Nutrition Therapy in a Pediatric Intensive Care Unit: Indications, Monitoring, and Complications

Background: Nutrition therapy (NT) is essential for the care of critically ill children. Inadequate feeding leads to malnutrition and may increase the patient`s risk of morbidity and mortality. The aim of this study was to describe the NT used in a tertiary pediatric intensive care unit (PICU). Methods: The authors evaluated NT administered to 90 consecutive patients who were hospitalized for 7 days in the PICU of Instituto da Crianca, Hospital das Clinicas, Universidade de Sao Paulo, Brazil. NT was established according to the protocol provided by the institution`s NT team. NT provided a balance of fluids and nutrients and was monitored with a weekly anthropometric nutrition assessment and an evaluation of complications. Results: NT was initiated, on average, within 72 hours of hospitalization. Most children (80%) received enteral nutrition (EN) therapy; of these, 35% were fed orally and the rest via nasogastric or postpyloric tube. There were gastrointestinal complications in patients (5%) who needed a postpyloric tube. Parenteral nutrition (PN) was used in only 10% of the cases, and the remaining 10% received mixed NT (EN + PN). The average calorie and protein intake was 82 kcal/kg and 2.7 g/kg per day. Arm circumference and triceps skinfold thickness decreased. Conclusions: The use of EN was prevalent in the tertiary PICU, and few clinical complications occurred. There was no statistically significant change in most anthropometric indicators evaluated during hospitalization, which suggests that NT probably helped patients maintain their nutrition status. (JPEN J Parenter Enteral Nutr. 2011;35:523-529)

Healing of displaced condylar process fracture in rats submitted to protein undernutrition

Introduction: This study evaluated the healing of mandibular condylar fracture in rats submitted to experimental and protein undernutrition (8% of protein) by means of histological analysis. Material: Forty-five adult Wistar rats were divided into three groups of 15 animals: a fracture group, who were submitted to condylar fracture with no changes in diet; an undernourished fracture group, who were submitted to a low protein diet and condylar fracture: an undernourished group, kept until the end of experiment, without condylar fracture. Displaced fractures of the right condyle were created under general anaesthesia. The histological study comprised fracture site and temporomandibular joint evaluations. Results: The undernourished fracture group showed significant weight loss. There was a marked decrease in the values of serum proteins and albumin in the undernourished fracture group. Histological analysis showed that protein undernutrition lead to atrophy of the condylar fibrocartilage. Fractures in undernutrition presented a delay in callus formation due to more extensive devitalized bone areas, and after 3 months there were still bone formation areas, while fibrous ankylosis occurred in the articular space. Conclusion: It was concluded that mandibular condyle fractures in rats with protein undernutrition had impaired callus formation, as well as fibrous ankylosis into the temporomandibular joint. (C) 2010 European Association for Cranio-Maxillo-Facial Surgery.