Há diferenças nas práticas de terapia nutricional entre pacientes pediátricos graves clínicos e cirúrgicos?

Introduction: Pediatric critically ill patients admitted for surgical reasons may differ from medical patients. However, guidelines for nutritional therapy (NT) include both medical and surgical patients. The aim of this study was to describe the NT practices of critically ill children admitted for medical and surgical reasons. Methods: Prospective cohort study conducted with critically ill children, between 1 month and 15 years old, admitted in a pediatric intensive care unit. Patients who were discharged within the first 48 hours, died within the first 72 hours or who received oral NT were excluded. Clinical and demographic were collected. Nutritional status was assessed at admission and NT data from the first 7 days was collected. Chi-square and Mann-Whitney tests were applied and p<0.05 was considered significant. Results: A total of 201 patients were included, with a median age of 2.2 years, 154 (76.6%) were admitted for medical reasons and 47 (23.4%) for surgical reasons. Compared to medical patients, surgical patients had a higher median age (5.0 vs. 1.4 years; p = 0.035), lower Pediatric Index of Mortality 2 (1.1 vs. 6.1%; p<0.001) and higher prevalence of complex chronic diseases (17 vs. 47%; p<0.001). There was no difference regarding nutritional status. Surgical patients showed higher median time for NT initiation (22.3 vs. 16.3 h; p=0.016), higher prevalence of parenteral nutrition (31.6 vs. 15.1%; p=0.019), lower energy (24.5 vs. 35.9 kcal/kg/d; p=0.003) and protein (0.82 vs. 0.99 g/kg/d; p=0.026) intake and higher prevalence of underfeeding (82.6 vs. 50%; p<0.001). There was a higher prevalence of abdominal distension (36.2 vs. 21.4%; p=0.04) and constipation (38.3 vs. 16.9%; p=0.002) in surgical patients. Conclusion: Surgical patients were older, less severe, had longer time for NT initiation, higher prevalence of underfeeding and abdominal distension in the first 7 days. NT protocols should be individualized according to the reason for hospitalization.