TRAINING OF CHILDREN'S AND ADOLESCENTS' FAMILY MEMBERS IN HOME PARENTERAL NUTRITION CARE

Bioelectrical impedance phase angle and nutritional status in children with intestinal failure on prolonged parenteral nutrition

OBJECTIVE

To compare the phase angle (PhA) through bioelectrical impedance (BIA) of children with intestinal failure (IF) using prolonged parenteral nutrition (PN) followed by an Intestinal Rehabilitation Program, with a control group.

METHODS

Children under 10 years of age with IF using prolonged PN for >60 days (study group) were included. The control group consisted of healthy children without chronic pathologies, matched by sex and age. Anthropometric parameters evaluated were: weight, height, weight/age z-score (W/A), height/age z-score (H/A), BMI, BMI/A z-score, arm circumference, triceps skinfold, subscapular skinfold, mid-arm muscle circumference. BIA parameters were resistance (R), reactance (Xc), and phase angle (PhA).

RESULTS

Twenty-eight children were included in the study group, median (IQR) age was 11 (8-27) months, 53.6 % were male. In the control group, 28 children were included, median (IQR) age was 12.5 (8-24.7) months, 50 % were male. Children from the study group had W/A z-scores and H/A z-scores significantly lower than controls. There was no significant difference between PhA in the study group and controls, [median (IQR) 4.3° (3.8;4.6) vs 4.0° (3.8;5.4) respectively, p = 0.980]. Prematurity was significantly higher in the study group than in the controls, but there was no significant correlation between gestational age at birth and PhA of the children from the study group.

CONCLUSION

Children with IF using prolonged PN showed lower W/A and H/A compared to the control group, but without significant difference between the PhA of children with IF compared to controls.

Nursing guidelines for caregivers of children with congenital heart disease after discharge: Integrative Review

Objective

To identify the nursing guidelines for caregivers of children with congenital heart disease (CHD) after hospital discharge.

Methods

This is an integrative literature review of articles published between 2016 and 2022. In order to select the studies, the controlled descriptors "Nursing Care", "Nursing", "Heart Defects, Congenital", "Caregivers" and "Child" were used in four scientific databases - LILACS, SCIELO, PUBMED and BDENF.

Results

The current integrative literature review analyzed 11 articles from the original sample. The main nursing care issues are those related to nutrition, oral health, leisure and physical activity, care with medication and the surgical wound, as well as the need to offer support to these children's families. The authors emphasize that nurses are present at various moments in a child's life, including at birth, but the approach to CHD is scarce in their basic training as nurses, as well as in their professional practice, and there is a shortage of continuing education proposals for the care of children with CHD.

Conclusion

The study showed that nursing guidelines are focused on basic care and family support for these children. Lastly, this study highlighted the important role of nurses in terms of consolidating guidelines on the care needs of these children.

Effects of Adipose Plasma Transfusion Compared with Normal Plasma Transfusion on Adverse Transfusion Reactions, Important Functional Indicators, and Clinical Safety in Patients with Parenteral Nutrition: Based on a Retrospective Cohort Study

Objective

Based on a retrospective cohort study, the study aims to investigate the effects of adipose plasma transfusion compared with normal plasma transfusion on adverse transfusion reactions, important functional indicators, and clinical safety in patients with parenteral nutrition (PN).

Methods

One hundred and twenty inpatients who needed PN and plasma transfusion in Xianning Central Hospital from September 1, 2021, to March 31, 2022, were enrolled as the actual application verification cases. All the patients in the group noticed the informed consent form, and the normal plasma transfusion was set as the control group (n = 40), and the fat plasma transfusion was set as the study group. Mild adipose plasma transfusion was adopted in study group ① and moderate adipose plasma transfusion was used in study group ②, 40 cases in each group. The blood routine tests, blood lipids, blood coagulation, liver function tests, and the incidence of adverse reactions of blood transfusion were compared.

Results

The comparison results of platelet count, red blood cell count, hemoglobin, and hematocrit among the three groups are as follows: study group ②> study group ①> control group (P < 0.05).The levels of blood lipids in the three groups, triglyceride, total cholesterol, high density lipoprotein, and low density lipoprotein were compared in group ②>group ①>control group (P < 0.05).The liver function tests indexes of the three groups were compared: ALT, AST, LDH: study ②study ①>control group. Regarding the incidence of adverse transfusion reactions, the incidence of adverse transfusion reactions in the study group was lower than in the control group (P < 0.05).

Conclusion

Compared with normal plasma transfusion, the inpatients who need PN and plasma transfusion can effectively use the scrapped mild and moderate fatty plasma and reduce the plasma scrap rate. In the meantime, it has little effect on the function of the important indexes of the patients, and the incidence of adverse reactions of blood transfusion is low and the safety is high. Infusion of adipose plasma can also improve the effective individual and rational utilization of blood products. Trial registration: This trial is registered with chiCTR220005918.

Outcomes of the First 54 Pediatric Patients on Long-Term Home Parenteral Nutrition from a Single Brazilian Center

OBJECTIVES

Data on multidisciplinary programs dedicated to home parenteral nutrition (HPN) in Latin America are limited. This study describes the results of the first multidisciplinary pediatric intestinal rehabilitation program for HPN at a public tertiary hospital in Brazil.

METHODS

We retrospectively reviewed patients aged 0-18 years with intestinal failure (IF) who required parenteral nutrition (PN) for >60 days between January/2014 and December/2020.

RESULTS

Fifty-four patients were discharged on HPN (15 achieved enteral autonomy, 34 continued on HPN at the end of the study, 1 underwent intestinal transplantation, and 4 died). The median (IQR) age at the study endpoint of patients who achieved enteral autonomy was 14.1 (9.7-19) versus 34.7 (20.4-53.9) months in those who did not achieve enteral autonomy. Overall prevalence of catheter-related thrombosis was 66.7% and catheter-related bloodstream infection rate was 0.39/1000 catheter-days. Intestinal failure-associated liver disease (IFALD) was present in 24% of all patients; none of the patients who achieved enteral autonomy had IFALD. All patients showed significant improvement in anthropometric parameters during the HPN period. The sociodemographic characteristics of the patients' family members were mothers less than 20 years old (7.5%), schooling time more than 10 years (55.5%), and household income between 1 and 3 times the minimum wage (64.8%). The 5-year survival rate for HPN is 90%, and 27.7% of patients achieve enteral autonomy.

CONCLUSION

The treatment of pediatric patients with IF followed by a multidisciplinary pediatric intestinal rehabilitation program with HPN is feasible and safe in the Brazilian public health system.