Segurança alimentar e qualidade em terapia nutricional de recém-nascidos pré-termo em UTI Neonatal

Abstract

The increasing prevalence of preterm infants’ birth and survival has challenged intensive care practitioners to develop and improve strategies to ensure the quality of nutritional therapy services and the nutritional security of these children. This study aimed to analyze which quality indicators of nutritional therapy can be implemented in a neonatal intensive care unit in order to monitor the service and prevent unwanted outcomes. A total of 81 preterm infants were divided into two groups according to their birth weight: Group 1, less than 1.500 grams and group 2, born with a weight equal to or greater than 1.500 grams. The quality indicators initially selected to be studied were: time to start nutritional therapy, time to meet energy needs, energy and protein adequacy, cumulative energy deficit, adequacy of nutritional formula, fasting periods, daily gastric residue and parenteral nutritional catheter infection. These indicators were correlated with the weight gain, the occurrence of necrotizing enterocolitis, mortality and the time of hospitalization of the unit. Statistical analysis was performed using the Skewness test (-1 to +1) and the Shapiro-Wilk test (> 0.05) and normality graphs. The parametric variables were compared between the groups by the T test and the non-parametric ones by the Mann Whitney test. Pearson's correlation tests were used when the distribution was normal and Spearman's correlation tests were used. The association of the categorized variables was evaluated by Fischer's exact test and the Odds Ratio was then calculated. It was observed significant differences between nutritional therapy and consequently nutritional status between groups 1 and 2 and the sensitivity of the indicators: time to onset of nutritional therapy, energy and protein adequacy, cumulative energy deficit, prolonged fasting, adequacy of the gastric residue and infection of the parenteral nutrition catheter with the outcomes of interest. We concluded by the recommendation of the immediate implantation of these indicators into the service in order to opportune the improvement of nutritional therapy quality and to reduce the prevalence of the unwanted outcomes, as well as the subsequent implantation of the other indicators that, although not related to the outcomes, still being important markers of nutritional safety of patients.