Evolução clinica e estado nutricional de crianças com pneumonia internadas no pronto-socorro de pediatria do hospital das clinicas da Universidade Estadual de Campinas

AUTOR(ES)
DATA DE PUBLICAÇÃO

2001

RESUMO

Every year in developing countries, five million children under 5 years of age die as a result of respiratory infections and seventy percent of these deaths are secondary to pneumonia. Infection of the upper airways is considered a predisposing factor for pneumonia and is present in various strata of society. Malnutrition is also considered a predisposing factor for pneumonia and other infections. Many authors have studied the relationship between unfavorable evolution of pneumonia and malnutrition, as well the relationship between deficient immunological response and serious infections. In 1996, the World Health Organization introduced, in Brazil, a program for the verification of malnutrition and anemia as a strategy for evaluating pneumonia. When pneumonia patients are hospitalized there is a preoccupation concerning the factors that could help in an unfavorable evolution. Anthropometrical assessment plays an important role in establishing the prognosis of this disease in children as malnutrition is thought to influence pneumonia cases. From April1999 to November 2000, 85 children above the age of 3 months and below the age of 5 years, hospitalized with pneumonia at the pediatric emergency unit of the Hospital das Clinicas, UNlCAMP, were observed in order to assess their evolution. The relationship between pneumonia evolution and sex, age, ethnicity, birth weight, mother s age and education, per capita family income, nutritional condition was evaluated using the Waterlow classification and the z score for weight/age, height/age, weight/height, upperarm circurnference, triceps skinfold, brachial fat area, brachial muscle area and body mass index. The distribution of sex and age factors in this casuistic was similar to that of previous studies. Using the Waterlow classification, the degree of malnutrition found was 8.2% and 3.2% suffered from acute malnutrition. In this study, the number of children bom with a low birth weight was higher (10.6%) than expected. It was found that 84.7% of the mothers hand up to 8 years of schooling, while the percentage for the westem region of the São Paulo State was 59.1%. Most of the mothers (56.5%) were between 20 years to 30 years and 22.4% were below the age of 20 years. The number of families with a per capita family income of less than 50% of a minimum salary was lower (7.6%) than the percentage for the entire region (36.5%). It was also observed that 75.3% ofthe children in this sample were anemic. The World Health Organization reports show that 30% of the world population is anemic, but this percentage varies in accordance with the country. The estimate of global anemia for children below school going age is 43%. A survey conducted in the State of São Paulo found that 22.6% to 59.1% of the children were anemic. Complications occurred in 27 patients (31.8%) - 22 patients had 1 complication and 5 patients had more than one complication. Pleural effusions occurred in 12 patients (44.4%), 6 patients (22.2%) had atelectasis and 8 patients (9.4%) presented acute respiratory insufficiency (ARI). No deaths occurred in this casuistic. Females predominated in the group with complications but this factor was not compatible with the information in literature. As there were no other factors that contributed towards an unfavorable evolution of pneumonia, this factor could be considered accidental because of the number of patients in this study. On the whole, malnutrition did not prove to be a determining factor for complications. However, a similar study conducted with populations having a higher percentage of malnutrition may detect the differences found by other studies.

ASSUNTO(S)

pediatria pneumonia em crianças crianças crianças - nutrição

ACESSO AO ARTIGO

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