Resumen
Se analiza la concentración de fracciones específicas en once niños menores de 13 meses, internados en una Unidad de Cuidados Intensivos Pediátricos con diferentes enfermedades al ingreso (T0) y luego de recibir durante 7 días alimentación enteral (T1). Se determina la concentración sérica de proteínas totales (g/dl) y fracciones específicas(mg/dl): apolipoproteína A-1 (ApoA-1), apolipoproteína B (ApoB), transferrina (Transf), fracciones C3 y C4 de complemento (C3c, C4c), ceruloplasmina (Cerul), haptoglobina (Hapto) y proteína C-reactiva (PCR) por inmunodifusión radial cuantitativa sobre placas. Los resultados, expresados en X ± DE son: T1 vs. To: PT: 5.9 ± 1.7* vs. 4.5 ± 1.0; Apo A-1: 120.2 ± 42.6* vs. 81.7 ± 18.7; ApoB: 111.5 ± 39.8* vs. 73.6 ± 41.8; ApoA-1/ApoB: 1.2 ± 0.5 vs.1.6 ± 1.1; Transf: 224.2 ± 83.0 vs. 201.2 ± 47.6; C3c: 121.2 ± 43.5* vs. 89.7 ± 47.5; C4c: 23.9 ± 11.4* vs.18.1 ± 10.1; Cerul: 51.7 ± 17.7 vs. 43.5 ± 11.4; Hapto: 175.5 ± 102.2 vs. 205.3 ± 154.4; PCR: 2.5 ± 2.5* vs. 4.8 ± 2.6 (* 0.01 < p < 0.05). Luego de la administración de la terapia nutricional y el adecuado tratamiento farmacológico se observa aumento significativo en la concentración de proteínas totales, ApoA-I, ApoB, C3c y C4c, con disminución significativa en los niveles de PCR. Estos resultados señalan a las fracciones estudiadas como indicadores tempranos que podrían incluirse dentro del seguimiento del paciente pediátrico en estado crítico.

Palabras clave
niños-pacientes críticos, fracciones proteicas, terapia nutricional

Artículo completo
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Abstract
Objective: In this preliminary study we measured specific serum proteins in pediatric critical patients, before (T0) and after (T1) an age-appropriate enteral nutritional support. Methods: 11 children, with different infections, between 2 and 13 months of age, assisted by the Unit of Intensive Care and the Service of Nutrition, were evaluated. Samples of whole blood sere collected from fasting patients before and after seven days of the nutritional support; specific sera proteins (mg/dl): (apolipoproteins A-I and B [ApoA-I, ApoB], transferrine transf, C3 and C4 complement fractions C3c, C4c, ceruloplasmine cerul, haptoglobine hapto and reactive C-protein [PCR]) were measured by single radial immunodiffusion techniques with commercially available kits (Diffuplate, Biocientifica, Buenos Aires, Argentina) and total protein concentration (TP) by Biuret's reaction (g/dl). Results: The results expressed as X + SD are: T1 vs. T0: TP: 5.9 ± 1.7* vs. 4.5 ± 1.0; Apo A-I: 120.2 ± 42.6* vs. 81.7 ± 18.7; ApoB: 111.5 ± 39.8* vs. 73.6 ± 41.8; A-I/B: 1.2 ± 0.5 vs. 1.6 ± 1.1; Transf: 224.2 ± 83.0 vs. 201.2 ± 47.6; C3c: 121.2 ± 43.5* vs. 89.7 ± 47.5; C4c: 23.9 ± 11.4* vs. 18.1 ± 10.1; Cerul: 51.7 ± 17.7 vs. 43.5 ± 11.4; Hapto: 175.5 ± 102.2 vs. 205.3 ± 154.4; PCR: 2.5 ± 2.5* vs. 4.8 ± 2.6 (* 0.01< p < 0.05). It was observed, after the administration of the nutritional support and pharmacologic therapy, a significant increase of total serum proteins,ApoA-I, ApoB, C3c and C4c with diminution in PCR concentration. These results point out to these protein fractions as rapid nutritional parameters in the evaluation of nutritional status of pediatric critical patients.

Key words
children- critical patients, protein fractions, nutritional therapy