title: [Treatment of severe malnourished children with WHO protocol: experience of a referral center in São Paulo, Brazil].
abstract: Mortality rate, anthropometric development and nutritional therapy with the use of World Health Organization guidelines (WHO) were assessed. In a cross-sectional retrospective study 191 hospitalized malnourished children were assessed. To classify and evaluate nutritional rehabilitation Z-score was used: weight-for-age (ZW), height-for-age(ZH) and weight-for-height(ZWH). The children were divided in three groups (G): GI (primary malnutrition--30,9%), GII (secondary malnutrition--51,7%) and GIII (children who were admitted as GI but during internation had an identified chronic disease--12%). Nutritional therapy used was based on WHO guidelines, with slight modifications. The formulas chosen were all industrialized: lactose-free polymeric formula (PLF) for children with diarrhea, low lactose polymeric formula (PLL) for children without diarrhea and cow's milk hydrolysate (H) for sepsis or chronic diarrhea. In the rehabilitation phase, all the children used PLL formula.
  
  
  METHODS
  Student's, chi-square tests, simple linear regression. The median age and mortality rate were 10,3 months and 4,2%, respectively. The GI and GII children were older than GIII (11vs12vs7months,p=0,02) and had shorter length of stay (20vs22vs37days,p=0,010). Mortality risks in GIII were twice as frequent as in GI+GII. Pneumonia, diarrhea and poor weight gain were the main diagnosis at admission. Tubes were used more frequently in GII+GIII than GI (p=0,004). Parenteral nutrition was indicated in 5,7% of children, more often in GIII than GI+GII (p=0,037). Tolerance of the initial formula wasn't satisfactory in 20% of the children. An improvement of 87% ZWH, 74,1% ZW and 22% was observed. ZW in GI and ZWH in GIII were the indices that showed the most effective gain during hospital stay. The modified WHO guidelines were effective in the multiprofessional treatment of malnourished children, resulting in good nutritional rehabilitation with low mortality rates. A high percentage of children admitted as primary malnutrition who had a chronic disease diagnosed was observed. The late diagnosis may be responsible for the high length of stay, formula intolerance and mortality risk.
authors.affiliation: Universidade Federal de São Paulo, UNIFESP/EPM, Materno-Infantil da Faculdade de Medicina da Fundação do ABC-FM ABC, Instituto de Ensino e Pesquisa do Hospital Israelita Albert Einstein, Brasil.
authors.forename: Roseli Oselka
authors.initials: RO
authors.lastname: Saccardo Sarni
authors.forename: Fabíola Isabel
authors.initials: FI
authors.lastname: Suano de Souza
authors.forename: Priscila
authors.initials: P
authors.lastname: Catherino
authors.forename: Cristiane
authors.initials: C
authors.lastname: Kochi
authors.forename: Fernanda Luisa
authors.initials: FL
authors.lastname: Ceragioli Oliveira
authors.forename: Fernando José
authors.initials: FJ
authors.lastname: de Nóbrega
mesh_terms: D000208:Acute Disease; D001938:Brazil; D002985:Clinical Protocols / Q000592:standards; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007223:Infant; D007228:Infant Nutrition Disorders / Q000178:diet therapy*; D007231:Infant, Newborn; D007902:Length of Stay; D008297:Male; D012017:Referral and Consultation; D012189:Retrospective Studies; D014944:World Health Organization