Atualização da padronização da dieta enteral artesanal do HC-UFU/EBSERH na orientação ambulatorial e alta hospitalar para pacientes com Paralisia Cerebral

Abstract

Introduction: Children with Cerebral Palsy may present difficulties in any phase of swallowing and need alternative ways of feeding, such as gastrostomy. Home Enteral Nutritional Therapy (DENT) plays an important role in this context and allows a better quality of life for the patient. Home-made diets can be used in DENT, but need standardization to ensure a safe and adequate supply of nutrients. Objective: To update the standardization of the enteral home-made diet for main meals currently used in the Hospital de Clínicas of the Universidade Federal de Uberlândia (UFU) and to compare home-made measures used, nutritional composition and fluidity in two types of dilutions, one thicker for syringe infusion and the other more fluid for gravitational infusion. Methodology: Tests were performed in the UFU's Dietetic Technique Laboratory on 6 types of recipes, each one in two preparation forms: a thicker one, with 150ml of water used for bolus infusion, and a more fluid one, with 200ml of water added, for gravitational infusion. The following were evaluated and compared: preparation time, weight of residues after sieving, fluidity of the diet in the gastrostomy tube, and centesimal composition, estimated using nutritional composition tables. In addition, the obtained homemade measurements were compared to the measurements of the original recipe. Results: The average pre-preparation and preparation time for the recipes was 1 hour and 25 minutes. Of the 6 formulations for gravity infusion, two contained noodles, which showed high residue content (20 to 30g) in the sieve. The time for infusion of the diets by gravitational method varied between 52 and 72 drops per minute. In the bolus infusion test, there was no syringe resistance, taking about 4 minutes for slow infusion of 1 syringe (60ml). The bolus infusion diets averaged 69.5 kcal and 4.8 g of protein and the gravity infusion diets averaged 60.0 kcal and 4.1 g of protein, and were considered hypocaloric and hyperproteinic compared to industrialized formulations for children over 1 year of age. The currently oriented home measures did not correspond, in most cases, to the indicated grammage. Conclusion: The standardized diets showed adequate fluidity for passage through the gastrostomy tube in both infusion methods and have a favorable nutritional composition for patients with difficulty in reaching protein. New studies are needed to evaluate the nutritional composition by bromatological analysis and to test new variations in formulations, both in composition and consistency.