BACKGROUND:Patients discharged from the intensive care unit (ICU) often experience high morbidity rates. The aim of the present study was to estimate the incidence of functional capacity impairment in pediatric patients who were discharged from the ICU in a middle-income country and to identify associated factors, considering the socioeconomic context. METHODS:This was a multicenter cohort study of 357 patients aged <18 years admitted to three ICUs in the interior cities of São Paulo State. The Functional Status Scale was used to assess the patients at admission, ICU discharge, and hospital discharge. New morbidity was defined as a change in any domain of the scale equal to or greater than two, or a change in the total score equal to or greater than three. A multiple logistic regression model was used to identify independent associations with new morbidity. RESULTS:New morbidity occurred in 14.6% and 12.3% of patients at ICU and hospital discharge, respectively, compared with those at admission. The feeding (p < 0.001) and respiratory (p = 0.036) functional domains were the most affected at ICU discharge. The risk factors associated with new morbidity at hospital discharge were heart disease, older age, longer ICU stay, and higher PELOD2 severity score. CONCLUSIONS:To reduce the risk of new functional morbidity, healthcare teams should be attentive to the critically ill pediatric population, particularly those who are older and have chronic clinical conditions, especially heart disease.

BACKGROUND:Children with intestinal failure are at risk for kidney dysfunction; however, the contributing factors are not well established. We aimed to describe risk factors associated with glomerular and tubular renal dysfunction in children with intestinal failure. METHODS:This retrospective cohort study assessed glomerular and tubular dysfunction in children receiving parenteral nutrition for intestinal failure at two subsequent time points. Glomerular function was assessed using the estimated glomerular filtration rate and urinary microalbumin/creatinine ratio. Tubular function was assessed using the urinary calcium/creatinine ratio and maximum tubular reabsorption of phosphate for estimated glomerular filtration rate. We tested the association between outcomes and ultrashort bowel, age at admission to the intestinal rehabilitation program, length of follow-up, prematurity, low birth weight, malnutrition, preserved colon in continuity, and ileocecal valve. RESULTS:The study included 25 patients with a median age of 0.3 (0-14) years, of whom 14 (56%) were boys. Two patients had decreased estimated glomerular filtration rate (one at each time point). Microalbuminuria was observed in four children at time point 1 and persisted in one child at time point 2. Hypercalciuria occurred in 10 of 23 and 9 of 24 children at time points 1 and 2, respectively; 5 maintained this alteration at both time points. Reduced maximum tubular phosphate reabsorption/estimated glomerular filtration rate ratios were observed in 6 of 12 and 2 of 14 children at time points 1 and 2, respectively. CONCLUSION:Two-thirds of children with intestinal failure had renal dysfunction, represented by microalbuminuria, reduced estimated glomerular filtration rate, hypercalciuria, and phosphaturia.

BACKGROUND & AIMS:To identify predictors of enteral autonomy and survival in pediatric intestinal failure patients followed up at three pediatric intestinal rehabilitation centers from a middle-income country. METHODS:This retrospective multicenter cohort study evaluated patients with intestinal failure from three high-volume intestinal rehabilitation centers on long-term parenteral nutrition between 2014 and 2023. The primary outcome was status at the end of the follow-up: parenteral nutrition dependence, enteral autonomy, transplantation, or death. Secondary outcomes were complications resulting from treatment and current parenteral nutrition dependency index. Competing risk analysis, Cox regression, and a decision tree model were employed. RESULTS:The cohort comprised 207 patients with a median (interquartile range) age at admission of 6.2 (3.1; 12.9) months and a median follow-up of 29.4 (10.2; 49.6) months. Short bowel (85 %) and motility disorders (10.6 %) were the primary causes of intestinal failure. Cumulative incidence of 5-year for enteral autonomy and survival rates were 37 % and 88 %, respectively. Intestinal failure-associated liver disease was present in 24 % of patients on admission. Enteral autonomy was associated with remnant intestine length >40 cm (hazard ratio: 2.0; 95 % confidence interval: 1.7; 3.6); age at admission <6.2 months (hazard ratio: 1.8; 95 % confidence interval: 1.0; 3.3); and preserved ileocecal valve (hazard ratio: 3.4; 95 % confidence interval: 1.9; 6.0). The overall mortality rate was 7.7 %. CONCLUSION:The overall survival rate was 92.3 % and the 5-year cumulative incidence of enteral autonomy was 37 %. The probability of achieving enteral autonomy was associated with early arrival at the intestinal rehabilitation center and favorable bowel anatomy.

Background: Sarcopenia, characterized by decreased muscle mass, strength, and function, is associated with adverse outcomes. The prevalence of sarcopenia and the effect of the inflammatory response on muscle strength loss in children undergoing hematopoietic stem cell transplantation (HSCT) are unknown. This study aimed to estimate the prevalence of sarcopenia on admission and its associated clinical factors in children and adolescents undergoing HSCT and to determine the extent to which the systemic inflammatory response during hospitalization affects muscle strength. Method: This was a prospective study of patients aged 6-18 years old undergoing HSCT. The outcome variables were the prevalence of sarcopenia on admission (loss of strength and skeletal muscle mass) and the loss of handgrip strength during hospitalization. Potential explanatory variables included age, sarcopenia, nutritional status and systemic inflammation as measured by serum C-reactive protein, albumin and ferritin concentrations. Results: Eighty patients with a mean age of 11.5 ( 3.5) years were included. The main diagnoses were acute lymphocytic leukemia, acute myeloid leukemia and aplastic anemia. Eleven percent of patients had sarcopenia upon admission. Female sex, sarcopenia on admission (/3 coefficient: 0.70; 95% CI:-1.30 to-0.12; p-value = 0.018) and serum C-reactive protein concentration (/3 coefficient:-0.10; 95% CI:-0.16 to-0.04; p-value = 0.001) were associated with handgrip strength loss from admission to 14 days after HSCT. Conclusion: Sarcopenia on admission and the degree of systemic inflammatory response are associated with decreased handgrip strength during hospitalization in pediatric patients undergoing HSCT. Further studies using the same criteria for diagnosing sarcopenia are required to enhance our understanding of these relationships. (c) 2024 Associa & ccedil;& atilde;o Brasileira de Hematologia, Hemoterapia e Terapia Celular. Published by Elsevier Espa & ntilde;a, S.L.U. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Objectives: Children on long-term parenteral nutrition (PN) are at high risk of iodine deficiency (ID). However, most available information comes from cross-sectional studies. We investigated the iodine status, associated factors, and prevalence of hypothyroidism in children with intestinal failure (IF) who were followed up longitudinally. Methods: This was a cohort study of children with IF monitored for urine iodine concentration (UIC), iodine intake, serum selenium concentration, and thyroid function in an intestinal rehabilitation program. The outcome variable ID was defined as a UIC value < 100 mu g/L. Adjusted generalized estimating equations were used to assess the effects of the exposure variables on the UIC. Results: Twenty-four patients aged 62.7 (39.1; 79.7) months who received PN for 46.5 (21.5) months were included. The average energy supply was 81.2 kcal/kg/day, 77.6% of which was provided by PN. An average of 5.2 UIC measurements per patient were performed. ID prevalence decreased from baseline (83.3%) to the last assessment (45.8%). Three patients had hypothyroidism secondary to iodine and selenium combined severe deficiency. Iodine intake from enteral or oral nutritional formulas was positively associated with UIC (beta = 0.71 [0.35, 1.07]; p < 0.001). Meeting approximately 80% of the estimated average requirement for iodine from nutritional formulas resulted in a greater probability of normal UIC values. Conclusion: ID is highly prevalent in children with IF who receive long-term PN and its frequency decreases with iodine intake from nutritional formulas. Severe combined iodine and selenium deficiencies are associated with the development of hypothyroidism in these patients. [GRAPHICS] .

Background: Zinc (Zn), copper (Cu), and selenium (Se) are involved in immune and antioxidant defense. Their role in systemic inflammatory response syndrome (SIRS) treatment and outcomes remains unclear. This sys-tematic review aimed to describe trace element concentrations in different types of biological samples and their relationship with morbidity and mortality in patients with SIRS.Methods: Literature was systematically reviewed according to the preferred reporting items for systematic reviews and meta-analyses (PRISMA). The search re-sults were screened and evaluated for eligibility, and data were extracted and summarized in tables and figures.Results: Most of the 38 included studies evaluated Se (75%), followed by Zn (42%) and Cu (22%). Plasma was the main biological sample evaluated (58%). Thirteen studies found lower plasma/serum concentrations of Zn, Se, and Cu in SIRS patients than in controls upon admission, 11 studies on adults (intensive care unit-ICU) and two in pediatric ICU (PICU). Three ICU studies found no difference in erythrocyte trace element concentrations in patients with SIRS. In all studies, the two main outcomes investigated were organ failure and mortality. In seven ICU studies, patients with lower plasma or serum Zn/Se levels had higher mortality rates. A study conducted in the PICU reported an association between increased Se variation and lower 28-day mortality. In an ICU study, lower erythrocyte selenium levels were associated with higher ICU/hospital mortality, after adjustment. Five ICU studies associated lower plasma/serum Zn/Se levels with higher organ failure scores and one PICU study showed an association between higher erythrocyte Se levels and lower organ dysfunction scores. Conclusion: There was no difference in erythrocyte Se levels in patients with SIRS. Serum/Plasma Zn and serum/plasma/erythrocyte Se are associated with organ dysfunction, mortality, and inflammation. Trace element deficiencies should be diagnosed by erythrocyte, or complementary measurements in the presence of inflammation.

The research by Andrades et al. on the nutritional status of critically ill pediatric patients with chronic complex conditions (CCC) [ [1] Rupp Hanzen Andrades G. Abud Drumond Costa C. Crestani F. Tedesco Tonial C. Fiori H. Santos I.S. et al. Association of nutritional status with clinical outcomes of critically ill pediatric patients with complex chronic conditions. Clin Nutr. 2022; 41: 2786-2791https://doi.org/10.1016/j.clnu.2022.10.019 Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar ] is welcome, as there is little data on children in the literature [ [2] Hecht C. Weber M. Grote V. Daskalou E. Dell’Era L. Flynn D. et al. Disease associated malnutrition correlates with length of hospital stay in children. Clin Nutr. 2015; 34: 53-59https://doi.org/10.1016/j.clnu.2014.01.003 Abstract Full Text Full Text PDF PubMed Scopus (150) Google Scholar ]. The authors concluded that these children were more likely to be underweight and overweight than those without CCC and that being underweight was associated with a prolonged length of stay (LOS). In addition to the appealing results, a careful reading of this article raises some interesting questions.

BACKGROUND:Most data on anemia in children with intestinal failure (IF) have been obtained from studies in which the data were collected at a single point in time. We aimed to identify the frequency of anemia and factors associated with hemoglobin levels in children with IF during their course of home parenteral nutrition. METHODS:We performed a longitudinal cohort study of patients with IF followed up at a pediatric intestinal rehabilitation center. Outcome variables were hemoglobin levels and prevalence of anemia during the follow-up period. The exposure variables were age, duration of parenteral nutrition, chronic disease, and serum concentrations of C-reactive protein, iron, copper, selenium, vitamins A, D, B12 , and folic acid. RESULTS:Twenty-five children with a median time of receiving parenteral nutrition of 40.7 months were included. A median (and interquartile range) of 40.7 (25.2-58) hemoglobin measurements were performed per patient. Mean (SD) hemoglobin was 10.7 (1.8) g/dL at baseline and 11.6 (0.9) g/dL in the last observation (paired t test, P = 0.07); 32% of patients had mean hemoglobin values below the lower limit for age. In a multivariable predictive model, having C-reactive protein >1 mg/dL was associated with a decrease of 0.57 g/dL in hemoglobin (95% CI, -0.90 to -0.24, P = 0.01), and an increase of 1 mg/L in vitamin A concentration was associated with the increase of 0.93 g/dL in Hb level (95% CI, 0.24-1.61; P = 0.008). CONCLUSION:Anemia affects almost one-third of children with IF and its frequency decreases during the follow-up period. Hemoglobin levels are associated with inflammatory response and serum micronutrient concentrations.

Background: The supply of essential micronutrients plays a critical role in children with intestinal failure (IF), because they are at risk of deficiency owing to reduced intestinal absorption, insufficient intake, losses from diarrhea, drains, fistulas and use of medications. Long term parenteral nutrition in children is associated with a risk of trace element deficiency, specially zinc, which is essential for immune function, antioxidant defenses and protein synthesis. Methods: For the preparation of this case report, the appropriate information was obtained through consultation of data from the patient’s electronic medical records. The study was approved by the ethics committee of the hospital and the consent form was applied to the patient’s parents. Due to the clinical picture of the patient, it was not possible to apply an assent term Results: This report presents a case of a 5- year- old boy, who has been receiving parenteral nutrition, since birth, due to necrotizing enterocolitis (NEC). He was a premature baby of 25 weeks, weighed 1115 g at birth, with tracheal atresia, needing a traqueostomy. During the first weeks of life, he developed NEC with a massive intestinal resection and needed a jejunostomy. At 7 months of age, an intestinal reconstruction with duodenoileoanastomosis was performed. At 8 months of age, he was discharged home for the first time. He is completely dependent on parenteral nutrition, with poor tolerance for enteral nutrition. After 5 years in parenteral nutrition, he developed a skin rash, first in perioral area, and quickly evolved into perineal region and around the gastrostomy and tracheostomy. He also presented with alopecia, brittle nails, and irritability. He was receiving the adequate amount of energy and protein requirement in his tailored made parenteral nutrition,with polivitamin and trace elements. His zinc sulfate prescription was 40mcg/kg/day and the blood level of zinc was in the normal range of 0,5mcg/ml (reference range 0,5 – 1,1 micrograms/ml). We performed blood tests, to look for infection, specially fungus, micronutrient tests, including copper, iron, aluminium, cromium, manganese, vitamins and excluded all of them, including fatty acid deficiency and essential aminoacid deficiency. We also performed a tricology test that revealed zinc deficiency. After nine days of zinc sulfate suplementation with 200mcg/kg/day, he solved completely the skin eruption. Conclusion: In general, it´s assumed that if we provide the ESPGHAN recomendation of trace element products, children will mantain their blood level of micronutrients adequate. However, children with intestinal failure depending on long term parenteral nutrition, might need a tailored provision of trace elements, accordingly to routinely measurements of blood levels and also taking into account their clinical condition with emphasis on those at risk of deficiency.

Background: Iodine is essential for thyroid hormone biosynthesis. We investigated the prevalence of iodine deficiency (ID) and hypothyroidism in children with intestinal failure (IF) followed up longitudinally, considering selenium status, which is also essential for thyroid gland function. Methods: Children admitted to an intestinal rehabilitation program and receiving home PN were regularly followed-up for urine iodine concentration (UIC), selenium, and thyroid function tests from April 2019 to June 2022. The outcome variable ID was defined as a UIC value < 100 μg/L. Generalized estimating equations were used to assess the effects of potential variables associated with UIC. The study was approved by the hospital’s ethics committee. Results: Twenty-four patients aged 62.7 (39.1; 79.7) months receiving PN for 46.5 (21.5) months were included. The average energy supply was 81.2 kcal/kg/day, 77.6% of which was provided by PN. An average of 5.2 UIC measurements per patient were performed. The prevalence of ID decreased from the first assessment (83.3 %) to the last (45.8%). Three patients developed hypothyroidism secondary to iodine and selenium combined severe deficiency. In the adjusted analysis, iodine intake from oral or enteral nutritional formulas was associated with UIC (β= 0.71 [0.35, 1.07]; p < 0.001). Normal UIC values were observed in patients who reached ≥ 80% of the recommended iodine intake from nutritional formula.Figure 1.: Adjusted linear prediction of iodine intake adequacy from oral or enteral nutritional formulas on urinary iodine concentration (µg/L). The dotted line represents the lower limit of UIC (urinary iodine concentration).Conclusion: ID is highly prevalent in children with IF who receive long-term PN, and its frequency decreases with iodine intake by nutritional formula. Patients who developed hypothyroidism had severe combined iodine and selenium deficiency. Iodine and selenium status, thyroid function, and iodine intake should be monitored in children with IF.

Introduction: Long-term parenteral nutrition (PN) has been associated with renal complications, including hypercalciuria, nephrocalcinosis/nephrolithiasis, proteinuria and reduced glomerular filtration rate (GFR). Pediatric data are scarce and mostly short-term or restricted to transversal studies. Our study aimed to evaluate renal complications in children with intestinal failure (IF) receiving long-term PN. Methods: We performed an observational longitudinal study of patients with IF followed up in a pediatric intestinal rehabilitation center. Outcome variables were estimated glomerular filtration (eGFR) rate, hypercalciuria, nephrocalcinosis/nephrolithiasis, proteinuria, phosphaturia and oxaluria during the follow-up period. The exposure variables were age, duration of parenteral nutrition and type of short bowel syndrome (SBS). The study was approved by the hospital’s ethics committee. Methods: Twenty-four children (54% males), aged 74 months (16; 205) with a median time receiving parenteral nutrition of 47.5 months (IQ 26.5). Data related to renal function were evaluated in two moments, with a median interval of 8 months (IQ 4.5 months). Hypercalciuria was observed in 60.8% and 58.3%, increased phosphaturia in 25% and 18.7%, increased oxaluria in 36.8% and 25% and increased microalbuminuria/proteinuria was observed in 19% and 13.6% of patients, respectively, at moments 1 and 2. Despite de high incidence of hypercalciuria, nephrolithiasis was observed in one patient. In addition to the patient with nephrolithiasis, small and hyperechogenic kidneys were observed in another patient in the image evaluation. The median eGFR rate was 164.5 ml/min/1.73m2 (IQ 52.7) and 195 ml/min/1.73m2 (IQ 38.7) at moments 1 and 2, respectively. There was only one patient with reduced eGFR (77.7 and 78 ml/min/1.73m2) at both times. A significant association was observed between SBS (type 3) and eGFR, with β-coefficient = - 41.07 (95% confidence interval [CI], -66.5; -15.6, p=0,002). Conclusion: The high frequency of hypercalciuria, microalbuminuria and proteinuria, in addition to the state of glomerular hyperfiltration represent risk factors for long-term renal dysfunction. Despite the high incidence of hypercalciuria, nephrocalcinosis/nephrolithiasis was observed in olnly one patient. Long-term monitoring of various aspects of renal function is essential to characterize the effects of prolonged PN on kidney functions in pediatric patients.

Abstract Objective: To describe weight and height evolution and to identify risk factors for insufficient anthropometric growth in children with congenital heart disease. Methods: Historical cohort study including 131 children with congenital heart disease, followed up at a nutrition outpatient clinic. The anthropometric indices over time (initial score, after 12 and 24 months of follow-up) were analyzed using generalized estimating equations. The outcome was ‘insufficient weight-height gain’, defined as an increase of ≤0.5 in the z-score of weight-for-age (W/A), height-for-age (H/A) or body mass index-for-age (BMI/A) after 12 months of follow-up. Multiple logistic regression models were applied to identify risk and confounding factors. Results: The z-scores of W/A (p<0.001) and BMI/A (p<0.001) improved after 12 months, as well as the three indexes after 24 months (p<0.001). At the end of this period, 55.7% of the patients did not achieve an increase of >0.5 in the Z score of W/A; 77.1%, of H/A; and 45.8%, of BMI/A. A follow-up of less than five appointments was associated with insufficient gain in W/A (OR 7.78; 95%CI 3.04–19.88), H/A (OR 10.79; 95%CI 2.22–52.45) and BMI/A (OR 2.54; 95%CI 1.12–5.75). Not having undergone cardiac surgery and being aged ≥12 months were factors associated with insufficient W/A gain (OR 3.95; 95%CI 1.38–11.29/OR 3.60; 95%CI 1.33–9.72) and BMI/A (OR 2.81; 95%CI 1.08–7.28/OR 3.39; 95%CI 1.34–8.56). Low income was associated with insufficient H/A gain (OR 4.11; 95%CI 1.25–13.46). Conclusions: Being aged less than or 12 months, the lowest number of appointments, absence of surgical treatment and low family income were risk factors for insufficient weight and height gain in children with congenital heart disease.

OBJECTIVES:Plasma selenium may not reflect selenium status in critically ill patients because it transiently decreases inversely with the magnitude of the systemic inflammatory response. The decision to supplement selenium should ideally be based on laboratory measurements that reliably reflect selenium status. We hypothesized that erythrocyte selenium, unlike plasma selenium, is not affected by the systemic inflammatory response in critically ill children. METHODS:In a prospective study of 109 critically ill children, plasma and erythrocyte selenium concentrations were evaluated on admission, and plasma selenoprotein P was evaluated on days 1, 2, and 3 of the ICU stay. The main outcome was the effect of systemic inflammation on the erythrocyte and plasma selenium concentrations. The magnitude of the systemic inflammatory response was measured using serum C-reactive protein (CRP) and procalcitonin levels. The covariates were age, sex, anthropometric nutritional status, diagnosis of severe sepsis/septic shock, and clinical severity on admission. Multiple linear regression and generalized estimating equations were used for statistical analysis. RESULTS:Erythrocyte selenium levels were not influenced by the magnitude of the inflammatory response or by the patient's clinical severity. Procalcitonin (β coefficient=-0.99; 95%CI: -1.64; -0.34, p = 0.003) and clinical severity (β coefficient= -11.13; 95%CI: -21.6; -0.63), p = 0.038) on admission were associated with decreased plasma selenium concentrations. Erythrocyte selenium was associated with selenoprotein P in the first three days of ICU stay (β coefficient=0.32; 95%CI: 0.20; 0.44, p < 0.001). CONCLUSION:Unlike plasma selenium, erythrocyte selenium does not change in children with an acute systemic inflammatory response and is associated with selenoprotein P concentrations. Erythrocyte selenium is probably a more reliable marker than plasma selenium for evaluating the selenium status in critically ill children.

Resumo Objetivo: Descrever a evolução pôndero-estatural e identificar fatores de risco para o crescimento antropométrico insuficiente de crianças com cardiopatia congênita. Métodos: Coorte histórica de 131 crianças com cardiopatia congênita acompanhadas em ambulatório de nutrição clínica. Os escores dos índices antropométricos ao longo do tempo (inicial, após 12 e 24 meses de acompanhamento) foram analisados por equações de estimativas generalizadas. O desfecho foi o ganho pôndero-estatural insuficiente, definido como aumento ≤0,5 nos escores Z de peso para idade (P/I), estatura para idade (E/I) e índice de massa corpórea para idade (IMC/I) em 12 meses de acompanhamento. Foram aplicados modelos de regressão logística múltipla para identificação dos fatores de risco e controle dos fatores de confusão. Resultados: Os escores Z de P/I (p<0,001) e IMC/I (p<0,001) melhoraram após 12 meses, e os três índices após 24 meses (p<0,001). Ao final desse período, 55,7% dos pacientes não alcançaram aumento >0,5 escore Z de P/I; 77,1%, de E/I; e 45,8%, de IMC/I. O acompanhamento inferior a cinco consultas associou-se ao ganho insuficiente de P/I (OR 7,78, IC95% 3,04–19,88), E/I (OR 10,79, IC95% 2,22–52,45) e IMC/I (OR 2,54, IC95% 1,12–5,75). Não ter sido submetido à cirurgia cardíaca e ter idade ≥12 meses estiveram associados ao ganho insuficiente de P/I (OR 3,95, IC95% 1,38–11,29/ OR 3,60, IC95% 1,33–9,72) e IMC/I (OR 2,81, IC95% 1,08–7,28/OR 3,39, IC95% 1,34–8,56), e a baixa renda, ao ganho insuficiente de E/I (OR 4,11, IC95% 1,25–13,46). Conclusões: Idade ≥12 meses, menor número de consultas, ausência de tratamento cirúrgico e baixa renda familiar foram fatores de risco para a evolução pôndero-estatural insuficiente em crianças com cardiopatia congênita.

Background & aims: Evidence that selenium has a role in endothelial function comes mainly from experimental research, but few clinical studies have examined the pathophysiology of selenium in endothelial activation. We aimed to investigate whether there are associations between selenium status and the magnitude of endothelial activation and the severity of multiple organ dysfunction during the acute phase of systemic inflammatory response syndrome (SIRS) in children. Methods: A prospective cohort study was carried out in 109 children with SIRS admitted to a pediatric ICU (PICU). Erythrocyte and plasma selenium were measured on admission and selenoprotein P and soluble plasma forms of the intercellular adhesion molecule 1 (ICAM-1), vascular cell adhesion molecule 1 (VCAM-1), sP-selectin, and endoCAM on days 1, 2 and 3 of hospitalization. Generalized estimating equations models were adjusted for clinical severity parameters, C-reactive protein, procalcitonin, and serum lactate. The effect of selenium status on organ dysfunction was defined by the Pediatric Logistic Organic Dysfunction (PELOD-2) during the PICU stay. Results: Erythrocyte selenium was associated with sP-selectin and endoCAM, but not with ICAM-1 and VCAM-2. An increase of 10 mu g/L in erythrocyte selenium resulted in increases of 43.2 ng/mL (p = 0.001) in sP-selectin and of 0.04 ng/mL (p < 0.001) in endoCAM. Erythrocyte selenium was also associated with a decrease in PELOD-2 (p = 0.015). Plasma selenium was not related to any of the outcomes. Conclusions: Erythrocyte selenium is associated with endothelial activation in the early phase of the systemic inflammatory response in children, and has a protective effect on multiple organ dysfunction during their PICU stay. (C) 2021 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd. All rights reserved.

Background We investigated to what extent serum copper influences hemoglobin (Hb), neutrophil, and platelet counts and the factors associated with serum copper in children with intestinal failure (IF) who have their micronutrient status monitored according to a standard protocol. Methods Children with IF admitted to a pediatric intestinal rehabilitation program and receiving home parenteral nutrition (PN) were followed up prospectively. Patients received vitamins and multi-trace elements (TEs) as part of the PN. Copper, iron, zinc, vitamin A, and cobalamin serum levels were routinely monitored at 3-month intervals or monthly when a deficiency was detected. Complete blood counts were performed biweekly. Repeated-measures analyses were used to estimate the effect of explanatory variables on the outcomes. Results Thirteen children with a median time receiving PN of 16.6 months were included. An average of 7 copper measurements per patient were performed; 53.8% of patients had a low serum level at least twice during the follow-up. Eight patients with cholestasis had TEs of PN discontinued. In the multivariable analysis, copper was not associated with Hb levels; an increase of 10 mu g/dL in serum copper resulted in an increase of 240/mm(3) (95% confidence interval [CI], 18.0-30.1) neutrophils and of 8429/mm(3) (95% CI, 466-1219) platelets (P < .001). Time of PN without copper, direct bilirubin levels, and ostomy were associated with lower serum copper. Conclusion The increase in serum copper was associated with significant increases in neutrophil and platelet counts. Time without copper in PN, cholestasis, and having an ostomy negatively influenced copper status.

Cardiac troponin-I (cTnI) is a biomarker of myocardial injury with implications for clinical outcomes. May other contributing factors that could affect outcomes have not been uniformly considered in pediatric studies. We hypothesized that there is an association between admission serum cTnI and outcomes in critically ill children taking into account the magnitude of the acute systemic inflammatory response syndrome (SIRS), serum lactate concentrations, and nutritional status. Second, we tested for potential factors associated with elevated serum cTnI. This was a prospective cohort study in 104 children (median age: 21.3 months) consecutively admitted to a pediatric intensive care unit (PICU) of a teaching hospital with SIRS and without previous chronic diseases. Primary outcome variables were PICU-free days, ventilator-free days, and 30-day mortality. Exposure variables were serum cTnI concentration on admission, revised pediatric index of mortality (PIM2), pediatric logistic organ dysfunction (PELOD-2), hypotensive shock, C-reactive protein, procalcitonin, and serum lactate on admission, and malnutrition. Elevated cTnI (>0.01 μg/L) was observed in 24% of patients, which was associated with the reduction of ventilator-free days (β coefficient = - 4.97; 95% confidence interval [CI]: -8.03; -1.91) and PICU-free days (β coefficient = - 5.76; 95% CI: -8.97; -2.55). All patients who died had elevated serum cTnI. The increase of 0.1 μg/L in cTnI concentration resulted in an elevation of 2 points in the oxygenation index (β coefficient = 2.0; 95% CI: 1.22; 2.78, p  < 0.001). The PIM2 score, hypotensive shock in the first 24 hours, and serum lactate were independently associated with elevated cTnI on admission. We conclude that elevated serum cTnI on admission is independently associated with adverse outcomes in children with SIRS and without associated chronic diseases.

Resumo O objetivo deste artigo é avaliar em que medida o apoio social a famílias de crianças com cardiopatia congênita impacta na qualidade de vida. Estudo transversal com 254 pais de crianças com cardiopatia congênita. Foi realizada entrevista semiestruturada com os pais, utilizando o ecomapa e as escalas de qualidade de vida (World Health Organization Quality of Life Bref) e de suporte social (Medical Outcomes Study). O apoio social teve correlação positiva com a qualidade de vida (r=0,535; p<0,001). O aumento de 10 pontos na escala de suporte social levou ao aumento de 3 pontos no escore total da escala de qualidade de vida (β=0,30; IC95%: 0,23; 0,37). A condição socioeconômica associou-se positivamente com qualidade de vida (β=0,27; IC95%: 0,11; 0,43) e os cuidadores que referiram não ter atividade de lazer (β=-3,27; IC95% -5,55; -1,12) e que estavam em tratamento de saúde (β=-2,86; IC95%: -5,55; -0,17) tiveram menor percepção na qualidade de vida. Consequências negativas à qualidade de vida de cuidadores de crianças com cardiopatia congênita podem ser intensificadas pela falta de atividade de lazer e problemas de saúde. Apoio social e condição socioeconômica adequados são fatores que influenciam positivamente na qualidade de vida destes cuidadores.

Journal of Parenteral and Enteral NutritionVolume 44, Issue 5 p. 944-947 Case Report Severe Hypothyroidism in a Child Receiving Long-Term Home Parenteral Nutrition Without Selenium Keilla Mayumi Castelo Branco Uchoa MD, Keilla Mayumi Castelo Branco Uchoa MD Center for Intestinal Rehabilitation, Hospital Samaritano de São Paulo, São Paulo, São Paulo, BrazilSearch for more papers by this authorNara Michelle de Araújo Evangelista MD, MSc, Nara Michelle de Araújo Evangelista MD, MSc Center for Intestinal Rehabilitation, Hospital Samaritano de São Paulo, São Paulo, São Paulo, BrazilSearch for more papers by this authorMaria Fernanda Carvalho de Camargo MD, Maria Fernanda Carvalho de Camargo MD Center for Intestinal Rehabilitation, Hospital Samaritano de São Paulo, São Paulo, São Paulo, BrazilSearch for more papers by this authorHeitor Pons Leite MD, PhD, Corresponding Author Heitor Pons Leite MD, PhD heitorpons@gmail.com orcid.org/0000-0001-8260-7559 Center for Intestinal Rehabilitation, Hospital Samaritano de São Paulo, São Paulo, São Paulo, Brazil Department of Pediatrics, Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil Corresponding Author: Heitor Pons Leite, Rua Luis, de França Junior 201 casa 17, 04648-070, São Paulo, SP, Brazil. Email: heitorpons@gmail.comSearch for more papers by this author Keilla Mayumi Castelo Branco Uchoa MD, Keilla Mayumi Castelo Branco Uchoa MD Center for Intestinal Rehabilitation, Hospital Samaritano de São Paulo, São Paulo, São Paulo, BrazilSearch for more papers by this authorNara Michelle de Araújo Evangelista MD, MSc, Nara Michelle de Araújo Evangelista MD, MSc Center for Intestinal Rehabilitation, Hospital Samaritano de São Paulo, São Paulo, São Paulo, BrazilSearch for more papers by this authorMaria Fernanda Carvalho de Camargo MD, Maria Fernanda Carvalho de Camargo MD Center for Intestinal Rehabilitation, Hospital Samaritano de São Paulo, São Paulo, São Paulo, BrazilSearch for more papers by this authorHeitor Pons Leite MD, PhD, Corresponding Author Heitor Pons Leite MD, PhD heitorpons@gmail.com orcid.org/0000-0001-8260-7559 Center for Intestinal Rehabilitation, Hospital Samaritano de São Paulo, São Paulo, São Paulo, Brazil Department of Pediatrics, Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil Corresponding Author: Heitor Pons Leite, Rua Luis, de França Junior 201 casa 17, 04648-070, São Paulo, SP, Brazil. Email: heitorpons@gmail.comSearch for more papers by this author First published: 20 February 2020 https://doi.org/10.1002/jpen.1807Citations: 2 Financial disclosure: None declared. Conflicts of interest: None declared. Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Citing Literature Volume44, Issue5July 2020Pages 944-947 RelatedInformation