorrentes desta. O objetivo do presente estudo foi verificar como a dor ? avaliada e tratada nas unidades de tratamento intensivo neonatais da cidade de Porto Alegre (RS). M?todos: trata-se de um estudo descritivo, realizado nas unidades de tratamento intensivo neonatais localizadas em Porto Alegre (RS), no per?odo de Setembro/2012 a Dezembro/2012. O estudo foi realizado em duas fases: na primeira, foi realizada uma entrevista estruturada junto ? enfermeira coordenadora da unidade de tratamento intensivo neonatal para saber se a dor neonatal ? avaliada/tratada e, em caso positivo, como a dor ? manejada; em um segundo momento foram realizadas observa??es in loco do manejo da dor para complementa??o dos dados obtidos atrav?s da entrevista. Os procedimentos observados foram pun??o venosa, passagem de sonda g?strica, aspira??o de tubo endotraqueal, aspira??o de vias a?reas, pun??o de calc?neo e administra??o de medica??o subcut?nea/intramuscular. Resultados: foram inclu?das no estudo 9 das 10 unidades de tratamento intensivo neonatais localizadas na cidade de Porto Alegre. Em rela??o a avalia??o da dor, 7 dos 9 hospitais inclu?dos no estudo tem institu?do a dor como o 5? sinal vital, por?m apenas 3 possuem protocolo escrito para avalia??o da dor. A escala de dor utilizada pela maioria foi a escala NIPS e os profissionais que realizam rotineiramente a avalia??o da dor s?o os t?cnicos de enfermagem e/ou enfermeira. Em rela??o ao manejo da dor, no total dos 269 procedimentos observados, apenas 31% foi realizado com algum tipo de medida analg?sica. Conclus?o: os procedimentos realizados rotineiramente pela equipe de enfermagem s?o subtratados em rela??o ? dor nas unidades de tratamento intensivo neonatais de Porto Alegre.

Made available in DSpace on 2015-04-14T13:33:08Z (GMT). No. of bitstreams: 1 451920.pdf: 503995 bytes, checksum: 18877f49594a02c1abdbc2ab1583ecfb (MD5) Previous issue date: 2013-08-30 / Objective : to evaluate the effects of positive fluid balance in infants under one year with bronchiolitis undergoing mechanical ventilation. Methodos : retrospective cohort study based on analysis of medical records of infants under one year admitted from April 2008 to September 2011 with bronchiolitis requiring mechanical ventilation in a tertiary Pediatric Intensive Care Unit (PICU) in southern of Brazil. We excluded patients with chronic lung disease, tracheostomy and previous use of mechanical ventilation due to acute pulmonary disease. We calculated the cumulative fluid balance within the first 3 days of the onset of mechanical ventilation. The outcomes assessed were ventilator-free days, length of stay in PICU, ventilator parameters used on the third day. Results : eighty-one patients were included in the study, 49 males (60.5%). The mean cumulative fluid balance on the third day of mechanical ventilation was 139 ? 68 ml/kg, the ventilator-free days was 19.7 ? 5.7 and the length of stay in PICU was 10.4 ? 5 6 days. In multivariate analysis, increasing cumulative fluid balance on the third day of mechanical ventilation was associated with a lower number of ventilatorfree days (&#946; -.03; 95% CI -.05, -.01; p <.001). The increasing cumulative fluid balance on the third day was also associated with higher PEEP and higher FiO2 used on the same day (&#946; .01; 95% CI.006, .019; p <.001 and &#946; .09; 95% CI .053, .136; p <.001 respectively). There was no relationship between cumulative fluid balance and length of stay in PICU (p = .950). Conclusion : cumulative fluid balance on the third day of mechanical ventilation is an independent risk factor for a lower number of ventilator-free days in infants under one year with bronchiolitis. There is also an association between higher cumulative fluid balance on the third day of mechanical ventilation and higher PEEP and higher FiO2 on the same day. / Objetivo : avaliar os efeitos do balan?o h?drico positivo em lactentes menores de um ano com bronquiolite viral aguda submetidos ? ventila??o mec?nica. Material e m?todo : estudo de coorte retrospectivo baseado na an?lise de prontu?rios de lactentes menores de um ano admitidos no per?odo de abril de 2008 a setembro de 2011 por bronquiolite viral aguda e submetidos ? ventila??o mec?nica em uma Unidade de Terapia Intensiva Pedi?trica (UTIP) terci?ria no sul do Brasil. Foram exclu?dos os pacientes com doen?a pulmonar cr?nica, traqueostomizados e com uso pr?vio de ventila??o mec?nica devido ? doen?a pulmonar aguda. Foi calculado o balan?o h?drico cumulativo nos primeiros 3 dias do in?cio da ventila??o mec?nica. Os desfechos avaliados foram: dias livres de ventila??o mec?nica, tempo de interna??o na UTIP e par?metros de ventila??o mec?nica utilizados no terceiro dia. Resultados : oitenta e um pacientes foram inclu?dos no estudo, sendo 49 meninos (60,5%). A m?dia do balan?o h?drico cumulativo no terceiro dia de ventila??o mec?nica foi de 139 ? 68 ml/kg, de dias livres de ventila??o mec?nica foi 19,7 ? 5,7 e do tempo de interna??o na UTIP foi 10,4 ? 5,6 dias. Na an?lise multivari?vel, um maior balan?o h?drico cumulativo no terceiro dia de ventila??o mec?nica apresentou associa??o com um menor n?mero de dias livres de ventila??o mec?nica (&#946; -0,03; IC 95% -0,05 a -0,01; p <0,001). O balan?o h?drico cumulativo no terceiro dia tamb?m apresentou associa??o com a utiliza??o de maior PEEP e FiO2 neste mesmo dia (&#946; 0,01; IC 95% 0,006 a 0,019; p <0,001 e &#946; 0,09; IC 95% 0,053 a 0,136; p <0,001 respectivamente). N?o houve rela??o entre balan?o h?drico cumulativo e tempo de interna??o na UTIP (p=0,950). Conclus?o : o balan?o h?drico cumulativo no terceiro dia de ventila??o mec?nica constitui fator de risco independente para um menor n?mero de dias livres de ventila??o mec?nica em lactentes menores do um ano com bronquiolite viral aguda. Existe, tamb?m, associa??o entre um maior balan?o h?drico cumulativo no terceiro dia de ventila??o mec?nica e a utiliza??o de maior PEEP e maior FiO2 neste mesmo dia.

Made available in DSpace on 2015-04-14T13:33:08Z (GMT). No. of bitstreams: 1 451963.pdf: 1054634 bytes, checksum: 22a1a79881824872b314b26c9cf9ec20 (MD5) Previous issue date: 2013-03-04 / Introduction: Asthma is a disease with predominant presence of CD4 Th2 cells that affects children. The disease main characteristics is inflammation and airway hyperreactivity. Asthma has two main phenotypes depending on the presence of atopy. It was not yet fully described in asthmatic children of school age the presence of different profiles of Th1, Th2, Th17 and Treg cells in peripheral blood, which may be related to the pathogenesis of the disease. Aims: To analyze the phenotypic of CD4 T cells in asthmatics children in Porto Alegre/RS. Methods: This was a croos-sectional study when it was recruited children between 9 to 15 years old, asthmatics and controls. The PBMCs were isolated using Ficoll and the cells were cultured with anti-CD3/CD28antibodies, Derp1 or left unstimulated. After 24hs the cells were stained with antibodies specifics for transcription factors in order to analyze Th1, Th2, Treg and Th17 cells by flow cytometry and the supernatant was collected for cytokine analysis by CBA assay. Plasma was used to perform analysis of specific IgE. Results: It was analyzed 104 patients, 12 controls and 92 asthmatics. Atopic asthmatic patients presented higher frequency of Th2 cells compared with non-atopic and atopic controls. When we analyzed cells expressing more than one transcription factor it was observed that atopic asthmatics patients have a higher frequency of CD4+GATA3+FOXP3+, CD4+ROR&#947;T+GATA3+ and CD4+GATA3+Tbet+ compared with non-atopic patients and controls atopic. Analyzing the asthma severity it was seen a higher frequency of CD4+ROR&#947;T+GATA3+ in patients with moderate asthma compared with patients with mild asthma. Stimulating the cells from atopic asthma patients with anti-CD3 and anti-CD28 induced more Th1 profile while stimulating with DerP1 protein changed the profile of the cells mainly to Th17 and Treg cells. Conclusion: This is the first study in children that analyzes Th1, Th2, Treg and Th17 cells using the tag transcription factor by flow cytometry in asthmatic or atopic and non-atopic controls. We found a Th2 profile in atopic asthmatic children according to the literature. Interestingly non-atopic children showed no predominant profile. Children with moderate asthma have a profile that expresses both the transcription factor GATA3 and ROR&#947;T. Depending on the stimulus used it was induced different phenotypes in the cells of this group of patients with asthma. / Introdu??o: A asma ? uma doen?a com predomin?ncia da presen?a das c?lulas T CD4 do tipo Th2, que afeta das crian?as e tem como principais caracter?sticas a inflama??o e hiperreatividade das vias a?reas. A asma apresenta dois fen?tipos principais dependendo da presen?a de atopia. Ainda n?o foi totalmente descrito em crian?as asm?ticas com idade escolar a presen?a dos diferentes perfis de c?lulas Th1, Th2, Th17 e Treg no sangue perif?rico, que podem estar relacionados com a patog?nese da doen?a. Objetivo: Avaliar o perfil fenot?pico de c?lulas T CD4 em pacientes asm?ticos escolares do munic?pio de Porto Alegre/RS. M?todos: Este foi um estudo transversal realizado com o recrutamento de crian?as com 09 a 15 anos de idade, asm?ticas e controles. O sangue perif?rico foi coletado e as c?lulas mononucleares foram separadas utilizando Ficoll e colocadas em cultura com anticorpos anti-CD3/CD28. Ap?s 24hs as c?lulas foram marcadas com anticorpos espec?ficos para fatores de transcri??o para an?lise do perfil Th1, Th2, Th17 e Treg por citometria de fluxo e o sobrenadante foi recolhido para analise de citocinas por CBA. No plasma foi realizada a an?lise de IgE espec?ficas. Resultados: Foram analisados 104 pacientes, sendo 12 controles e 92 asm?ticos. Os pacientes asm?ticos at?picos apresentaram um perfil Th2 mais acentuado, comparado com os n?o-at?picos e controles at?picos. Quando analisamos as c?lulas que expressam mais de um fator de transcri??o foi observado que os pacientes asm?ticos at?picos apresentam maior frequ?ncia de c?lulas T CD4 positivas GATA3+FOXP3+, ROR&#947;T+GATA3+, GATA3+Tbet+ comparada com pacientes n?o-at?picos e controles at?picos. Analisando a severidade foi observado uma frequencia maior de c?lulas T CD4+ ROR&#947;T+ GATA3+ em pacientes com asma moderada comparado com pacientes com asma leve. O est?mulo com anti-CD3 e anti-CD28 nas c?lulas dos pacientes asm?ticos at?picos induziu mais um perfil Th1 enquanto que est?mulo com DerP1 mudou o perfil de algumas c?lulas principalmente de c?lulas Tregs e Th17. Conclus?o: Este ? o primeiro estudo em crian?as que analisa o perfil Th1, Th2, Th17 e Treg utilizando a marca??o de fatores de transcri??o por citometria de fluxo em crian?as asm?ticas at?picas ou n?o-at?picas e controles. Encontramos um perfil mais Th2 em crian?as asm?ticas at?picas de acordo com a literatura. Interessantemente as crian?as n?o-at?picas n?o apresentaram nenhum perfil predominante. As crian?as com asma moderadas apresentam um perfil que expressa ao mesmo tempo o fator de transcri??o RORgT e GATA3. Dependendo do estimulo s?o induzidas diferentes fen?tipos nas c?lulas deste grupo de pacientes com asma.

Made available in DSpace on 2015-04-14T13:33:09Z (GMT). No. of bitstreams: 1 459023.pdf: 766453 bytes, checksum: df09225ab12d18f640f368a0a5436a50 (MD5) Previous issue date: 2014-03-31 / Introduction : Cystic Fibrosis (CF) is a disease of autosomal recessive character, chronic and progressive, with involvement in various organs and systems. Respiratory and gastrointestinal disorders are more prevalent, which usually results in nutritional deficit. However, when there is a worsening of the clinical condition, requiring hospitalization, the risk of nutritional inbalance increases. The aim of this study was to evaluate variation in weight and body composition during hospitalization of children and adolescents with cystic fibrosis who received hypercaloric and hyperlipidic diet during hospitalization. Methods : This is a longitudinal study involving children and adolescents with CF hospitalized at S?o Lucas's Hospital/ PUCRS. Bioimpedance analysis was used to assess body composition. The evaluation took place within 48 hours after admission and 24 hours prior to hospital discharge. The energy and nutrient intake was investigated through a food record during three consecutive days. Comparisons between weight and body composition during hospitalization were performed through the corresponding statistical tests (t test and the Mann - Whitney test). Differences were considered significant at p < 0.05. Results : The sample consisted of 13 patients, 8 (62 %) male. The mean age was 10.8 ? 3.61 years. The mean hospital stay was 14.5 ? 3.75 days. At the beginning of hospitalization, most patients were eutrophic (n = 9). Regarding categorization by pulmonary function, patients had moderate pulmonary disease according to FEV1 (52.08 ? 22.2). Patients received hypercaloric and hyperlipidic diet during hospitalization , and the findings showed significant changes in the variables, weight and fat mass (weight = 1.47 kg and fat mass 1.06 kg , p < 0.0001). Conclusion : The hypercaloric and hyperlipidic diet recommended during hospitalization was associated with significant weight gain and fat mass, with improvement of the nutritional status of most patients. / Introdu??o : A Fibrose C?stica (FC) ? uma doen?a gen?tica de car?ter autoss?mico recessivo, cr?nica e progressiva, com acometimento em diversos ?rg?os e sistemas. As altera??es respirat?rias e gastrointestinais s?o mais prevalentes, o que resulta geralmente em um comprometimento nutricional. Todavia, quando existe uma piora do estado cl?nico com necessidade de interna??o hospitalar, o risco ou fal?ncia nutricional aumenta. O objetivo deste estudo foi avaliar a varia??o de peso e da composi??o corporal durante a interna??o hospitalar de crian?as e adolescentes portadores de Fibrose C?stica que receberam dieta hipercal?rica e hiperlip?dica durante a interna??o hospitalar. M?todos : Estudo longitudinal, envolvendo crian?as e adolescentes com Fibrose C?stica internados no Hospital S?o Lucas/PUCRS. A an?lise de bioimped?ncia foi utilizada para avalia??o da composi??o corporal. A avalia??o ocorreu em at? 48 horas ap?s a interna??o e 24 horas antes da alta hospitalar. A ingest?o energ?tica e de nutrientes foi investigada por meio do registro alimentar de tr?s dias consecutivos. As compara??es entre o peso e a composi??o corporal durante a interna??o foram realizadas mediante os testes estat?sticos correspondentes (teste t e teste de Mann-Whitney). As diferen?as foram consideradas significativas com p < 0,05. Resultados : A amostra estudada constituiu-se de 13 pacientes, sendo 8 (62%) do sexo masculino. A m?dia de idade foi de 10,8? 3,61 anos. O tempo m?dio de interna??o foi 14,5?3,75 dias. No in?cio da interna??o, a maioria dos pacientes encontravam-se eutr?ficos (n=9). Quanto ? categoriza??o pela fun??o pulmonar, os pacientes apresentaram doen?a pulmonar moderada conforme os valores de VEF1 (52,08?22,2). Os pacientes receberam dieta hipercal?rica e hiperlip?dica durante a interna??o, e os achados demonstraram altera??o significativa nas m?dias das vari?veis, peso e massa gorda (peso= 1,47 kg e massa gorda 1,06 kg; p<0,0001). Conclus?o : A dieta hipercal?rica e hiperlip?dica preconizada durante a interna??o esteve associada a um ganho significativo de peso e de massa gorda, com melhoria do estado nutricional de grande parte dos pacientes.

Made available in DSpace on 2015-04-14T13:33:09Z (GMT). No. of bitstreams: 1 459167.pdf: 601334 bytes, checksum: 717c74d4f578d29024efee12660fc997 (MD5) Previous issue date: 2014-03-31 / Background: Term neonates delivered by elective cesarean section who developed Transient Tachypnea of the Newborn have shown a low number of stable microbubbles on gastric fluid. The oral fluid has not been previously used to evaluate the pulmonary maturity after birth. Objective: To evaluate the Stable Microbubble Test in oral and gastric fluids for predicting of Transient Tachypnea of the Newborn. Methods: Patients with gestational age &#8805; 37 who were born by elective cesarean section were in the delivery room, oral fluid obtained immediately after birth and gastric fluid up to one hour of life. The samples were frozen to be analyzed blindly by two observers according to the method described by Pattle. Results: In total, 544 neonates were included in the study. Of these, 22 developed respiratory distress requiring hospitalization in the Neonatal Intensive Care Unit (NICU). Twenty four patients had mild transient respiratory symptoms and were not admitted to the NICU. Patients who were admitted to the neonatal intensive care unit, in oral fluid had a median, minimum and maximun of 67.5 (18-150) microbubbles/mm2 and 498 newborns without respiratory distress had a score of 350 (5-10000) microbubbles/mm2 - p < 0.001. In gastric fluid, the neonates had a score of 150 (24-1200) microbubbles/mm2 and neonates without respiratory distress were 600 (6-7000) microbubbles/mm2 - p< 0.05. The 24 patients with mild respiratory symptoms and not admitted to the NICU had a count of oral microbubbles, minimum and maximun of 137.5 (20-3750) microbubbles/mm2 in gastric fluid and 725 (20-4000) microbubbles/mm2. Considering only the 22 patients admitted and a cutoff point of 200 microbubbles/mm2, oral fluid showed a sensitivity of 81.8% and specificity of 76.9 % for the diagnosis of Transient Tachypnea of the Newborn. For the gastric fluid, with a cutoff point of 250 microbubbles/mm2, sensitivity was 68.2 % and specificity of 76.7 %. Conclusion: The results suggest that Transient Tachypnea of the Newborn is associated with alterations of the surfactant system. The oral fluid is an alternative method to the use of the amniotic fluid and gastric fluid for assessing fetal lung maturity after birth / Introdu??o: Os rec?m-nascidos submetidos ? cesariana eletiva que desenvolvem Taquipn?ia Transit?ria do Rec?m-nascido tem apresentado uma baixa contagem de microbolhas est?veis no fluido g?strico. O fluido oral n?o foi usado anteriormente para avaliar a maturidade pulmonar ap?s o nascimento. Objetivo: Avaliar o Teste das Microbolhas Est?veis nos fluidos oral e g?strico ao nascimento para a predi??o da Taquipn?ia Transit?ria do Rec?m-nascido. M?todos: Pacientes com idade gestacional &#8805;37 semanas, nascidos por cesariana eletiva, tiveram na sala de parto o fluido oral obtido imediatamente ap?s o nascimento e o fluido g?strico com at? uma hora de vida. As amostras foram congeladas para serem analisadas, cegamente, por dois observadores, conforme o m?todo descrito por Pattle. Resultados: No total, 544 neonatos foram inclu?dos no estudo. Destes, 22 desenvolveram dificuldade respirat?ria, necessitando de interna??o na Unidade de Terapia Intensiva Neonatal. Vinte e quatro pacientes apresentaram sintomas respirat?rios transit?rios leves e n?o foram admitidos na Unidade de Terapia Intensiva Neonatal. Os pacientes que foram admitidos na unidade neonatal tiveram no fluido oral uma contagem mediana, m?nimo e m?ximo de 67,5 (18-150) microbolhas/mm2 e os 498 neonatos sem dificuldade respirat?ria tiveram uma contagem de 350 (5-10000) microbolhas/mm2 p<0,001. No fluido g?strico, os neonatos internados tiveram uma contagem de 150 (24-1200) microbolhas/mm2 e os neonatos sem dificuldade respirat?ria tiveram 600 (6-7000) microbolhas/mm2 p<0,05. Os 24 pacientes com sintomas respirat?rios leves e n?o internados na Unidade de Terapia Intensiva Neonatal tiveram uma contagem de microbolhas oral, m?nimo e m?ximo de 137,5 (20-3750) microbolhas/mm2 e no fluido g?strico 725 (20-4000) microbolhas/mm2. Considerando somente os 22 pacientes admitidos e com um ponto de corte de 200 microbolhas/mm2, o fluido oral mostrou uma sensibilidade de 81,8% e especificidade de 76,9% para o diagn?stico de Taquipn?ia Transit?ria do Rec?m-nascido. Para o fluido g?strico, com um ponto de corte de 250 microbolhas/mm2, a sensibilidade foi de 68,2% e a especificidade de 76,7%. Conclus?o: Os resultados sugerem que a Taquipn?ia Transit?ria do Rec?m-nascido est? associada a altera??es do sistema surfactante. O fluido oral ? uma alternativa ? utiliza??o do fluido g?strico para avaliar a maturidade pulmonar ap?s o nascimento.

Made available in DSpace on 2015-04-14T13:33:10Z (GMT). No. of bitstreams: 1 462948.pdf: 3573892 bytes, checksum: a0cdf6bf58f8ea4366b46e3326db4515 (MD5) Previous issue date: 2014-10-30 / Objective: Assess the offer and the energy restriction of patients hospitalized in a PICU. Methods: This is a prospective observational cohort descriptive, conducted from 01/09/2009 to 31/08/2010 in patients admitted to the PICU of a university hospital. Some additional data were collected from medical records of patients in Service Medical Records. The study was approved by the Ethics in Research Committee. The energy offer was received compared to Basal Energy Expenditure (BEE) and restrictions were also evaluated in the energy offer of patients, by analyzing the period No Initial Offer Energy and Pauses in Energy Offer, as well as the reason for the same. Data were collected during admission and hospitalization. Outcomes such as mortality, malnutrition, severity, organ dysfunction, length of hospitalization, mechanical ventilation, vasoactive drugs and adequacy of energy offer were evaluated. Results: The sample consisted of 475 admissions. Interned No Initial Offer Energy 97.5% patients. 55.2% of these initiated within the first 24 hours. The surgery (35%), critical clinical condition (30%) and examination (21%) on admission were not primarily responsible for introducing the initial energy offer. The PIM2> 6, acute illness, infection, hematologic, gastrointestinal, and renal dysfunction, MODS on admission, mechanical ventilation, vasoactive drugs and patients who had prolonged hospitalization are associated with an increased time to onset of nutrition (p <0.05 ). There were a total of 379 Pauses in Energy Offer during hospitalization in 175 patients. Of these, 91% reached the BEE to discharge, taking 24-502 hours. The gastrointestinal dysfunction (89%), intubation/extubation (71%) and fluid restriction (31%) during hospitalization, were primarily responsible for Pauses in the Energy Offer. The patients under one year, malnourished, PIM2> 6, clinical patients with infection with respiratory and liver dysfunction with MODS, who used mechanical ventilation, vasoactive drugs and those who had prolonged hospitalization are associated with a greater number of pauses (p <0.05). Prolonged hospitalization and mechanical ventilation are independently associated with delay to the beginning of the energy offer (greater than 38 hours) and the presence of pauses in the diet. BEE reached 79% of patients, 4% achieved only after the 5th day, being 75% of the total considered adequate energy offer and 25% in inadequate energy offer. PIM2 patients with>6, respiratory, hepatic and hematologic dysfunction, with MODS, who used vasoactive drugs and who died reached less adequate energy offer during hospitalization (p <0.05). Conclusions: The Majority of patients hospitalized No Initial Offer Energy . Of these, only 55.2% started their nutrition in the first 24 hours. The surgery, critical clinical condition and the need to perform tests on admission were not primarily responsible for introducing the initial energy supply for patients. The gastrointestinal dysfunction, intubation/extubation and fluid restriction during hospitalization, were primarily responsible for pauses in the energy offer. Prolonged hospitalization and the use of mechanical ventilation are independently associated with delay to the start of the energy offer and with the presence of food pauses. / Objetivo: Avaliar a oferta e a restri??o energ?tica dos pacientes internados em uma UTIP. M?todos: Trata-se de um estudo de coorte prospectivo descritivo observacional, realizado entre 01/09/2009 a 31/08/2010 nos pacientes admitidos na UTIP de um hospital universit?rio. Alguns dados complementares foram coletados nos prontu?rios dos pacientes no Servi?o de Arquivo M?dico. O estudo foi aprovado pelo Comit? de ?tica em Pesquisa da institui??o. A oferta energ?tica recebida foi comparada ao Gasto Energ?tico Basal (GEB) e tamb?m foram avaliadas as restri??es na oferta energ?tica dos pacientes, atrav?s da an?lise do per?odo Sem Oferta Energ?tica Inicial e das Pausas na Oferta Energ?tica, assim como o motivo das mesmas. Foram coletados dados durante a admiss?o e a interna??o. Desfechos como a mortalidade, desnutri??o, gravidade, disfun??es org?nicas, tempo de interna??o, de uso de ventila??o mec?nica, drogas vasoativas e adequa??o da oferta energ?tica foram avaliados. Resultados: A amostra foi constitu?da de 475 interna??es. Internaram Sem Oferta Energ?tica Inicial 97,5% pacientes. Destes 55,2% iniciaram nas primeiras 24 horas. A cirurgia (35%), quadro cl?nico cr?tico (30%) e exames (21%) na admiss?o foram os principais respons?veis pela n?o introdu??o da oferta energ?tica inicial. O PIM2>6, doen?a aguda, infec??o, disfun??o hematol?gica, gastrointestinal e renal, SDMO na admiss?o, ventila??o mec?nica, drogas vasoativas e os pacientes que tiveram interna??o prolongada est?o associados a um tempo maior para o in?cio da nutri??o (p<0,05). Houveram um total de 379 Pausas na Oferta Energ?tica durante a interna??o em 175 pacientes. Destes, 91% atingiram o GEB at? a alta, demorando de 24 a 502 horas. A disfun??o gastrointestinal (89%), intuba??o/extuba??o (71%) e restri??o h?drica (31%) durante a interna??o, foram os principais respons?veis pelas Pausas na Oferta Energ?tica. Os pacientes menores de um ano, desnutridos, PIM2>6, pacientes cl?nicos, com infec??o, com disfun??o respirat?ria e hep?tica, com SDMO, que utilizaram ventila??o mec?nica, drogas vasoativas e os que tiveram interna??o prolongada est?o associados a um n?mero maior de pausas (p<0,05). A interna??o prolongada e a ventila??o mec?nica est?o associadas de forma independente com a demora para o in?cio da oferta energ?tica (maior que 38 horas) e com a presen?a de pausas na dieta. Atingiram o GEB 79% dos pacientes, 4% atingiram apenas depois do 5? dia, sendo do total 75% considerados em oferta energ?tica adequada e 25% em oferta energ?tica inadequada. Pacientes com PIM2>6, com disfun??o respirat?ria, hep?tica e hematol?gica, com SDMO, que utilizaram drogas vasoativas e que foram a ?bito atingiram menos a oferta energ?tica adequada durante a interna??o (p<0,05). Conclus?es: A maioria dos pacientes internou Sem Oferta Energ?tica Inicial. Destes, apenas 55,2% iniciaram sua nutri??o nas primeiras 24 horas. A cirurgia, o quadro cl?nico cr?tico e a necessidade de realizar exames na admiss?o foram os principais respons?veis pela n?o introdu??o da oferta energ?tica inicial nos pacientes. A disfun??o gastrointestinal, a intuba??o/extuba??o e a restri??o h?drica durante a interna??o, foram os principais respons?veis pelas pausas na oferta energ?tica. A interna??o prolongada e o uso da ventila??o mec?nica est?o associados de forma independente com a demora para o in?cio da oferta energ?tica e com a presen?a de pausa alimentar.

Made available in DSpace on 2015-04-14T13:33:10Z (GMT). No. of bitstreams: 1 463170.pdf: 740690 bytes, checksum: 9dba9e0a16f1d45607760959a7972ac1 (MD5) Previous issue date: 2014-08-29 / OBJECTIVES : To assess the association between fluid management and the occurrence of pulmonary hemorrhage in extremely low birth weight infants. To investigate prenatal conditions (as corticosteroid and intrauterine growth restriction) and postnatal conditions (as surfactant and patent ductus arteriosus) as possible risk factors for pulmonary hemorrhage in premature infants. PATIENTS AND METHODS : A retrospective case-control study was conducted through analysis of medical records, in the Neonatal Intensive Care Unit of Hospital S?o Lucas da PUCRS, Porto Alegre, Brazil, including the period between 2003 and 2013. All infants with birth weight less than or equal to 1000 g who developed a clinical picture of massive pulmonary hemorrhage were eligible for the study. Infants without pulmonary hemorrhage, at the same range of weight and/or gestational age, born consecutively to each case, were selected as controls. RESULTS : Fifty-six preterm infants, 28 cases and 28 controls, participated in the study. Patients with pulmonary hemorrhage had higher in-hospital mortality, occurring 23 deaths (82.1%), when compared with controls, who had 12 deaths (42.9%) (p=0.006). Intracranial hemorrhage was diagnosed in 12 of 28 cases (48%) and in four of 28 control patients (14%) (p=0.01). Diuresis in the second day of life was lower in the pulmonary hemorrhage group (2.5 mL/kg/h) compared with controls (3.5 mL/kg/h) (p=0.019). In the group of cases, reduction of the infused volume was associated with the outcome: of the 21 patients who had fluid restriction, 15 (71.5%) survived to pulmonary hemorrhage, whereas all patients in whom the reduction in volume was not performed had pulmonary hemorrhage-related death (p=0.003). Volume reduction associated with the use of diuretic was also associated with lower risk of death from pulmonary hemorrhage: in 14.2% of those who used this combination and 69.2% of those who did not use, death due to pulmonary hemorrhage occurred (p=0.006). These results suggest that fluid retention may be associated to the occurrence of pulmonary hemorrhage and that the management with infused volume restriction and diuretic administration shortly after the start of pulmonary hemorrhage can be effective in reducing mortality. / OBJETIVOS : Avaliar a associa??o entre o manejo h?drico e a ocorr?ncia de hemorragia pulmonar em rec?m-nascidos prematuros de extremo baixo peso. Investigar condi??es pr?-natais (como uso de corticoide e restri??o do crescimento intrauterino) e p?s-natais (como uso de surfactante e persist?ncia do canal arterial) como poss?veis fatores de risco para hemorragia pulmonar em prematuros. PACIENTES E M?TODOS : Foi realizado um estudo tipo caso-controle retrospectivo, por meio da an?lise de prontu?rios, na Unidade de Terapia Intensiva Neonatal do Hospital S?o Lucas da PUCRS, Porto Alegre, Rio Grande do Sul, abrangendo o per?odo entre 2003 e 2013. Todos os rec?m-nascidos com peso de nascimento de 1000 g ou menos que apresentaram quadro cl?nico de hemorragia pulmonar maci?a foram eleg?veis para o estudo. Rec?m-nascidos sem hemorragia pulmonar, da mesma faixa de peso e/ou idade gestacional, nascidos consecutivamente a cada caso, foram selecionados como controles. RESULTADOS : Participaram deste estudo 56 rec?m-nascidos prematuros, sendo 28 casos e 28 controles. Os pacientes que tiveram hemorragia pulmonar apresentaram maior mortalidade intra-hospitalar, ocorrendo 23 ?bitos (82,1%), em compara??o aos controles, que totalizaram 12 ?bitos (42,9%) (p=0,006). Hemorragia intracraniana foi diagnosticada em 12 dos 28 casos (48%) e em quatro dos 28 controles (14%) (p=0,01). A diurese do segundo dia de vida foi menor no grupo com hemorragia pulmonar (2,5 ml/kg/h) em compara??o aos controles (3,5 ml/kg/h) (p=0,019). No grupo de casos, a redu??o do volume h?drico infundido associou-se ao desfecho: dos 21 pacientes que tiveram restri??o h?drica, 15 (71,5%) sobreviveram ? hemorragia pulmonar, enquanto todos os pacientes em que n?o foi realizada a redu??o de volume tiveram ?bito relacionado ? hemorragia pulmonar (p=0,003). A redu??o de volume associada ao uso de diur?tico tamb?m foi associada a menor risco de morte pela hemorragia pulmonar, sendo que em 14,2% dos que usaram essa combina??o e em 69,2% dos que n?o usaram, ocorreu ?bito devido ? hemorragia pulmonar (p=0,006). CONCLUS?ES : Os resultados sugerem que a reten??o h?drica pode estar associada ? ocorr?ncia de hemorragia pulmonar, e que o manejo com restri??o de volume infundido e administra??o de diur?ticos, logo ap?s o in?cio da hemorragia, pode ser efetivo na redu??o da mortalidade.

Made available in DSpace on 2015-04-14T13:33:11Z (GMT). No. of bitstreams: 1 464694.pdf: 2239500 bytes, checksum: dffe466aa07a18c4c357e965ce0174ea (MD5) Previous issue date: 2014-10-27 / Introduction: Studies of children with severe therapy-resistant asthma are scarce in developed countries and there is no published data about clinical presentations and characteristics of these patients in developing countries. Objective: To describe the main clinical characteristics, lung function, radiological findings, and inflammation of induced sputum of children with severe therapy-resistant asthma from a reference center in southern Brazil. Methods: Children between 6-14 years of age, followed by at least 6 months in a reference center, with severe therapy-resistant asthma (uncontrolled asthma using elevated doses of inhaled corticoid associated with long-acting beta-2 agonist) were retrospectively selected. All subjects from the reference center had clinical data, disease control, lung function, skin test reactivity to aeroallergens, inflammation of induced sputum, chest computerized tomography, and pH esophageal monitoring results prospectively collected. Results: 21 patients were selected (mean age: 9.2 yo). Eighteen patients (86%) were atopic. Most patients presented uncontrolled disease during most visits, with nearly normal baseline lung function parameters. The sputum of two patients were paucigranulocytic, 4 were eosinophilic and 7 neutrophilic, where 67% of the children who repeated sputum exam changed the inflammatory patterns. 6/7 (86%) of the children who were treated with omalizumab (anti-IgE) showed improvement in quality of life, with an important reduction in exacerbations and hospitalizations. Conclusions: Most children with severe therapy-resistant asthma from a non-affluent population were patients with difficult-to-control disease, with nearly normal lung function and prone to change airway inflammatory pattern during follow-up, most of them atopics. This profile, unlike adults, need to be better understood in relation to the mechanisms that result in symptoms unresponsive to optimized drug therapies. / Introdu??o: estudos de crian?as com asma grave resistente ? terapia (AGRT) s?o escassos em pa?ses desenvolvidos e n?o h? dados publicados sobre apresenta??o cl?nica e caracter?sticas desses pacientes em pa?ses em desenvolvimento. Objetivo: descrever as principais caracter?sticas cl?nicas, funcionais, radiol?gicas e de inflama??o no escarro induzido de crian?as com AGRT, provenientes de um centro de refer?ncia do sul do Brasil. M?todos: foram selecionadas retrospectivamente crian?as entre 6-14 anos, acompanhadas por pelo menos 6 meses em um centro de refer?ncia do sul do Brasil, com diagn?stico AGRT (asma n?o controlada, usando doses elevadas de corticoide inalat?rio associado a beta-2 agonista de a??o longa). A partir de dados coletados prospectivamente no seguimento cl?nico, foram analisados controle da doen?a, fun??o pulmonar, teste cut?neo para aeroal?rgenos, avalia??o da inflama??o no escarro induzido, tomografia de t?rax, e phmetria. Resultados: 21 pacientes foram selecionados (m?dia de 9,2 anos). Dezoito (86%) pacientes s?o at?picos. A maioria dos pacientes apresenta pouco controle da doen?a, com fun??o pulmonar basal sempre pr?xima do normal. Dois pacientes apresentaram escarro paucigranuloc?tico, 4 eosinof?lico e 7 neutrof?lico, onde 67% que repetiram o exame apresentaram mudan?a no padr?o inflamat?rio. 6/7 (86%) pacientes que utilizaram omalizumabe (anti-IgE) apresentaram melhora importante da qualidade de vida, com redu??o importante das exacerba??es. Conclus?es: crian?as com AGRT apresentam doen?a dif?cil de controlar, fun??o pulmonar pr?xima do normal e padr?o inflamat?rio das vias a?reas vari?vel durante seguimento cl?nico, sendo em sua maioria at?picas. Esse perfil, diferente dos adultos, precisa ser melhor entendido em rela??o aos mecanismos que resultam em sintomas n?o responsivos a terapias medicamentosas otimizadas.

Made available in DSpace on 2015-04-14T13:33:11Z (GMT). No. of bitstreams: 1 464696.pdf: 1541077 bytes, checksum: 0c2d114cff07d5c5d0ebce53d08830e6 (MD5) Previous issue date: 2014-11-10 / Background: Many developing countries have a high prevalence of asthma. However, the burden of disease has been scarcely reported from non-affluent populations. Aims: To assess the impact of the disease in Brazilian children with asthma from a large capital city. Methods: We selected inner-city children with asthma and healthy controls from public schools, between eight and 16 years of age, from a capital city of southern Brazil. The study was divided into three phases, with questionnaires (asthma prevalence, quality of life, knowledge and impact of disease) applied, with assessment of lung function, nutritional status and allergic sensitization. Results: From 2,500 children selected, with male gender of 1,211 (48.4%) and mean age of 11.42?2.32 years, 511 (20.4%) were diagnosed with asthma. The disease was not controlled in nearly half of the children with asthma, with a 7.5% of hospitalization rate in the last year. The majority of patients presented a history of dyspnea, exercise limitation or sleep disturbance because of asthma symptoms in the last 12 months, with high school absenteeism. Many patients required oral steroids in the previous year, and only 34% had a prescription of rescue medication, with 55% of passive smoking. Despite the free asthma medication access in Brazil since 2012, less than half of patients were using preventive treatment. Many parents assume that are not adherent to treatment and believe that rescue medication and exercise may be harmful. Conclusions: We have shown that the burden of asthma in children from southern Brazil is substantial, and this may reflect the scenario of many non-affluent populations worldwide. New international guidelines more focused in developing countries with pragmatic approaches should be a priority for discussion and implementation. / Introdu??o: muitos pa?ses em desenvolvimento t?m uma elevada preval?ncia de asma. No entanto, o impacto da doen?a tem sido pouco relatado a partir de popula??es economicamente menos favorecidas. Objetivo: avaliar o impacto da asma em crian?as brasileiras a partir de uma grande capital. M?todos: foram selecionadas crian?as com asma e controles saud?veis, de escolas p?blicas, entre oito e 16 anos de idade, de uma capital do sul do Brasil. O estudo foi dividido em tr?s fases, com question?rios (preval?ncia de asma, qualidade de vida, o conhecimento e o impacto da doen?a), aplicada, com a avalia??o da fun??o pulmonar, estado nutricional e sensibiliza??o al?rgica. Resultados: de 2.500 crian?as selecionadas, com o g?nero masculino de 1.211 (48,4%) e idade de 11,42?2,32 anos, 511 (20,4%), foram diagnosticadas com asma. A doen?a n?o estava controlada em cerca de metade das crian?as com asma, com 7,5% de taxa de hospitaliza??o no ?ltimo ano. A maioria dos pacientes apresentavam hist?ria de dispneia, limita??o ao exerc?cio ou dist?rbio do sono por causa de sintomas de asma nos ?ltimos 12 meses, com elevado absentismo. Muitos pacientes necessitaram de esteroides orais, nos doze meses, e apenas 34% tiveram prescri??o de medica??o de resgate, com 55% de tabagismo passivo. Apesar do acesso gratuito ? medica??o para a asma no Brasil desde 2012, menos da metade dos pacientes faziam uso de tratamento preventivo. Muitos pais assumem que n?o s?o aderentes ao tratamento e acreditam que a medica??o de resgate e exerc?cio pode ser prejudicial. Conclus?es: mostramos no estudo que o ?nus da asma em crian?as do sul do Brasil ? substancial, e isso pode refletir o cen?rio de muitas popula??es economicamente menos favorecidas, em todo o mundo. Novas diretrizes internacionais mais focadas nos pa?ses em desenvolvimento com abordagens pragm?ticas deve ser uma prioridade para a discuss?o e implementa??o.

Made available in DSpace on 2015-04-14T13:33:11Z (GMT). No. of bitstreams: 1 464697.pdf: 879216 bytes, checksum: 37696acdb93f5257a99df54817b38653 (MD5) Previous issue date: 2014-08-26 / Background and aims: Studies show that offering supplementary formula to the newborn interferes with the maintenance of breastfeeding. However, these studies did not select only term infants born by elective cesarean section. It is important to know the characteristics of this population of newborns to ensure that they are exposed to the same effects of supplement feedings observed in newborns in general. The aim of this study was to evaluate the effect of formula supplement in newborns at term undergoing elective cesarean section. Methods: A cohort study including newborns at term and their mothers, whose deliveries occurred by elective cesarean section at Moinhos de Vento Hospital, a private general hospital located in Porto Alegre city, in South Brazil, was conducted from October 2011 to April 2013. Initial data were obtained from medical records of newborns and through interviews with mothers in the recovery room. Follow-up was done by telephone contact with each mother, at the end of the second week of life, in the third month, and in the sixth month after birth. The proportion of infants who had a food supplement prescribed in the first prescription was evaluated, as well as the use of supplement before and / or after the first 24 hours of life. The chi-square test was performed with the respective residue analysis. To obtain the effects corrected for the influence of other variables, a model of logistic regression was adjusted, having as response variables "exclusive breastfeeding at three months" and "breastfeeding at six months," and as dependent variables those significant at the 30% level in previous analyzes. Quality of fit and significance of the logistic model were verified using the Hosmer and Lemeshow test. Significance of the coefficients of the model was verified by the Wald statistics, and those significant at the 5% level were kept in the model. Data were analyzed with SPSS version 17.0. Results: At all 964 pairs mother / baby were studied, whose median maternal age was 32 years (from 29.5 to 35.5, min., 18 max. 40th). Nineteen (1.9%) mothers started breastfeeding already in the delivery room, and 936 (97.0%) started in the recovery room. In the first prescription, 811 (84.1%) newborns had already formula supplement prescribed, however only 467 (48.5%) actually received it. Of the 964 mothers, 675 (70.0%) were breastfeeding exclusively in the third month. At six months, 781 (81.0%) mothers were still breastfeeding, but 868 (90.0%) had already introduced other foods, and 737 (76.4%) were already working. Infants that were fully breastfeeding at three months comprised: 386/497 (77.7%) infants who never received supplementation; 289/467 (61.8%) who received in-hospital formula at some point (p<0.001); 146/246 (56.9%) who received supplementation before 24 hours of life (P<0.001); and 242/396 who received supplementation after 24 hours of life (P<0.001). After multivariate analysis, it was found that supplement use before 24 hours of life and supplement use after 24 hours of life remained associated with lack of exclusive breastfeeding at three months (p=0.001 and p=0.003 respectively). Conclusions: In this population of babies born by elective caesarean section, even with a good breastfeeding success rate, use of formula supplement in the first hours of life was strongly associated with reduction in exclusive breastfeeding at three months. It should be emphasized the importance of a very careful decision to use supplementation and prescription of formula feedings to newborn infants, as well as the need for justifying the decision in the hospital records. / Introdu??o e objetivos: Estudos mostram que oferecer complemento alimentar ao rec?m-nascido interfere com a manuten??o do aleitamento materno. Entretanto, esses estudos n?o selecionaram somente beb?s a termo nascidos por cesariana eletiva. ? importante conhecer as particularidades dessa popula??o de rec?m-nascidos e verificar se est?o expostos aos mesmos efeitos da complementa??o alimentar observados nos rec?m-nascidos em geral. O objetivo deste estudo foi avaliar o efeito do complemento alimentar sobre o aleitamento materno, em rec?m-nascidos a termo submetidos ? cesariana eletiva. M?todos: Foi realizado um estudo de coorte incluindo rec?m-nascidos a termo e suas m?es, cujos partos ocorreram por ces?rea eletiva no Hospital Moinhos de Vento, um hospital geral 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 dos rec?m-nascidos e mediante entrevistas com as m?es na sala de recupera??o. O seguimento foi feito por contato telef?nico com cada m?e, ao final da segunda semana de vida, no terceiro m?s e no sexto m?s ap?s o nascimento. Foi avaliada a propor??o de rec?m-nascidos que tiveram o complemento alimentar prescrito na primeira prescri??o, assim como a utiliza??o de complemento antes e/ou ap?s as primeiras 24 horas de vida. Foi realizado o teste de associa??o qui-quadrado, com a respectiva an?lise de res?duos. Para a obten??o dos efeitos corrigidos pela influ?ncia das demais vari?veis, um modelo de regress?o log?stica foi ajustado tendo como vari?veis de resposta amamenta??o exclusiva aos tr?s meses e "amamentando aos seis meses, e vari?veis dependentes aquelas significativas ao n?vel de 30% nas an?lises anteriores. A qualidade do ajuste e a signific?ncia do modelo log?stico foram verificadas atrav?s do teste de Hosmer e Lemeshow. A signific?ncia dos coeficientes do modelo foi verificada atrav?s da estat?stica de Wald e foram mantidos aqueles significativos ao n?vel de 5%. Os dados foram analisados com o aux?lio do programa SPSS vers?o 17.0. Resultados: Foram estudados 964 pares m?e/beb?, cuja mediana de idade materna foi de 32 anos (29,5-35,5, m?n. 18, m?x. 40), sendo que 19 (1,9%) come?aram a amamentar j? na sala de partos e 936 (97,0%) iniciaram na sala de recupera??o. Na primeira prescri??o, 811 (84,1%) rec?m-nascidos j? tinham complemento alimentar prescrito, entretanto somente 467 (48,5%) efetivamente o receberam. Das 964 m?es, 675 (70,0%) estavam amamentando exclusivamente ao seio no terceiro m?s. Com seis meses, 781 (81,0%) ainda estavam amamentando, por?m 868 (90,0%) j? haviam introduzido outros alimentos, e 737 (76,4%) j? estavam trabalhando. Estavam com aleitamento materno exclusivo aos tr?s meses: 386/497 (77,7%) beb?s que nunca receberam complemento; 289/467 (61,8%) que receberam complemento em algum momento (p<0,001); 146/246 (56,9%) que receberam complemento antes de 24 horas de vida (p<0,001); e 242/396 que receberam complemento ap?s as 24 horas de vida (p<0,001). Ap?s an?lise multivariada, verificou-se que uso de complemento antes das 24 horas de vida e uso de complemento ap?s as 24 horas de vida mantiveram associa??o com aus?ncia de aleitamento materno exclusivo aos tr?s meses (p=0,001 e p=0,003 respectivamente). Conclus?es: Nesta popula??o de beb?s nascidos por cesariana eletiva, mesmo com um bom ?ndice de sucesso na amamenta??o, a utiliza??o do complemento alimentar nas primeiras horas de vida foi fortemente associada ? redu??o da amamenta??o exclusiva aos tr?s meses. Salienta-se a import?ncia de que a prescri??o e a decis?o de uso de complemento para os rec?m-nascidos devam ser bastante criteriosas e justificadas nos registros hospitalares dos pacientes.