Seguimento de crianças com intoxicação grave no Noroeste do Paraná

Abstract

Childhood poisoning is an emerging public health problem, with effects on children´s and family´s health. Current analysis studied the outcome of severe poisoning cases in children through a follow-up descriptive and observational study with the family members of nine children hospitalized in the Neonatal Intensive Care and Pediatric Intensive Care Units at the University Hospital of Maringá, Maringá PR Brazil, between January 2002 and June 2012. The children, registered at the Intoxication Control Center - CCI / HUM and residents in the municipalities of Maringa, Sarandi and Paiçandu PR Brazil, were diagnosed with poisoning by several toxic agents. Data sources comprised Inpatients Monthly List and Toxicological Occurrence Files of CCI/HUM including four instruments: Toxicology Occurrence Data Collection Form, Interview Guide to Family, Residence Observation Guide and Field Diary. Data collection was undertaken by home interviews and documentary analysis. Interviews were recorded and data were compiled on Microsoft Excel 2007 spreadsheet software and analyzed descriptively; Depositions by family members were transcribed and analyzed by thematic content analysis. Research project was submitted to the Ethics Committee on Research Involving Humans of the Universidade Estadual of Maringá (Proc. 168.316/2013). Respondents were female, most of whom were the children´s mothers, aged between 31 and 47 years old. Intoxication prevailed in males, with children´s average age two years old. Most poisonings were acute, accidental, involving licit drugs at the children's home. In three cases the site of occurrence was the health service, involving acute overchronic poisonings. Average hospitalization period was 14 days and although seven children underwent intubation and mechanical ventilation, all improved clinically and were discharge. The monitoring process failed to detect physical sequelae in children, even though three deaths occurred after hospitalization, two at the children´s home. Four families reported outpatient care after hospitalization and two children suffered reintoxication. Intoxication impact on families was grouped under the following themes: guilt, misinformation and family strained relationships since the negative impact of poisonings on family relationships in five families was reported. Lack of information on the severity of poisoning and trend changes in habits or behaviors, with a view to preventive behavior, initiated by changes in personal level, extending to home/family and social life, has been observed. The outcome assessment, although conducted on a purposive sample, is of considerable interest to parents, intensive care staff and health managers. Specific guidelines by health professionals and enhancement of effective and specific preventive measures should be implemented, contributing towards knowledge on the severity and outcome of poisoning cases among children.