Lesões pulmonares e nutrição parenteral total em crianças internadas em unidade de terapia intensiva pediátrica

Abstract

Suggested citation: Ramos-Silva V, Castello JS, da Motta LL, Pereira FE, Oliveira NS, Lamounier JA. Pulmonary lesions and total parenteral nutrition in children admitted to a pediatric intensive care unit. J Pediatr (Rio J). 2005;81:155-61. AbstractObjective: To describe lung injuries in autopsied pediatric patients (neonates through 15 years old) subjected or not to total parenteral nutrition, in an intensive care unit. Methods:Sections from six paraffin-embedded lung fragments, from 114 children were studied by routine staining. Demographic, clinical and therapeutic data were retrieved from the records. Statistical analysis was performed using Statistical Package for the Social Sciences.Results: The 114 patients were divided in two groups: 50 who were treated with total parenteral nutrition with lipid emulsion and 64 who did not receive total parenteral nutrition. The two groups did not differ in gender (p = 0.654), age (p = 0.682) or body weight (p = 0.175), but duration of hospital stay (p = 0.000), prematurity (p = 0.008) and treatment with blood products (p=0.009) were all higher in the group treated with total parenteral nutrition. All patients received mechanical ventilation during hospitalization. Chi-square comparisons showed that diffuse alveolar injury (p=0.022), pulmonary fibrosis (p = 0.019), pneumocyte hyperplasia (p = 0.004), microthromboembolism (p = 0.047) and thrombophlebitis (0.033) all exhibited a significant relationship with total parenteral nutrition. However, a multivariate analysis by logistic regression, taking into account prematurity and duration of hospital stay, demonstrated that total parenteral nutrition was an independent factor only with respect of pulmonary fibrosis. Conclusion:Although lung injuries were significantly more frequent in children who had received total parenteral nutrition, it was impossible to conclude that the lipid infusion had a direct relationship with these injuries, because prematurity and duration of hospital stay were significant co-factors.