RESUMO
OBJECTIVES: To evaluate patterns and determinants of longitudinal growth among children requiring complex biventricular repair for congenital heart disease, as well as to assess for associations of growth with early feeding modality, comorbidities, postoperative complications, and socioeconomic characteristics. STUDY DESIGN: A single-institution retrospective cohort study was performed in children born February 1999 to March 2009 with complex congenital heart disease who underwent biventricular repair before age 4 years, defined by Risk Adjustment in Congenital Heart Surgery-1 category 3-5. Clinical characteristics, height, weight, and body mass index (BMI) from ages 2-12 years were collected by chart review. Neighborhood-level socioeconomic data were identified using a geographic information system approach. The adjusted association of covariates with growth outcomes was estimated using multivariable linear regression models using generalized estimating equations. RESULTS: Compared with population growth curves, the cohort (n = 150) trended toward early decrease in age-adjusted weight and height. Early tube feeding was significantly associated with decreased BMI before adolescence (-0.539; 95% CI -1.02, -0.054; P = .029). In addition, other clinical and perioperative characteristics had significant associations with growth, including low birth weight, preoperative tube feeds, need for multiple bypass runs, and diagnosis of feeding disorder. CONCLUSIONS: Early childhood growth in children with complex biventricular repair may be impaired. Early tube feeding was associated with decreased BMI over the course of early childhood, which may indicate a need for continued close nutrition follow-up and support even beyond the duration of tube feeds.
Assuntos
Nutrição Enteral , Cardiopatias Congênitas , Criança , Adolescente , Humanos , Pré-Escolar , Lactente , Estudos Retrospectivos , Índice de Massa Corporal , Estado Nutricional , Cardiopatias Congênitas/cirurgiaRESUMO
OBJECTIVE: To determine whether clinical and patient-reported outcomes differ in children receiving blenderized diets compared with conventional formula. STUDY DESIGN: We conducted a prospective cohort study of 70 children aged 1-18 years receiving blenderized diets vs conventional formula via feeding tube. We assessed rates of hospitalization and visits to the emergency department (ED) at Boston Children's Hospital in 2017 and Likert scale addressing satisfaction with feeding regimen; Pediatric Gastroesophageal Reflux Disease Symptom and Quality of Life Questionnaire; Pediatric Quality of Life Inventory; and Pediatric Quality of Life Inventory Gastrointestinal Symptoms Scale. RESULTS: Participants receiving blenderized diets (n = 42, 60%) did not differ in demographics or comorbid diagnoses from those receiving conventional formula (n = 28, 40%). Rates of total visits to the ED (0.8 ± 1.5 vs 1.4 ± 2.7, P = .05), total admissions (0.8 ± 1.2 vs 1.7 ± 2.3, P = .01), and respiratory-related admissions (0.2 ± 0.5 vs 0.6 ± 0.8, P = .04) per year were significantly lower in participants receiving blenderized diets, and respiratory-related visits to the ED trended toward significance (0.1 ± 0.4 vs 0.4 ± 0.8, P = .08). Compared with those receiving conventional formula, participants on blenderized diets reported greater satisfaction ratings (Likert scale 4.3 ± 1.0 vs 3.3 ± 1.2, P = .001), lower symptom (0.7 ± 0.8 vs 1.2 ± 1.1, P = .03), and total (0.8 ± 0.8 vs 1.2 ± 1.0, P = .02) scores on Pediatric Gastroesophageal Reflux Disease Symptom and Quality of Life Questionnaire and greater scores on the Pediatric Quality of Life Inventory Gastrointestinal Symptoms Scale, indicating less nausea and vomiting (64.0 ± 22.6 vs 49.0 ± 37.9, P = .02), abdominal pain (65.0 ± 26.8 vs 56.4 ± 33.9, P = .04), diarrhea (87.9 ± 15.5 vs 73.6 ± 26.3, P = .004), and fewer total symptoms (70.2 ± 16.3 vs 62.3 ± 19.6, P = .03). CONCLUSIONS: Blenderized diets are associated with decreased healthcare use, improved symptom scores, and increased patient satisfaction compared with conventional formulas.
Assuntos
Nutrição Enteral , Alimentos Formulados , Qualidade de Vida , Dor Abdominal/epidemiologia , Boston/epidemiologia , Criança , Pré-Escolar , Estudos de Coortes , Diarreia/epidemiologia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Humanos , Masculino , Náusea/epidemiologia , Admissão do Paciente/estatística & dados numéricos , Satisfação do Paciente , Vômito/epidemiologiaRESUMO
Resumen: El uso de apoyo nutricional ambulatorio, enteral o parenteral, ha sido un paso necesario en la opti mización del soporte nutricional en pacientes, que, por diversas patologías, no logran cumplir con sus requerimientos por vía oral (VO). En el presente artículo se presentan las recomendaciones de la Rama de Nutrición, dirigidas a los equipos de salud que atienden pacientes pediátricos, que requieran alimentación enteral por un tiempo prolongado. Su objetivo general es entregar pautas para un co rrecto manejo en estos pacientes. Se describe la conformación ideal del equipo de salud para atención y seguimiento de dichos pacientes, los criterios de ingreso al programa y su forma de evaluación en el tiempo. Además, se describen características generales de la alimentación enteral, vías de admi nistración, fórmulas enterales disponibles, complicaciones de este soporte nutricional y por último monitorización y seguimiento del paciente.
Abstract The use of home enteral or parenteral nutrition has been a necessary step in the optimization of nu tritional support in patients who, due to several diseases, fail to meet their nutritional requirements by oral feeding. This article presents the recommendations of the Chilean Pediatric Society Nutritio nal Branch, aimed at health teams that treat pediatric patients who require enteral feeding for a long time. The general objective is to provide guidelines for the proper management of these patients. It describes the ideal conformation of the health team for the care and follow-up of those patients, the program admission criteria, and its evaluation method over time. In addition, it describes general characteristics of enteral feeding, routes of administration, available enteral formulas, complications, and patient follow-up.
Assuntos
Humanos , Criança , Adolescente , Nutrição Enteral/normas , Serviços de Assistência Domiciliar/normas , Pediatria , Sociedades Médicas , Chile , Doença Crônica , Nutrição Enteral/efeitos adversos , Nutrição Enteral/métodos , Assistência ao Convalescente/métodos , Assistência ao Convalescente/normasRESUMO
As Tecnologias da Informação e Comunicação (TIC) são reconhecidas como ferramentas que estimulam o senso crítico, a reflexão e a autonomia na formação profissional em enfermagem, enquanto estratégia para fortalecimento da cultura de qualidade e segurança, visando à prevenção de incidentes relacionados à administração de medicamentos por sonda enteral. Este estudo retrata uma pesquisa de desenvolvimento ou Design-Based Research (DBR), com objetivo de desenvolver e avaliar uma tecnologia educacional sobre a temática de segurança na administração de medicamentos por sonda enteral. O Ambiente Virtual de Aprendizagem (AVA) foi desenvolvido em três etapas: 1) Planejamento; 2) Desenvolvimento e 3) Avaliação. Na Etapa 1, o planejamento contempla a caracterização do público-alvo, definição da temática e dos objetivos a serem alcançados. A Etapa 2 corresponde ao desenvolvimento da Tecnologia Educacional utilizando a metodologia WebQuest (Introdução, Tarefa, Processo, Avaliação, Conclusão e Créditos). Na Etapa 3 foi realizada a avaliação da tecnologia educacional digital por cinco profissionais da área de Informática e cinco enfermeiros docentes, mediante aprovação do projeto junto ao Comitê de Ética em Pesquisa. A pesquisa resultou no desenvolvimento de uma WebQuest curta sobre a temática de segurança do paciente, com enfoque na proposta de ações estratégicas visando a prevenção de erros e incidentes relacionados à administração de medicamentos por sonda enteral. A avaliação dos aspectos pedagógicos indicou que as características foram plenamente alcançadas em relação à Pertinência, Aplicabilidade e Consistência do Conteúdo; Interação Aluno-aluno, Aluno-grupo, Aluno-professor e Grupo-Professor; Pertinência, Quantidade e Avaliação Educacional das Atividades. Na avaliação dos aspectos técnicos, as características foram plenamente alcançadas em relação às Cores (Qualidade da Interface), segundo a opinião de todos os especialistas em enfermagem e em informática. As contribuições dos especialistas em relação às características parcialmente alcançadas e não alcançadas permitiram a realização de ajustes para implementação futura junto a estudantes do curso técnico em Enfermagem. Vale destacar que não foram relatadas características não alcançadas em relação aos aspectos pedagógicos. Os resultados evidenciam a relevância do domínio dos atributos próprios da WebQuest, visando a superação dos desafios relacionados ao desenvolvimento do pensamento crítico e aplicação de conhecimentos na solução de problemas vivenciados na busca por maior qualidade e segurança na assistência ao paciente, compatíveis com a exigências de ampliação do uso de tecnologias educacionais digitais inovadoras na formação profissional em enfermagem
Information and Communication Technologies (ICT) are recognized as tools that stimulate critical thinking, reflection and autonomy in professional nursing training, as a strategy to strengthen the culture of quality and safety, in order to prevent incidents related to the administration of medicines for enteral tube. This study describes a development research or Design-Based Research (DBR) aiming to develop and evaluate an educational technology on the theme of safety in the administration of medicines by enteral tube. The Virtual Learning Environment (VLE) was developed in three stages: 1) Planning; 2) Development and 3) Evaluation. In Step 1, the planning contemplates the characterization of the target audience, definition of the theme and the objectives to be achieved. The Step 2 corresponds to the development of Educational Technology using the WebQuest methodology (Introduction, Task, Process, Evaluation, Conclusion and Credits). In Step 3, the evaluation of the digital educational technology was carried out by five professionals in the area of Informatics and five nursing professors, after approval of the project by the Research Ethics Committee. The research resulted in the development of a short WebQuest on the subject of patient safety, with a focus on the proposal of strategic actions aimed at the prevention of errors and incidents related to the administration of medicines by enteral tube. The evaluation of pedagogical aspects indicated that the characteristics were fully achieved in relation to the Relevance, Applicability and Consistency of Content; Student-student interaction, Student-group, Student-teacher and Group-Teacher; Relevance, Quantity and Educational Evaluation of Activities. In the evaluation of the technical aspects, the characteristics were fully achieved in relation to the Colors (Quality of Interface), according to the opinion of all specialists in nursing and computer science. The experts' contributions in relation to the partially achieved and unrealized characteristics allowed to make adjustments for future implementation with students of the technical course in Nursing. It is worth mentioning that there were no reported unrealized characteristics in relation to the pedagogical aspects. The results highlight the relevance of the domain of WebQuest attributes, aiming to overcome the challenges related to the development of critical thinking and application of knowledge in the solution of problems experienced in the search for higher quality and safety in patient care, compatible with the requirements of expansion of the use of innovative digital educational technologies in nursing professional training