Universitatea de Stat de Medicina si Farmacie N.

Testemitanu Catedra pediatrie si neonatologie FEC MF Recomandarea metodica la tema:

Autorii: Liudmila Cerempei, d.h.s.m., professor universitar, Ludmila Grico

Terapia transfuzionala la copii. Alimentatia enteral !i parenterala. Scopul: a face cunostinta Obiectivele:
1. Notiunea de alimentatie parenterala 2. Classificarea alimentatiei parenterale 3. Indicatii alimentatiei parenterale 4. Componentele alimentaiei parenterale 5. eneficiile alimentaiei eneterale !. Complicatiile alimentatiei parenterale ". Complicaiile supraalimentaiei #. Componentele alimentaei parenterale $. Necesitatea fi%iolo&ic' (n lic)ide 1*.+,ust'rile la volumul de lic)ide infu%ate 11. -ipuri de des)idratare 12. .erturbari acido/ba%ice 13. 0olori normale acido/ba%ice 14. Necesit'ile ener&etice a copiilor stabili 15. Necesit'ile fi%iolo&ice (n aminoaci%i 1!. Necesarul (n lipide 1". Necesitatea %ilnic' (n carbo)idrai 1#. Rata ma1imal' de infu%ie recomandat' 1$. 2ana&ementul des)idratarii la copii 2ana 2*. 2etodele de alimentare eneteral'

medicilor cursanti cu aspecte actuale in terapia transfuzional la copii, alimentaia enteral i parenteral.

21. 0olumul total san&uin 22. 3emnele )ipovolemiei 23. Indicatii pentru )emotransfu%ie 24. 4o%area concentratului trombocitar 25. -ransfu%iile de Crioprecipitat Cursantul tre"uie sa poseda# 1.Cunoasterea notiunii de alimentatia parenterala 2.Cunoasterea clasificarii alimentatiei parenterale pentru defirentierea. 3.Componentele alimentaiei parenterale 4. eneficiile alimentaiei eneterale 5.Complicatiile alimentatiei parenterale !.Complicaiile supraalimentaiei ".Componentele alimentaei parenterale #.Necesitatea fi%iolo&ic' (n lic)ide $.-ipuri de des)idratare 1*..erturbari acido/ba%ice 11.0olori normale acido/ba%ice 12. 2ana&ementul des)idratarii la copii 2ana 13.2etodele de alimentare eneteral' 14.3emnele )ipovolemiei 15.Indicatii pentru )emotransfu%ie Motivarea +limentaia parenterala sic ea enteral' permite de a prote,a mucoasa intestinal' 5i mic5orea%' r'sp(ndirea procesului inflamotor6 reduce malabsorbia. +limentaia enteral' este eficient'6 u5or de administrat6 reduce complicaiile care pot surveni6 previne de%volt'rii insuficienei multior&anice. Nutrienii stimulea%' re&enerarea mucoasei6 (nbun't(e5te microcirculaia6 reduce catabolismul6 alimentaia enteral' (nbo&ait' cu &lutamina are un efect benefic asupra recuper'rii de I&7 5i I&2 cu o tendin' de a scurta durata bolii 8emora&iile din compartimentul superior a tubului di&estiv: 9 In )iperten%ia portala e1tra)epatica : 5!;6 in "3; de ca%uri evolutia recidivanta 9 In fibro%a con&enitala )epatica : 3*;6 in #*; cu caracter recidivant 9 In ciro%a )epatica /"64; I fa%a terminala a bolii 2edic pediatru trebuie sa posede principiile de ba%a a terapiei transfu%ionale6 alimentatiei enterale si parenterale.

$eg turile integrale

Catedra terapie a. 465 Catedra de medicina de familie a.365 Catedra de farmacolo&ie a.3 Catedra de farmocolo&ie clinica a.56 re%identiat

Catedra de fi%iolo&ie <a.2=6 fi%iopatolo&ie <a. 3=. Catedra de patomorfolo&ie a. 3. $iteratura pentru cunostintele de "aza# 1. >olet%?o 6 7oulet O6 8unt @6 >ro)n >6 3)amir R6 .arenteral Nutrition 7uidelines Aor?in& 7roup6 Buropean 3ocietC for Clinical Nutrition and 2etabolism6 Buropean 3ocietC of .aediatric 7astroenterolo&C6 8epatolo&C and Nutrition <B3.78+N=6 Buropean 3ocietC of .aediatric Researc) <B3.R= <2**5= 1. 7uidelines on .aediatric .arenteral Nutrition of t)e Buropean 3ocietC of .aediatric 7astroenterolo&C6 8epatolo&C and Nutrition <B3.78+N= and t)e Buropean 3ocietC for Clinical Nutrition and 2etabolism <B3.BN=6 3upported bC t)e Buropean 3ocietC of .aediatric Researc) <B3.R=. @ .ediatr 7astroenterol Nutr 413uppl 2: 31/#". 2. +calovsc)i I. -ransfu%ia de sin&e si terapiile ad,uvante. 7)iduri si protocoale. -imisoara6 2**". 3. +merican National Red Cross. .ractice 7uidelines for lood -ransfusion: + complicationfrom recent. .eer/RevieDed Eiterature. 3econd Bdition6 2**"6 !4. 4. lood -ransfusion -)erapC. + .)CsicianFs 8andboo?. " t) Bdition. 2**26 1"4p. 5. Carless ..+.6 8enrC 4.+.6 2o1eC +.@. et al. 4emopressine for minimisin& perioperative allo&enic blood transfusion. Coc)rane 4atabase of 3Cstematic RevieDs 2**4G 1: C4 **1##4. !. Cristop)er @. 7resens. 4irective pentru transfu%ia sin&elui si a componentelor san&uine:.acientii pediatrici si nou nascuti. 2**#. ". 7)idul national de perinatolo&ie. .rotocoale de in&ri,ire si tratament in obstetrica si neonatolo&ie 2**5G vol. II: 15$/1!4. #. 7rintescu Ioana6 2irca Eiliana6 7recu Irina. 2ana&ementul de%ec)ilibrarilor sistemice induse de trauma multipla. +ctualitati in +-I si medicina de ur&ente. -imisoara6 2**!. $. 7uidelines for policies on alternatives to allo&enic blood transfusion. I. .redeposit autolo&ous blood donation and transfusion. -ransfusion medicine. 2**". 1": 354/3!5. 1*. 7uidelines for autolo&ons transfusion. II. .erioperative )emodilution and cell salva&e. ritis) ,ournal of +naest)esia6 1$$"6 "#: "!#/""1. 11. 8ippala 3.-.6 2CllCaia 7.@.6 0a)tera B.2. 8emostatic factors and replacement of ma,or blood loss Dit) plasma : poor red cell concentrates. +nest). +nal& 2**!G 1*2: 34" 51. 12. Instructiune cu privire la transfu%ia componentelor san&uine. ucuresti6 2**". 13. >aren 3cru&&s6 2ic)ael -. @o)nson. .ediatric -reatment 7uidelines6 2**4. Bdition. 14. 2a1Dell 2@.6 Ailson 2@.+. Complications of blood transfusion. Continuin& Bducation in +naest)esia6 Critical Care and .ain6 2**!G !: 225/$. 15. 2untean +na2aria. 3trate&ie de reducere a necesarului transfusional alo&en in c)irur&ia ortopedica electiva. ucuresti6 2**".

1!. .etra 3eeber6 +rCe) 3)ander. asics of lood 2ana&ement6 Hirst Bdition. 2**"6 3#$. 1". Rivers B.6 N&nCen .6 8avstad 3. et al. BarlC 7oal/4irected -)erapC Collaborative 7roup. BarlC &oal/dirested t)erapC in t)e treatment of severe sepsis and septic s)oc?. NeD Bn&. @.2ed. 2**1G 345: 13!#/"". 1#. Robert @. +rceci6 @an 2. 8ann6 ODen .. 3mit). .ediatric 8ematolo&C. -)ird Bdition6 2**!6#2!. 1$. 0an der Einden ..6 4e 8ert 3.6 elisle 3. et al. Comparative effects of red blood cell transfusion and increasin& blood floD on tissue o1C&enation in o1C&en supplC dependent conditions. +m. @. Resp Crit Care 2ed 2**1: 1!3: 1!*5/#. 2*.>olet%?o 6 7oulet O6 8unt @6 >ro)n >6 3)amir R6 .arenteral Nutrition 7uidelines Aor?in& 7roup6 Buropean 3ocietC for Clinical Nutrition and 2etabolism6 Buropean 3ocietC of .aediatric 7astroenterolo&C6 8epatolo&C and Nutrition <B3.78+N=6 Buropean 3ocietC of .aediatric Researc) <B3.R= <2**5= 1. 7uidelines on .aediatric .arenteral Nutrition of t)e Buropean 3ocietC of .aediatric 7astroenterolo&C6 8epatolo&C and Nutrition <B3.78+N= and t)e Buropean 3ocietC for Clinical Nutrition and 2etabolism <B3.BN=6 3upported bC t)e Buropean 3ocietC of .aediatric Researc) <B3.R=. @ .ediatr 7astroenterol Nutr 41 3uppl 2: 31/#". 21.+calovsc)i I. -ransfu%ia de sin&e si terapiile ad,uvante. 7)iduri si protocoale. -imisoara6 2**". 22. +merican National Red Cross. .ractice 7uidelines for lood -ransfusion: + complication from recent. .eer/RevieDed Eiterature. 3econd Bdition6 2**"6 !4. 23. lood -ransfusion -)erapC. + .)CsicianFs 8andboo?. " t) Bdition. 2**26 1"4p. 24.8ippala 3.-.6 2CllCaia 7.@.6 0a)tera B.2. 8emostatic factors and replacement of ma,or blood loss Dit) plasma : poor red cell concentrates. +nest). +nal& 2**!G 1*2: 34"/51. 25. Instructiune cu privire la transfu%ia componentelor san&uine. ucuresti6 2**". 2!. >aren 3cru&&s6 2ic)ael -. @o)nson. .ediatric -reatment 7uidelines6 2**4. Bdition. 2". 2a1Dell 2@.6 Ailson 2@.+. Complications of blood transfusion. Continuin& Bducation in +naest)esia6 Critical Care and .ain6 2**!G !: 225/$. $iteratura recomandata 1. 3piess ruce 4.6 3pence Ric)ard >.6 3)ander +rCe). .erioperative -ransfusion 2edicine6 2 nd Bdition. 2**!6 !14. 2. -)e clinical Ise of lood. 2**2. Aorld 8ealt) Or&ani%ation. lood -ransfusion 3afetC6 7eneva6 22*. 3. -ransfusion &uidelines for neonates and older c)ildren. lac?Dell .ublis)in& E td6 ritis) @ournal of 8ematolo&C: 123G 433/453. 3. -ec)nical 2anual6 14 t) Bdition. 2**36 #25 p. 4. -ransfusion 2edicine. + european course on blood transfusion Coordinators: A. 0an +?en : .7enetet.123

5. +calovsc)i I. -ransfu%ia de sin&e si terapiile ad,uvante. 7)iduri si protocoale. -imisoara6 2**". !. +merican National Red Cross. .ractice 7uidelines for lood -ransfusion: + complicationfrom recent. .eer/RevieDed Eiterature. 3econd Bdition6 2**"6 !4. ". lood -ransfusion -)erapC. + .)CsicianFs 8andboo?. " t) Bdition. 2**26 1"4p. #. Carless ..+.6 8enrC 4.+.6 2o1eC +.@. et al. 4emopressine for minimisin& perioperative allo&enic blood transfusion. Coc)rane 4atabase of 3Cstematic RevieDs 2**4G 1: C4 **1##4. $. CorDin 8.E.6 +n uc)on @... Is leucoreduction of blood components for everConeJ @+2+6 2**3G 2#$: 1$$3/5. 1*. Cristop)er @. 7resens. 4irective pentru transfu%ia sin&elui si a componentelor san&uine:.acientii pediatrici si nou nascuti. 2**#. 11. 4utton R...6 Cooper.6 @o)nes +. et al. 4ailC multidisciplinarC rounds s)orten len&t) of staC for trauma patients. -)e ,ournal of -rauma. 2**3G 55: $13 $. 12.7uidelines for autolo&ons transfusion. II. .erioperative )emodilution and cell salva&e. ritis) ,ournal of +naest)esia6 1$$"6 "#: "!#/""1. 11. 8ippala 3.-.6 2CllCaia 7.@.6 0a)tera B.2. 8emostatic factors and replacement of ma,or blood loss Dit) plasma : poor red cell concentrates. +nest). +nal& 2**!G 1*2: 34" 51. 12. Instructiune cu privire la transfu%ia componentelor san&uine. ucuresti6 2**". 13. >aren 3cru&&s6 2ic)ael -. @o)nson. .ediatric -reatment 7uidelines6 2**4. Bdition. 14. 2a1Dell 2@.6 Ailson 2@.+. Complications of blood transfusion. Continuin& Bducation in +naest)esia6 Critical Care and .ain6 2**!G !: 225/$. 15. 2untean +na2aria. 3trate&ie de reducere a necesarului transfusional alo&en in c)irur&ia ortopedica electiva. ucuresti6 2**". 1!. .etra 3eeber6 +rCe) 3)ander. asics of lood 2ana&ement6 Hirst Bdition. 2**"6 3#$. 1". Rivers B.6 N&nCen .6 8avstad 3. et al. BarlC 7oal/4irected -)erapC Collaborative 7roup. BarlC &oal/dirested t)erapC in t)e treatment of severe sepsis and septic s)oc?. NeD Bn&. @.2ed. 2**1G 345: 13!#/"". 1#. Robert @. +rceci6 @an 2. 8ann6 ODen .. 3mit). .ediatric 8ematolo&C. -)ird Bdition6 2**!6#2!. 1$. 0an der Einden ..6 4e 8ert 3.6 elisle 3. et al. Comparative effects of red blood cell transfusion and increasin& blood floD on tissue o1C&enation in o1C&en supplC dependent conditions. +m. @. Resp Crit Care 2ed 2**1: 1!3: 1!*5/#. 2*.>olet%?o 6 7oulet O6 8unt @6 >ro)n >6 3)amir R6 .arenteral Nutrition 7uidelines Aor?in& 7roup6 Buropean 3ocietC for Clinical Nutrition and 2etabolism6 Buropean 3ocietC of .aediatric 7astroenterolo&C6 8epatolo&C and Nutrition <B3.78+N=6 Buropean 3ocietC of .aediatric Researc) <B3.R= <2**5= 1. 7uidelines on .aediatric .arenteral Nutrition of t)e Buropean 3ocietC of .aediatric 7astroenterolo&C6 8epatolo&C and Nutrition <B3.78+N= and t)e Buropean 3ocietC for Clinical Nutrition and 2etabolism <B3.BN=6 3upported bC t)e Buropean 3ocietC of .aediatric Researc) <B3.R=. @ .ediatr 7astroenterol Nutr 41 3uppl 2: 31/#".

21. +calovsc)i I. -ransfu%ia de sin&e si terapiile ad,uvante. 7)iduri si protocoale. -imisoara6 2**". %ntre"ari pentru autocontrol 1.Notiunii de alimentatia parenterala Clasificarea alimentatiei parenterale 3.Componentele alimentaiei parenterale 4. eneficiile alimentaiei eneterale 5.Complicatiile alimentatiei parenterale !.Complicaiile supraalimentaiei ".Componentele alimentaei parenterale #.Necesitatea fi%iolo&ic' (n lic)ide $.-ipuri de des)idratare 1*..erturbari acido/ba%ice 11.0olori normale acido/ba%ice 12. 2ana&ementul des)idratarii la copii 2ana 13.2etodele de alimentare eneteral' 14.3emnele )ipovolemiei 15.Indicatii pentru )emotransfu%ie %ntre"ari pentru autopregatire 1.+limentatia parenterala si enterala 2.0alori necesare si metoda de administrare 3. 0olumul necesar pentru administrare 4. 2etodele de dia&nostic6 corectia dere&larilor depistate. 5. Bc)ilibrul acido/ba%ic fi%iolo&ic si patolo&ic. !. 8emotransfu%ia indicatii si contraindicatii ". 4es)idratarea6 tipuri6 metoda de apreciere6 tratament. .roblema 1. 4eficitul de lic)id B1emplu: Ea copil de 23 ?& a fost estimat &radul de des)idratre 5;. 5; 1 23 ?& 1 1* K 115* ml +cest deficit este restituit pe parcurs de 24 ore 5i este sumat la necesit'ile %ilnice (n fluide6 reparti%at (n 24 ore pentru a determina vite%a infu%iei Ln e1emplul nostru: 0olumul %ilnic este de 15!* ml M 5; 4eficit 115* ml K 2"1*ml : 24 ore K 112 mlNor' .roblema 2 Care sunt devieri in ec)ilibrul acido/ba%ic. Corectia adecvata. .8 "645 .CO2 2"6" .O2 55 -CO2 2*61 8CO3 1$63 B /3646 3 C 2261