Casos pediatricos en soporte nutricional

 

Xikvhrsk`n` `hl Unllh

 

Mblhmmkýi ]nlu`

>

 

Hl ph`kntrn nmtunl `hdh mbibmhr phrehmtnahith dkhi lbs prkimkpkbs prkimk pkbs dîskmbs `h ln nlkahitnmkýi kienitkl, ib sýlb hi munitb n ln skblbgán `hl brgniksabs `hl ikþb, skib tnadkëi mbi rhsphmtb n lbs iutrkahitbs quh sh lh vni n suakikstrnr tnitb hi hl hstn`b `h snlu` mbab hi hl `h hiehrah`n`. Hl thxtb , drki`n ln bpbrtuik`n` bpbrtuik` n` pnrn quh `h uin ebran shimklln, prîmtkmn, nahin y `k`îmtkmn hl lhmtbr thign uin mbaprhiskýi glbdnl `hl hstn`b `h snlu` y lns `kehrhiths hitk`n`hs quh sh prhshitni hi ln h`n` ph`kîtrkmn, nsá mbab `hl anihob iutrkmkbinl `h lns aksans n pnrtkr `h lbs `kvhrsbs mnsbs mláikmbs quh sh klustrni.

4

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MXN@TB 4.  

MLN]KEKMNMKÝI MLN]KEKMNMKÝ I NIPTBZBAËPTKMN @H LN @H]IXPTKMKÝI HI IKÞB] ]HGßI GÝAH_ (ZH]B/H@N@) [ WNPHTLBW (PNLLN/H@N@ [ ZH]B/PNLLN)

 

p%

p8:%

@ëmkt b hxmhsb

Hutrýmb Lhvh

@IP Ab`hrn`n

]hvhrn

 

Grn`b K

Grn`b KK

Grn`b KKK

Zhsb/h`n` Pnlln/h`n` nlln/h` n` Zhsb/tnlln ZM/h`n` ZM/tnlln

>:-40% 8-;% >:->;%

48-=;% >:->0% 4:-4;%

Z0:% Z>8% Z=:%

7 `áns `h h`n` mbi tnlln >>4 ma (ski nithmh`h nithmh`hiths iths `h prbdlhans prbdlhans mrbabsýakmbs b ahtndýlkmbs, enaklknrhs `h dnon tnlln, rhtnr`b mbistktumkbinl `hl `hsnrrbllb, htm.). ]h sblkmktn ln vnlbrnmkýi `h su hstn`b iutrkmkbinl shgÿi tnlln pnrn ln h`n`. 4. ²Muîlhs pb`ráni shr lbs `kngiýstkmbs quh sh pb`ráni rhnlkznr hi hsth ikþb2   n. Dnon tnlln pnrn ln h`n`   d. @hsiutrkmkýi mrýikmn   m. @hsiutrkmkýi grn`b K shgÿi tnlln pnrn ln h`n`   `. @hsiutrkmkýi lhvh mrýikmn mbi `ëmkt `hl ;.=%   h. Pb`ns  IBPN? Pbanrhabs mbab rhehrhimkn lns Pndlns `h ln IMF] pnrn tnlln/h`n` (Mun`rb =).

MXN@TB =.   H`n`

PNDLN] @H LN IMF]. PNLLN ZNTN H@N@. IKÞB] 4 N 4: NÞB]

Z=% Z>:% Z=:% Z8:% Z7:% Z;:% Z;7% -4@]

  7n0a >>=.7 >>5.6 >4:.6

>4=.8 >45.4 >=:.> >==.4 > ==.4 >>=.>

->@]

A

+>@] +4@]

>>6.= >4=.8 >46.7

>==.6

>8

 

Pnlln pnrn ln h`n`.  Hi hsth mnsb sh skguhi lbs aksabs prh-rhquksktbs utklkzn`bs quh  pnrn ninlkznr lbs `ntbs `hl phsb pnrn ln h`n` (akmmkýi, `hehmnmkýi, ehmfn `h inmkakhitb, mbrrhmmkýi `h ln h`n`, ski rbpn, htm.). Znrn kithrprhtnr n lbs ikþbs ik þbs anybrhs `h 4 nþbs hi lns tndlns `hl IMF] hitrh 4 y 4: nþbs `h h`n`, hstbs `hdhi shr phsn`bs y ah`k`bs `h pkh, hi  pbskmkýi nintýakmn. nintýakmn. ]h prbmh`h hitbimhs n dusmnr ln h`n` `hl ikþb hhii hl hl hoh hoh `h lns hquks ((hi hi hsth mnsb 7 nþbs 0 ahshs), luhgb akrnr hi quë phrmhitkl sh himuhitrn shgÿi su tnlln `h >>4 ma (hi hsth mnsb hstî pbr `hdnob `hl phrmhitkl =%), `hspuës udkmnr hl phrmhitkl 8:% pnrn hsn h`n` `h 7 nþbs 0 ahshs (hi hsth mnsb >4=.8 ma) pnrn nsá snmnr hl `ëmkt b hxmhsb shgÿi ln tnlln pnrn ln h`n` (hi hsth mnsb tkhih ui `ëmkt `h ;.=%) y inlahith shgÿi ln mlnskmnmkýi `h Wnthrlbw Wnthrlbw `hthrakinr hl grn`b `h `hsiutrkmkýi mrýikmn quh prhshith (hi hsth mnsb lhvh b grn`b K) (Mun`rb 4). Unlh Unlh ln phin nmlnrnr quh ln prkahrn kaprhskýi `kngiýstkmn quh sh fnrî shrî ln `h dnon tnlln pnrn ln h`n`, y uin vhz `hsmnrtn`ns tb`ns lns pbskdlhs mnusns, ln ÿltkan n phisnr shrán pbr `hsiutrkmkýi, h kgunlahith quh ln vnlbrnmkýi `hl hstn`b iutrkmkbinl shgÿi tnlln pnrn ln h`n` hs aîs kapbrtnith hi ikþbs hitrh = y 4: nþbs, pbrquh hi ikþbs hitrh : y =5 ahshs, lb prkahrb quh sh nlthrn pbr `hsiutrkmkýi hs hl phsb, luhgb ln tnlln y pbr ÿltkab hl phráahtrb mheîlkmb. THZBTPH @HL PHTMHT MN]B  Ikþb `h >:: ma `h hstnturn (ah`k`b hi pbskmkýi nmbstn`b) y >4.8 > 4.8 cg `h phsb ski h`hh`hans (phsn`b hi pbskmkýi shitn`b). ]h sblkmktn ln vnlbrnmkýi `h su hstn`b iutrkmkbinl shgÿi  phsb pnrn ln tnlln.

=. ²Muîl shrî su `kngiýstkmb shgÿi hl puitnoh z `hl phsb pnrn pnrn ln tnlln pbr ah`kb `h lns tndlns `hl Intkbinl Mhithr ebr Fhnltf ]tntkstkms (IMF]) `h lbs Hstn`bs Xik`bs2   n. Tkhsgb `h bdhsk`n`   d. Tkhsgb `h `hsiutrkmkýi   m. Hutrýmb   `. Munlqukhrn hs kgunl   h. Ikiguib hs mkhrtb.  IBPN?  IBP N? Pbanrhabs mbab rhehrhimkn lns tndlns `h ln IMF] pnrn phsb/tnlln (Mun`rb 0)

MXN@TB 0.

PNDLN] @H LN IMF]. ZH]B ZNTN PNLLN. IKÞB] : N =5 AH]H]

  Pnlln

Z=% Z>:% Z=:% Z8:% Z7:% Z;:% Z;7% -4@]

->@]

A

+>@]

+4@]

  >::.:

>=.0

>0.0

>8.8

>5.5

>7.7

>>0.> 0.>

>0.;

>8.8

>5.> >5.;

>7.5

>=.=

>5

 

 Zhsb pnrn ln tnlln. Znrn hsth hohrmkmkb vnabs n mnlmulnr hl puitnoh z prhvknahith hiuihiui mkn`b, quh usn pnrn su kithrprhtnmkýi ln ah`knin y uin, `bs b trhs `hsvknmkbihs hstîi`nr pnrn su mîlmulb 1 vnlbr nitrbpbaëtrkmb nmtunl ahibs vnlbr `h rhehrhimkn `h ln ah`knin sbdrh ln `hsvknmkýi hstîi`nr. Hi ghihrnl skhaprh sh prhhrh utklkznr 4 `hsvknmkbihs hstîi`nrhs. ]h rhÿihi kgunl tb`bs lbs prh-rhquksktbs `hl phsb pnrn ln h`n` y ln tnlln pnrn ln h`n`, mbi ln vhitnon quh hi hsth mnsb ib sh rhqukhrh `h ln ehmfn `h inmkakhitb, y hi ikþbs hi lbs quh ib sh sndh uin h`n` hxnmtn, pb`rhabs `nr ui `kngiýstkmb iutrkmkbinl nitrbpbaëtrkmb.

]h prbmh`h prkahrb n dusmnr ln tnlln `h ln ikþn hi hl hoh `h lns hquks (hi hsth mnsb >:: ma) y luhgb akrnr muîl hs su ah`knin b hl phrmhitkl 8:% (hi hsth mnsb hs >8.8 cg.). Znrn `hthrakinr sk lns 4 `hsvknmkbihs hstîi`nrhs n utklkznr sbi lns `h ln `hrhmfn b lns `h ln kzqukhr`n, ibs onabs sk hl phsb pnrn ln tnlln hstî pbr `hdnob `hl phrmhitkl 8:%, hi muyb mnsb lns `hsvknmkbihs hstîi`nrhs n utklkznr sbi lns `h ln kzqukhr`n y sk hsth phsb ppnrn nrn ln tnlln hstî pbr himkan `hl phrmhitkl 8:%, lns `hsvknmkbihs hstîi`nrhs hstîi `nrhs n k`hitkmnr sbi lns `h ln `hrhmfn. Nfbrn dkhi, uin vhz `hthrakin`ns lns `hsvknmkbihs hstîi`nrhs `h ln kzqukhr`n b `h ln `hrhmfn, hl vnlbr n thihr hi muhitn hi hl `hibakin`br `h ln eýrauln pnrn hl mîlmulb `hl puitnoh z, hs ln `kehrhimkn hitrh ln ah`knin y lns 4 `hsvknmkbihs hstîi`nr. Znrn hl hoha hoha- plb, mbab hl phsb pnrn ln`htnlln hstî pbr `hdnob `hlhlphrmhitkl 8:%, ibs>4.8 onrhabs lns 4y `hsvknmkbihs hstîi`nrhs ln kzqukhr`n. Hitbimhs iuahrn`br shrî? - >8.8 1hi- =.: hl `hibakin`br >8.8 - >=.= 1 4.4, pnrn ui puitnoh z `h ->.=5. Ekinlahith mbapnrnabs lbs rhsultn`bs bdthik`bs mbi lbs `ntbs hstni`nrkzn`bs pnrn tnl i. Nmî sh puh`h hitbimhs `hmkr quh sk hl puitnoh z hs anybr `h +>.66 hl ikþb hstnrán n rkhsgb `h sbdrhphsb, sk hsth puitnoh z hs ahibr `h ->.66 hl ikþb hstnrán n rkhsgb `h `hsiutrkmkýi y sk hl puitnoh z hs :.:: hl ikþb hs hutrýmb. Hi hsth mnsb hl ikþb sh nmhrmn n ->.66, hs `hmkr, hstî mhrmnib nl phrmhitkl =%, n rkhsgb `h prhshitnr `hsiutrkmkýi (Mun`rb 8). Fny quh rhmbr`nr quh hi hl mnsb quh hsth ikþb mláikmnahith prhshitnrn mbab skgib ui h`han `h mnusn iutrkmkbinl, iutrkmkbinl, sh mlnskmnrán `krhmtnahith mbab `hsiutrkmkýi shvhrn tkpb cwnsfkbrcbr.

MXN@TB 8?

ZXIPNOH _ ZNTN MLN]KEKMNT LN @H]IXPTKMKÝI HI IKÞB]

 

Zuitnoh

z

     

Z;7% Z8:% Z=%

+ >.66 :.:: - >.66

THZBTPH @HL MXNTPB MN]B

 Ikþn `h >4 ahshs `h h`n`, mbi lbigktu` `h 56 ma (ski nithmh`hiths `h prbdlhans mrb mrb-absýakmbs b ahtndýlkmbs, enaklknrhs `h dnon tnlln, rhtnr`b mbistktumkbinl `hl `hsnrrbllb, htm.) y phráahtrb mheîlkmb `h 04 ma. ]h sblkmktn s blkmktn mbibmhr sk hl phráahtrb mheîlkmb `h ln ikþn sh himuhitrn nehmtn`b pbr su anl hstn`b iutrkmkbinl.

>7

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]BCBL TO, Anmc M, Inrchwkmz AT, Cnrrhr EA. Zntfbghihsks ni` butmbah be dklknry ntrhskn? murrhit mbimhpts. O Zh`kntr Gnstrbhithrbl Gnstrbhithrbl Iutr  4::=3  4::=3 =7? 0-4>. ]XMF[ ]XM F[ EO. Npprbnmf tb tfh kienit wktf mfblhstnsks. Ki? ]umfy EO, ]bcbl TO, Dnlkstrhrk WE, (h`s.). Lkvhr `kshnsh ki mfkl`rhi. 4i` h`. Zfkln`hlpfkn? Lkppkimbtt Wkllknas ni` Wklckis3 4::>. p. >67->;0. PFBAZ]BI TO, Nzhvh`b TN, Gnlbppb M, Lhwki`bi Z, AmCkhrini Z. Mfblhstntkm ni` ahtndblkm lkvhr `kshnshs? Wbrckig Grbup Thpbrt be tfh ]hmbi` Wbrl` Mbigrhss be Zh`kntrkm Gnstrbhithrblbgy, FhpnFhpn tblbgy, ni` Iutrktkbi. O Zh`kntr Gnstrbhithrbl Iutr  4::03 =; (uppl 4)? 5>>-5>8. UHL N]MB UHLN] MB MN, Nan`b AZ AZ.. Mblhstnsks `hl lnmtnith y ikþb anybr. anybr. Hi? Abrhib OM, Uhlnsmb MN, Aëi`hz N, (h`s.). Phans shlhmtbs hi ph`kntrán.  Dumnrnanign? ]km H`ktbrknl Lt`n3 4::4. p. 0;5-8::. . Mbrtës HZ. Iutrkmkýi hi hl lnmtnith mbi hiehrah`n` fhpîtkmn mrýikmn.  Thv Lhmt Iutr   4::43 ;? 74-75. . Mblhstnsks mrýikmn.  Hi? Uhlnsmb MN, (h`.). Mnsbs ph`kîtrkmbs hi gnstrbhithrblbgán, fhpntblbgán y iutrkmkýi Mnlk? Zrbgrnan H`ktbrknl Xikvhrsk`n` `hl Unllh3 4::=. p. 8;-56. . Mblhstnsks mrýikmn.  Hi? Uhlnsmb MN, (h`.).  Hiehrah`n`hs `kghstkvns hi ikþbs. Mnlk? Zrbgrnan H`ktbrknl Xikvhrsk`n` `hl Unllh3 4::=. p. >;;-4:7. . Iutrkmkýi hi hiehrah`n` hiehrah`n` fhp fhpîtkmn. îtkmn. Hi? Uhlnsmb MN, (h`.). Hiehrah`n`hs `kghstkvns hi ikþbs Mnlk? Zrbgrnan H`ktbrknl Xikvhrsk`n` `hl Unllh3 4::=. p. 0=>-0=;. . Iutrkmkýi y hiehrah`n` fhpîtkmn.  Hi? Uhlnsmb MN, (h`.). Phans shlhmtbs hi iutrkmkýi kienitkl.  Dbgbtî? H`ktbrknl @kstrkduin3 4::8. p. 77-66.

68

 

ZÎGKIN HI DLNIMB HI LN H@KMKÝI KAZTH]N

65

 

ÁI@KMH N

nd`bahi ngu`b 77. ndlnmtnmkýi >5, 4=, 40. ndlnmtnr mbi mhrhnlhs 40. îmk`b nrnquk`ýikmb 05. îmk`b dîskmbs y ahtndýlkmbs 7:. îmk`b `hmbsnfhxnhibkmb 05. îmk`bs grnsbs pblk-kisnturn`bs `h mn`hin lnrgn 05. nmk`bsks cnlkbpëikmn 48. nmk`bsks ahtndýlkmn 64. nmbi`kmkbinakhitb ehmnl 76. nmtkvk`n` hizkaîtkmn 07. n`hmun`b mrhmkakhitb y `hsnrrbllb kienitkl 64. n`akikstrnmkýi `h iutrkmkýi pnrhithrnl 6=. nehmmkbihs rhspkrntbrkns 08. ngu`hzn vksunl 05. nldÿakin 87. nldÿakin hi`bvhibsn 6=. nlhrgëikmbs 4=. nlhrgkn n ln prbtháin `h ln lhmfh hithrn `h vnmn 48. nlhrgkn nlkahitnrkn 40. Nlkahitnmkýi ibranl `hl lnmtnith ahibr 45. nlkahitnr pbr gnstrbmlksks 0=.