Maria Carolina Witkowski

Vulnerabilities of children admitted to a pediatric inpatient care unit

Resumo Objetivo Identificar as vulnerabilidades de criancas admitidas em unidade de internacao pediatrica de um hospital universitario. Metodos Estudo transversal, descritivo, realizado de abril a setembro de 2013. A amostra foi constituida por 136 criancas de 30 dias a 12 anos incompletos admitidas em unidades clinico-cirurgicas de internacao pediatrica de um hospital universitario, e seus responsaveis. Dados referentes ao contexto sociocultural, socioeconomico e clinico das criancas e suas familias foram coletados por entrevista com o responsavel da crianca e por prontuario dos pacientes, sendo analisados por estatistica descritiva. Resultados Do total da amostra, 97,1% (n=132) das criancas tinham pelo menos um tipo de vulnerabilidade, relacionadas, na sua maioria, ao nivel de escolaridade do responsavel da crianca, seguida por: situacao financeira do responsavel, historico de saude da crianca, situacao familiar do responsavel, uso de alcool, tabaco e drogas ilicitas pelo responsavel, condicoes de moradia da familia, nivel de escolaridade da crianca e vinculo do responsavel com a crianca. Apenas 2,9% (n=4) das criancas nao apresentaram criterios que as classificassem como pertencentes a um tipo de vulnerabilidade, conforme pesquisado. Conclusoes A maioria das criancas foi classificada com vulnerabilidade social. A criacao de redes de apoio entre o ambiente hospitalar e a atencao basica, promovendo a utilizacao de praticas direcionadas para as necessidades de cada crianca e sua familia, torna-se imperativa.OBJECTIVE: To identify the vulnerabilities of children admitted to a pediatric inpatient unit of a university hospital. METHODS: Cross-sectional, descriptive study from April to September 2013 with36 children aged 30 days to 12 years old, admitted to medical-surgical pediatric inpatient units of a university hospital and their caregivers. Data concerning sociocultural, socioeconomic and clinical context of children and their families were collected by interview with the child caregiver and from patients, records, and analyzed by descriptive statistics. RESULTS: Of the total sample, 97.1% (n=132) of children had at least one type of vulnerability, the majority related to the caregivers level of education, followed by caregivers financial situation, health history of the child, caregivers family situation, use of alcohol, tobacco, and illicit drugs by the caregiver, familys living conditions, caregivers schooling, and bonding between the caregiver and the child. Only 2.9% (n=4) of the children did not show any criteria to be classified in a category of vulnerability. CONCLUSIONS: Most children were classified has having a social vulnerability. It is imperative to create networks of support between the hospital and the primary healthcare service to promote healthcare practices directed to the needs of the child and family.

Variability index of tacrolimus serum levels in pediatric liver transplant recipients younger than 12 years: Non-adherence or risk of non-adherence?

MLVI has been used to assess adherence. To determine the MLVI in children <12 years of age at transplantation and to identify demographic correlates and consequences for the graft. This is a retrospective study of 50 outpatients (4.0 ± 3.5 years), at least 13‐month post‐liver transplantation. The outcomes evaluated were MLVI, ALT > 60 IU/L, ACR, death, and graft loss. We analyzed demographic and socioeconomic characteristics, indication for transplantation, and type of donor. Students t test and the chi‐square test were used. Statistical significance was set at P ≤ .05. Seventy‐two percent were infants or preschoolers, 62% biliary atresia. Seventy‐four percent of the mothers had middle‐school education, and 54% of the families had an income ≤3632.4 US

Ganho de peso gestacional e estado nutricional do neonato : um estudo descritivo

/y. Twenty‐two (44%) patients had a MLVI ≥ 2 SD; this was more prevalent in families with higher incomes (P = .045). ALT levels > 60 IU/L were more common in MLVI ≥ 2 SD group (P = .035). ACR episodes were similar between groups (P = 1.000). No patient died or lost the graft. MLVI ≥ 2 SD may be an indicator of the risk of medication non‐adherence.

Association between nutritional status, exclusive breastfeeding and length of hospital stay of children

The objective was to characterize puerperal women in relation to gestational weight gain and their newborns in accordance with the nutritional state at birth. This is a descriptive, quantitative and retrospective study approved by the Ethics Committee at the institution responsible. The collection of data was from December 2012 to May 2013. The sample was composed of 24 puerperal women and their children. The participants presented an average age of 26.5 (DP=5.4) years, 79.2% white; 91.7% married; 58.3% multiparous; 75% with a level of education between secondary school and higher education; 58.3% with a low family income; 54.1% presented an altered pre-gestational nutritional state and 75% obtained an inadequate gestational weight gain. 79.2% of the newborns were classified as Adequate for Gestational Age (AIG). The newborns classified as Large for Gestational Age (GIG) were from pregnant women that had excessive weight gain or were overweight. It was concluded that health professionals should be attentive to nutritional deviations with the intention of avoiding complications for maternal/fetal health.

Asociación entre estado nutricional, la lactancia materna exclusiva y el tiempo de hospitalización de los niños

OBJECTIVE To verify the association between nutritional statuses, exclusive breastfeeding and the hospital stay of children. METHOD Cross-sectional study. Convenience sample of 146 children aged 1-48 months and their caregivers. Data were collected in paediatric units at a university hospital of southern Brazil from January to August 2012. Pearsons and Spearmans correlation coefficients were used for data analysis. RESULTS The children were classified as: eutrophic (71.9%), risk for overweight (13.0%) obese (6.2%); thin (4.1%); overweight (2.7%) and extremely thin (2.1%). Exclusive breastfeeding proved to be a protective factor for extremely thin (P = 0.029); and currently breastfeeding (P = 0.024) and previous breastfeeding (P = 0.000) were protective factors for overweight, risk for overweight and obese. The hospital stay was 3.29 ± 0.18 days. The stay was longer for the classifications overweight/obese and shorter for extremely thin/thin (P = 0.785). CONCLUSION Nutritional status and exclusive breastfeeding were not risk factors for a longer hospital stay in this sample.

Associação entre estado nutricional, aleitamento materno exclusivo e tempo de internação hospitalar de crianças

OBJECTIVE To verify the association between nutritional statuses, exclusive breastfeeding and the hospital stay of children. METHOD Cross-sectional study. Convenience sample of 146 children aged 1-48 months and their caregivers. Data were collected in paediatric units at a university hospital of southern Brazil from January to August 2012. Pearsons and Spearmans correlation coefficients were used for data analysis. RESULTS The children were classified as: eutrophic (71.9%), risk for overweight (13.0%) obese (6.2%); thin (4.1%); overweight (2.7%) and extremely thin (2.1%). Exclusive breastfeeding proved to be a protective factor for extremely thin (P = 0.029); and currently breastfeeding (P = 0.024) and previous breastfeeding (P = 0.000) were protective factors for overweight, risk for overweight and obese. The hospital stay was 3.29 ± 0.18 days. The stay was longer for the classifications overweight/obese and shorter for extremely thin/thin (P = 0.785). CONCLUSION Nutritional status and exclusive breastfeeding were not risk factors for a longer hospital stay in this sample.

Su1022 Medication Level Variability Index (Mlvi) and Non-Adherence in Children Undergoing Liver Transplantation in Use of Tacrolimus

OBJECTIVE To verify the association between nutritional statuses, exclusive breastfeeding and the hospital stay of children. METHOD Cross-sectional study. Convenience sample of 146 children aged 1-48 months and their caregivers. Data were collected in paediatric units at a university hospital of southern Brazil from January to August 2012. Pearsons and Spearmans correlation coefficients were used for data analysis. RESULTS The children were classified as: eutrophic (71.9%), risk for overweight (13.0%) obese (6.2%); thin (4.1%); overweight (2.7%) and extremely thin (2.1%). Exclusive breastfeeding proved to be a protective factor for extremely thin (P = 0.029); and currently breastfeeding (P = 0.024) and previous breastfeeding (P = 0.000) were protective factors for overweight, risk for overweight and obese. The hospital stay was 3.29 ± 0.18 days. The stay was longer for the classifications overweight/obese and shorter for extremely thin/thin (P = 0.785). CONCLUSION Nutritional status and exclusive breastfeeding were not risk factors for a longer hospital stay in this sample.

Gestational weight gain and nutritional state of the newborn: a descriptive study

Backgrounds/aims De-novo autoimmune hepatitis (AIH) after liver transplantation (LT) is rising. Yet there is scarcity of data on the characteristics and the long-term outcomes of this condition. The aim of this study is to investigate the clinical characteristics and long-term outcomes of patients with de novo AIH following LT.Methods Using transplant liver biopsy database, we identified all patients with de-novo AIH following LT at our institution between 2008 and 2013. Patients with hepatitis C virus infection were excluded. The diagnosis of de-novo AIH was made according to the classical and simplified criteria defined by the International Autoimmune Hepatitis Group. Clinical information was gathered from electronic medical records. H&E stained sections and histochemical stains from the liver biopsies revealed findings compatible with AIH. Results A total of nineteen patients with de-novo AIH were identified (58% female, median age of 46 years), with mean international autoimmune hepatitis score of 12.1. Underlying liver disease were primary sclerosing cholangitis (n=4), primary biliary cirrhosis (n=3), biliary atresia (n=3), drug induced liver failure (n=2), alcoholic hepatitis (n=2) and others (n=5). The interval period from the LT to diagnosis of de-novo AIH was 19.6 months (1.6-197.8), during which 11 (58%) patients developed at least one episode of acute cellular rejection prior to the diagnosis of de-novo AIH. All patients were successfully treated with corticosteroids and incremental dose in immunosuppression. All showed complete biochemical response to treatment but 9 (47.4%) patients relapsed upon tapering down corticosteroids. Patients were followed over 6.7 year (1.5-17) years post-LT. Eight (42%) patients progressed to cirrhosis of whom 3 (15%) patients expired and 2 (10%) required second LT due to complications of end stage liver disease. Conclusion The present study shows the long term clinical outcomes of the patients with de-novo AIH post-LT. Although most patients exhibit a good initial response to medical therapy, de-novo AIH post-LT is likely to recur and progress to liver cirrhosis. Therefore, we should consider denovo AIH in patients who show abnormal liver tests or graft dysfunction after LT.

Ganancia de peso gestacional y estado nutricional de neonatos: un estudio descriptivo

The objective was to characterize puerperal women in relation to gestational weight gain and their newborns in accordance with the nutritional state at birth. This is a descriptive, quantitative and retrospective study approved by the Ethics Committee at the institution responsible. The collection of data was from December 2012 to May 2013. The sample was composed of 24 puerperal women and their children. The participants presented an average age of 26.5 (DP=5.4) years, 79.2% white; 91.7% married; 58.3% multiparous; 75% with a level of education between secondary school and higher education; 58.3% with a low family income; 54.1% presented an altered pre-gestational nutritional state and 75% obtained an inadequate gestational weight gain. 79.2% of the newborns were classified as Adequate for Gestational Age (AIG). The newborns classified as Large for Gestational Age (GIG) were from pregnant women that had excessive weight gain or were overweight. It was concluded that health professionals should be attentive to nutritional deviations with the intention of avoiding complications for maternal/fetal health.

Tu1716 Quality of Life and Pediatric End-Stage Liver Disease Scores of Pediatric Liver Transplant Recipients in an Outpatient Clinic: A Cross-Sectional Study

The objective was to characterize puerperal women in relation to gestational weight gain and their newborns in accordance with the nutritional state at birth. This is a descriptive, quantitative and retrospective study approved by the Ethics Committee at the institution responsible. The collection of data was from December 2012 to May 2013. The sample was composed of 24 puerperal women and their children. The participants presented an average age of 26.5 (DP=5.4) years, 79.2% white; 91.7% married; 58.3% multiparous; 75% with a level of education between secondary school and higher education; 58.3% with a low family income; 54.1% presented an altered pre-gestational nutritional state and 75% obtained an inadequate gestational weight gain. 79.2% of the newborns were classified as Adequate for Gestational Age (AIG). The newborns classified as Large for Gestational Age (GIG) were from pregnant women that had excessive weight gain or were overweight. It was concluded that health professionals should be attentive to nutritional deviations with the intention of avoiding complications for maternal/fetal health.