Pr??ticas nutricionais nos rec??m-nascidos com menos de 1500 gramas

Com o objetivo de conhecer as pr??ticas nutricionais nas unidades neonatais do Rio de Janeiro fizemos um estudo descritivo, n??o intervencionista, sobre as pr??ticas nutricionais nas maiores unidades neonatais do munic??pio do Rio de Janeiro, de uma coorte de rec??m-nascidos com menos de 1.500g de peso ao nascer, admitidos de novembro de 1999 a abril de 2000. Analisamos 416 prontu??rios. Dos rec??m-nascidos acompanhados, 60,4 por cento sobreviveram. O peso m??dio do grupo populacional foi de 1140g mais ou menos 270. O suporte nutricional parenteral foi institu??do em 55,28 por cento dos rec??m-nascidos, com in??cio em torno do quarto dia.O suporte parenteral total ou parcial durou em m??dia nove dias. A primeira dieta foi ofertada em m??dia no quarto dia de vida, predominando o uso do leite humano (materno e/ou pool de doadoras), em 89,8 por cento. A dieta plena foi atingida em m??dia ap??s 12 dias da sua introdu????o e foi suspensa em 52,4 por cento dos casos, predominando a "piora cl??nica" como motivo principal da suspens??o. O intervalo entre uma alprescri????o de oferta de 2/2 horas at?? 6/6 horas. Predominantemente a dieta foi ofertada em gavagem simples. A recupera????o do peso de nascimento foi em m??dia com 17 dias, sendo que os rec??m-nascidos que receberam dieta enteral mais cedo atingiram o peso de nascimento mais precocemente. Encontramos treze casos de enterocollite necrosante, sem rela????o com Apgar, escore de risco e/ou introdu????o precoce da dieta. Dos treze casos, oito faleceram. Em que pese toda a import??ncia que o leite materno possui para essa popula????o, a alta em aleitamento materno ocorreu em 33,75 por cento. Conclu??mos que diferentes pr??ticas nutricionais s??o utilizadas no grupo estudado,variando inclusive dentro da mesma unidade.N??o h?? uma rotina estabelecida e as condutas tra??adas est??o aqu??m das preconizadas na literatura.The higher survival rate of underweight neonate in the latest years has brought a new challenge: the nutrition issue. A theme that is much controversy. With the objective of knowing the nutritional practices in neonatal units in Rio de Janeiro, a descriptive, non-intervening work has been undertaken on the nourishing practices in major neonatal units in the city of Rio de Janeiro, comprehending a cohort of newborns weighing under 1500g at birth, admitted from November 1999 to April 2000. Four hundred sixteen medical records were analyzed and a questionnaire filled out with demographic data of the population, the different kinds of therapy used, the results obtained, and the variation in procedures among the centers. CDC Epi-info (Epi ??? 6.04) software was used for data analysis. Variance analysis and Kruskal-Wallis nonparametric tests were used for analyzing the continuous variables and chi-square for the categorical variables. Also, Pearson correlation coefficient was used for correlating continuous data. Of those newborn, 60.4% survived. Life span was longer for newborns weighing over 1000g and born after a gestation period of over 30 weeks. Average weight of the population was 1140g??270. Parenteral nutrition support was applied to 55,28% of the newborns, starting around the fourth day. Initial aliquot were around 2g/kg/day (amino acid and/or lipid). Total or partial parenteral support has been applied for nine days in average. The first diet was offered in the fourth day of life in average, predominantly human milk (from mother and/or a pool of donors), for 89,8%. In average, full diet was attained twelve days after its introduction, and it was suspended in 52,4% of the cases, the main motive for suspension being ???general clinical picture???, generally sometime before completing fifteen days from its introduction (77,5%). The interim between one aliquot and the other diet varied, prescription for the offer being from every two hours every six hours. Predominantly the diet was offered by plain gavage (99,2%). Recovery of birth weight was attained in about seventeen days, the newborns that received enteral diet having attained their birth weight earlier. Thirteen cases of necrotizing enterocolitis were found, without relation with Apgar, risk score and/or premature introduction of diet. Of the 13 cases, eight died (61,5%). Notwithstanding the importance of maternal milk for this population, halting of maternal milk nourishing occurred in 33,75%. The conclusion was that there are different nutritional practices in use within the group focused, such practices varying included within the same unit. There insn???t a guideline of nutrition and the conducts are not in papers found in the literature