Bronquiolitis obliterante: perfil clínico y radiológico de 35 niños acompañados I Médico Residente de Pneumologia Pediátrica do Hospital Infantil Albert Sabin. Bronquiolitis Obliterante Pediatria Pdf. Abstract Childhood bronchiolitis obliterans (CBO) is an uncommon disease characterized by persistent. El rechazo agudo es casi un problema universal en el primer año, mientras que la bronquiolitis obliterante limita la supervivencia a largo plazo. Las infecciones.
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Assessment of nutritional status in children and adolescents with post-infectious bronchiolitis obliterans.
J Pediatr Rio J. Bronchiolitis obliterans, nutritional status, body composition, anthropometry, malnutrition, spirometry. Post-infectious bronchiolitis obliterans BO is a consequence of aggression to the epithelium of the lower respiratory tract. It is characterized by obstruction of the distal airways.
Bronquiolitis obliterante posinfecciosa en niños con deficiencia de α1-antitripsina
Published studies peidatria BO highlight that, as well its diagnosis, aggressive treatment for infections and oxygen therapy, an adequate nutritional plan should also be developed so that the illness can have favorable clinical evolution. Despite the sparsity of literature stressing the specific importance of nutritional care in BO, as well bronquioligis in other chronic respiratory diseases with acute energy consumption, patients require adequate energy intake. Though these needs are specific for each individual, the ultimate goal is to allow them to grow properly for their age.
The few studies available which describe the nutritional status of BO patients are inconsistent in their methods and do not explore the nutritional status of the individuals. The objective of this study is to assess the nutritional status of children and adolescents with BO and to analyze associations with clinical and nutritional factors. The diagnosis of BO was based on the coexistence of: Patients were classified as either child or adolescent, depending on their age group.
Weight and stature anthropometric measurements were taken through the use of standard techniques and calibrated equipment. In children, nutritional status was determined using the following z scores: Children with ZPE ranging from When more than one anthropometric index ZPE, ZPI and ZEI was used for kbliterante of nutritional status, the lowest value was used in cases where there were discrepancies in the ranges used. Pulmonary function was assessed for patients 8 years-old and older through the use of spirometry and 6-minute walk tests 6MWT.
Spirometry was performed using a portable spirometer SpiroDoc v. The parameters assessed were total distance run and final and initial oxygen saturation.
Distance run was presented in terms of peditria score predicted Z6MWT. Those who accepted signed release forms giving their free pediatrja informed consent. The study was approved by the research ethics committees of the two hospitals involved, as per resolution Results are expressed as follows: Student’s t test or analysis oblitrante variance ANOVA were used for comparing quantitative variables with symmetrical distribution.
Obluterante Pearson chi-squared test or the Fisher exact test were used for een association between categorical variables. Pearson’s symmetrical distribution or Spearman’s asymmetrical distribution correlation tests were used for assessing associations between quantitative variables. The kappa test was used for assessing concordance between methods.
Fifty-seven patients took part in the study, 40 At the time of the assessment, the mean average age was 8. The mean average birth weight was 3, Regarding nutritional status, 24 patients The data for nutritional status of children and adolescents, divided by age group, are shown in Table 1.
The data for body composition for the whole sample can be found in Table 2. In analyses of the association between nutritional status and body composition, patients were divided into three groups, according to nutritional status: For excess adiposity, the use of TSF and SSF shows that malnourished patients are significantly associated with low fat reserves.
We should stress that, among eutrophic patients, eight Thirty-two patients in total took part in pulmonary function analysis. One patient showed exacerbating symptoms and could not finish the 6MWT, though he did perform spirometry. The data for nutritional status, body composition, spirometry and the 6MWT are shown in Table 3.
Figure 1 shows that the average difference between both groups was 1 SD, both for nutritional status and for body composition.
The data collected in this study for diagnosis age and early clinical signs are similar to those found in other studies, which featured diagnosis ages ranging from 1 month-old to 3 years-old, 4,8,23 while the first respiratory signs are always seen before the age of 2 4 and the disease was most frequent among boys. The role of socioeconomic factors on morbidity and mortality for childhood respiratory diseases has been widely described in the literature: Caldwell 26 presented evidences of the positive and independent effect of schooling of the mother on childhood mortality rates and recognized the importance of the environment as an intervening factor for this association.
Literature on the assessment of nutritional status in BO patients is scarce, and there is no published scientific material similar to the methods used in this study.
Therefore, this study can be considered pioneering in its assessment of the nutritional status and body composition of children and adolescents with BO. The individuals in this study were followed by a multidisciplinary team whose members are always and at all times concerned with nutritional status. There was a notable incidence of malnutrition This scenario is probably due to the use of more sensitive criteria for the assessment of nutritional status, which used various indices for the description or classification of nutritional status since it is known that none is universalas well as the morbidity secondary to BO, such as recurring infections, exacerbation episodes and frequent hospitalizations.
Even without detailed nutritional diagnosis methods, or with the use of only one index, malnutrition was also a frequent finding in the few existing studies of BO. The latter index is more sensitive for the diagnosis of overweight and obesity. The literature does not feature reports of patients with BO who are overweight. In this study, we found 8. We must consider the particularities of the indices used when analyzing these results.
It reflects the individual’s global status, but it does not discriminate between acute and chronic nutritional compromise. For body composition, depleted muscle reserves were found in The lack of studies of body composition in BO patients led to making comparisons with other diseases. In CF, as well as pulmonary compromise, many patients also present digestive manifestations.
Therefore, these features should be taken into consideration for comparisons with BO. Among patients classified as eutrophic, In the present study, if not for the use of wider assessment which associated weight and stature indices to body composition data, up to The data indicate the deterioration of their nutritional status. Impairment of pulmonary function was found to be associated with lower performance 6MWT, a fact which can be associated with the condition of the patients, most of which suffered from moderate-to-severe chronic obstructive pulmonary disorder.
Malnutrition or risk for malnutrition, as well as low muscle reserves, were significantly associated with 6MWT, which indicates the level of functional limitation for the patients.
This sample allows us to infer that the deterioration of nutritional status is directly related to performance in the 6MWT.
We must consider that, since this is a rare disorder, only a small sample of patients performed spirometry. The population presented an important nutritional deficit. The data may reflect the morbidity associated with BO. It reinforces the need for multidisciplinary follow-up for these patients, similar to what happens with other pulmonary disorders, such as CF.
We stress the importance of systematic nutritional assistance, as well the periodic and detailed assessment of nutritional status for these patients.
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Nutrition might become an important prognostic factor for BO evolution due to the importance of pulmonary growth tracking somatic growth. In the present study, patients presented major nutritional compromise, which indicates that both impairment of pulmonary function and malnutrition are associated with lower performance levels in the 6MWT exercise.
Future studies are needed to discover whether malnutrition and low muscle reserves are inherent consequences to BO or if this condition can be reverted with the use of more specific nutritional therapy.
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