Publications by authors named "Alice Missagia de Mattos Springer"

2 Publications

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Hypophosphatemia in critically ill pediatric patients receiving enteral and oral nutrition.

JPEN J Parenter Enteral Nutr 2021 Jul 21. Epub 2021 Jul 21.

Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, SP, Brazil.

Background: Hypophosphatemia(HP) is related to several comorbidities in pediatric intensive care units (PICUs). This study aimed to evaluate the incidence of HP in severely ill pediatric patients receiving oral and/or enteral nutrition. The secondary objectives were to investigate the association between HP and the inflammatory state, PICU length of stay, severity, mortality, nutrition status, and protein, energy, calcium, vitamin D, and phosphate intake.

Methods: A prospective, observational cohort study was conducted in a PICU of a quaternary hospital. Participants aged between 28 days and 14 years were included. Anthropometric and laboratory assessments were performed ≤72 h after PICU admission and repeated after 7 days for three consecutive times. Energy, protein, calcium, phosphate, and vitamin D intake per day of hospitalization were recorded individually. The Pediatric Index of Mortality 2 (PIM2) was used to determine each patient's severity score.

Results: A total of 103 participants were included in the study. Hypophosphatemic events ranged from 27.2% to 37.5% among the assessments. HP was associated with high C-reactive protein levels (P = .012) and lower energy adequacy (P = .037). Serum phosphorus was inversely correlated (weak correlation) with PIM2 (P = .017).

Conclusion: HP is common in critically ill pediatric patients, even when they are not receiving parenteral nutrition. It is necessary to monitor serum phosphorus levels and consider the possibility of early replacement, especially in patients showing high levels of inflammation. In addition to inflammation itself, low energy intake and illness severity were related to HP.
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July 2021

Protein intake deficiency in critically ill children with respiratory insufficiency: A call to action?

Clin Nutr ESPEN 2020 06 17;37:69-74. Epub 2020 Apr 17.

University of Campinas, Unicamp, School of Medical Sciences, 126 Tessália Vieira de Camargo St., Cidade Universitária "Zeferino Vaz", Campinas, SP, 13083-887, Brazil; São Leopoldo Mandic College of Medicine and Dentistry, 13 Dr. José Rocha Junqueira St., Swift, Campinas, SP, 13045-755, Brazil. Electronic address:

Background & Aims: Adequate energy-protein intake is associated with improved clinical outcomes in critically ill children. The aim of this study was to evaluate the time of enteral nutrition (EN) onset and the energy-protein intake in critically ill pediatric patients admitted with respiratory insufficiency.

Methods: A single-center prospective cohort study, including children and adolescents, aged from 1 month to 14 years. All patients had been diagnosed with respiratory insufficiency and were exclusively enterally fed and had been admitted to a Pediatric Intensive Care Unit (PICU) of a public quaternary hospital in southeastern Brazil. Demographic, clinical, and nutritional therapy characteristics were recorded. Early EN (EEN) was considered when EN was initiated within the first 48 h of PICU admission.

Results: Seventy-one patients were included in this study, 64.79% were male with a median age of 6 months (2; 13) and a median PICU length of stay of 13.00 days (6.75; 23.00). PICU mortality was 4.23% and 78.87% of patients were under mechanical ventilation within the first 48 h of PICU admission with a median time of mechanical ventilation of 10 days (6.00; 16.50). The median energy adequacy was 74.97% (50.29; 93.94) and the median protein adequacy was 56.12% (40.72; 69.81). Only 7.25% of the patients achieved protein adequacy. Nutritional variables were compared between groups: EEN and late EN (LEN). EEN was utilized in 69.01% of patients who had increased energy (41.80 [34.07; 51.17] versus 23.60 [11.22; 35.17] kcal/kg/day; p < 0.0001) and protein intake (0.94 [0.78, 1.16] versus 0.53 [0.30, 0.79] g/kg/day, p < 0.0001) and better nutritional adequacies (p < 0.0001).

Conclusions: Patients who received EEN had increased energy-protein delivery and adequacies. However, protein inadequacy occurred throughout in all patients within this sample, regardless the onset of EN.
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June 2020