Intervenciones de enfermería para prevenir trastornos nutricionales en niños de 0 a 2 años
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Publicado:
may. 9, 2019
Palabras clave:
Enfermería basada en la evidencia, Cuidados de Enfermería, Enfermería de Atención Primaria, Trastornos de la nutrición del lactante, prevención primaria
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Resumen
En Colombia ocurre una transición nutricional; los profesionales de Enfermería participan en el diseño de intervenciones para prevenir trastornos nutricionales en la primera infancia; el objetivo es generar una guía de recomendaciones para intervenciones de Enfermería en la prevención de trastornos nutricionales en niños menores de dos años. Se adelantó una Investigación documental con fuentes de información de base secundaria; se realiza la aplicación de las 3 primeras etapas del proceso de Enfermería Basada en la Evidencia (EBE). Para la clasificación de la evidencia y elaboración de las recomendaciones se usó la herramienta Canadian Task Force on Preventive Health Care (CTFPHC). La evidencia disponible refiere que el impulsar el desarrollo de estrategias dirigidas a garantizar una nutrición óptima previa a la concepción tanto en hombres como mujeres garantiza una disminución en la presentación de malnutrición en la infancia. La aplicación de la EBE identifica la evidencia científica de calidad que permite la toma de decisiones y el desarrollo de acciones que pueden llevar a fortalecer el estado de salud de las poblaciones y disminuir los costos de atención en salud desde el enfoque preventivo.
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Barrera-Sánchez, L. F., & Ospina-Díaz, J. M. (2019). Intervenciones de enfermería para prevenir trastornos nutricionales en niños de 0 a 2 años. Duazary, 16(2), 161–172. https://doi.org/10.21676/2389783X.2950
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Artículo de investigación científica y tecnológica
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Citas
1. Colombia. Comisión Intersectorial para la Atención Integral de Primera Infancia. Lineamiento Técnico de Alimentación y Nutrición para la Primera Infancia Estrategia Nacional de Cero a Siempre. Bogotá, DC; 2012.
2. Colombia. Ministerio de Salud. Encuesta Nacional de la Situación Nutricional 2015. Bogotá, DC; 2017.
3. Coello P, Ezquerro O, Fargues I, García J, Marzo M, Navarra M, et al. Enfermería Basada en la Evidencia: hacia la excelencia en los cuidados. Madrid; 2004.
4. Manterola C, Asenjo-Lobos C, Otzen T. Jerarquización de la evidencia: Niveles de evidencia y grados de recomendación de uso actual. Rev. chil. infectol. 2014; 31(6): 705-718. DOI: http://dx.doi.org/10.4067/S0716-10182014000600011
5. Birtwhistle R, Pottie K, Shaw E, Dickinson JA, Brauer P, Fortin M, et al. Canadian Task Force on Preventive Health Care: we’re back!. Canadian Family Physician. 2012 Jan; 58:13-15.
6. Canadian Task Force on Preventive Health Care. Putting prevention into practice. Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) Working Group. [Internet]. [consultado 2018 sep. 26] Disponible en: http://canadiantaskforce.ca/ methods/grade.
7. Guyatt G, Oxman A, Vist G, Kunz R, Falck-Ytter Y, Alonso-Coello P, et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ. 2008; 336:924-926.
8. Pérez-Escamilla R, Bermúdez O. Early Life Nutrition Disparities: Where the Problem Begins?. Advances in Nutrition. 2012;3(1):71-72.
9. Pérez-Escamilla R, Kac G. Childhood obesity prevention: a life-course framework. International Journal of Obesity Supplements. 2013;3(S1):S3-S5.
10. Poston L, Caleyachetty R, Cnattingius S, Corvalán C, Uauy R, Herring S, et al. Preconceptional and maternal obesity: epidemiology and health consequences. Lancet Diabetes Endocrinol. 2016 Dec;4(12):1025-1036. DOI: 10.1016/S2213-8587(16)30217-0
11. Veena S, Krishnaveni G, Karat S, Osmond C, Fall C. Testing the fetal overnutrition hypothesis; the relationship of maternal and paternal adiposity to adiposity, insulin resistance and cardiovascular risk factors in Indian children. Public Health Nutrition. 2012;16(09):1656-1666.
12. Perez-Escamilla R, Bermudez O, Buccini G, Kumanyika S, Lutter C, Monsivais P, et al. Nutrition disparities and the global burden of malnutrition. BMJ. 2018; 361:k2252.
13. Shamah-Levy T, Mundo-Rosas V, Morales-Ruan C, Cuevas-Nasu L, Méndez-Gómez-Humarán I, Pérez-Escamilla R. Food insecurity and maternal–child nutritional status in Mexico: crosssectional analysis of the National Health and Nutrition Survey 2012. BMJ Open. 2017jul;7 (7):e014371.
14. Jomaa L, Naja F, Cheaib R, Hwalla N. Household food insecurity is associated with a higher burden of obesity and risk of dietary inadequacies among mothers in Beirut, Lebanon. BMC Public Health. 2017;17(1).
15. Young M, Nguyen P, Gonzalez Casanova I, Addo O, Tran L, Nguyen S, et al. Role of maternal preconception nutrition on offspring growth and risk of stunting across the first 1000 days in Vietnam: A prospective cohort study. PLoS One. 2018 Aug;13(8):e0203201.
16. Gubert MB, Spaniol AM, Segall-Corrêa AM, Pérez-Escamilla R. Understanding the double burden of malnutrition in food insecure households in Brazil. Matern Child Nutr. 2017;13.
17. Schleiff M, Kumapley R, Freeman P, Gupta S, Rassekh B, Perry HB. Comprehensive review of the evidence regarding the effectiveness of community-based primary health care in improving maternal, neonatal and child health: 5. equity effects for neonates and children. J Glob Health. 2017;7(1):010905. DOI: 10.7189/jogh.07.010905
18. Sacks E, Freeman PA, Sakyi K, Jennings MC, Rassekh BM, Gupta S, et al. Comprehensive review of the evidence regarding the effectiveness of community–based primary health care in improving maternal, neonatal and child health: 3. neonatal health findings. J Global Health. 2017;7(1):010903.
19. Melo e Lima TR de, Maia PFC de MD, Valente EP, Vezzini F, Tamburlini G. Effectiveness of an action-oriented educational intervention in ensuring long term improvement of knowledge, attitudes and practices of community health workers in maternal and infant health: a randomized controlled study. BMC Med Educ. 2018 Sep; 18:224.
20. Tran NT, Portela A, Bernis L, Beek K. Developing capacities of community health workers in sexual and reproductive, maternal, newborn, child, and adolescent health: mapping and review of training resources. PLoS One. 2014;9(4):1–9:e94948.
21. Horwood C, Butler L, Barker P, Phakathi S, Haskins L, Grant M, et al. A continuous quality improvement intervention to improve the effectiveness of community health workers providing care to mothers and children: a cluster randomised controlled trial in South Africa. Human Resources for Health. 2017;15:39. DOI:10.1186/s12960-017-0210-7.
22. Waiswa P, Pariyo G, Kallander K, AkuzeJ, Namazzi G, Ekirapa-Kiracho E, et al. Effect of the Uganda Newborn Study on care-seeking and care practices: a cluster-randomised controlled trial. Global Health Action. 2015 Mar;8:24584.
23. Darmstadt GL, Choi Y, Arifeen SE, Bari S, Rhman S, Mannan I, et al. Evaluation of a Cluster-Randomized Controlled Trial of a Package of Community-Based Maternal and Newborn Interventions in Mirzapur, Bangladesh. Belizan JM, ed. PLoS ONE. 2010;5(3):e9696.
24. Balogun OO, O'Sullivan EJ, McFadden A, Ota E, Gavine A, Garner CD, et al. Interventions for promoting the initiation of breastfeeding. Cochrane Database of Syst Rev. 2016 Nov; 11:CD0D1688.
25. Arikpo D, Edet ES, Chibuzor MT, Odey F, Caldwell DM. Educational interventions for improving primary caregiver complementary feeding practices for children aged 24 months and under. Cochrane Database of Syst Rev. 2018 May; 5: CD011768.
26. Waswa L, Jordan I, Herrmann J, Krawinkel M, Keding G. Community-based educational intervention improved the diversity of complementary diets in western Kenya: results from a randomized controlled trial. Public Health Nutr. 2015 Dec;18(18):3406-3419.
27. Agbozo F, Colecraft E, Ellahi B. Impact of type of child growth intervention program on caregivers’ child feeding knowledge and practices: a comparative study in Ga West Municipality, Ghana. Food Sci Nutr. 2015 Dec;4(4):562-572.
28. Salam R, MacPhail C, Das J, Bhutta Z. Effectiveness of Micronutrient Powders (MNP) in women and children. BMC Public Health. 2013;13(Suppl 3):S22.
29. Soofi S, Cousens S, Iqbal S, Akhund T, Khan J, Ahmed I, et al. Effect of provision of daily zinc and iron with several micronutrients on growth and morbidity among young children in Pakistan: a cluster-randomised trial. Lanceta. 2013;382(9886):29-40.
30. Wang J, Chang S, Zhao L, Yu W, Zhang J, Man Q, et al. Effectiveness of community-based complementary food supplement (Yingyangbao) distribution in children aged 6-23 months in poor areas in China. PLoS ONE. 2017;12(3):e0174302.
31. Reinbott A, Schelling A, Kuchenbecker J, JeremiasT, Russell I, Kevanna O, et al. Nutrition education linked to agricultural interventions improved child dietary diversity in rural Cambodia. Br J Nutr. 2016;116(8):1457-1468.
32. Haselow N, Stormer A, Pries A. Evidence‐based evolution of an integrated nutrition‐focused agriculture approach to address the underlying determinants of stunting. Matern Child Nutr. 2016 ;12(Suppl 1):155-168.
33. Bhutta Z, Das J, Rizvi A, Gaffey M, Walker N, Horton S, et al. Evidence‐based interventions for improvement of maternal and child nutrition: what can be done and at what cost?. Lancet. 2013; 382:452–477.
34. Mulmi P, Masters WA, Ghosh S, Namirembe G, Rajbhandary R, Manohar S, et al. Household food production is positively associated with dietary diversity and intake of nutrient-dense foods for older preschool children in poorer families: Results from a nationally-representative survey in Nepal. PLoS ONE. 2017; 12(11): e0186765.
35. Bibiloni M, Fernández J, Pujol N, Martín N, Fernández M, Roca M, et al. Mejora de la calidad de la dieta y del estado nutricional en población infantil mediante un programa innovador de educación nutricional: INFADIMED. Gac Sanit. 2017;31(6):472-477.
36. Bissell K, Baker K, Pember S, Zhang X, Yang Y. Changing the Face of Health Education via Health Interventions: Social Ecological Perspectives on New Media Technologies and Elementary Nutrition Education. Health Commun. 2018 Aug;1-10.
37. Antwi F, Fazylova N, Garcon M, Lopez L, Rubiano R, Slyer J. The Effectiveness of web-based programs on the reduction of childhood obesity in school-aged children: a systematic review. JBI Libr Syst Rev. 2012;10(42 suppl):1-14.
38. Cerda-Muñoz L. Lactancia materna y gestión del cuidado. Rev Cubana Enfermer [Internet]. 2011 Dic [citado 2018 sept 28] ; 27( 4 ): 327-336. Disponible en: http://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S0864-03192011000400010&lng=es.
39. Renault F. Trastornos de la succión-deglución del recién nacido y el lactante. EMC - Pediatría. 2012;47(1):1-7.
40. De la Flor Picado S, Hernández A. Plan de cuidados de enfermería estandarizado en lactancia materna. NURE Inv [Internet]. 2013 [citado 02 oct 2018]; 10(62):1-11. Disponible en: http://www.fuden.es/FICHEROS_ADMINISTRADOR/PROTOCOLO/NURE62_protocolo_lactancia.pdf
41. Herrero M, Moráis A, Pérez J. Valoración nutricional en Atención Primaria, ¿es posible?. Rev Pediatr Aten Primaria. 2011;13:255-269.
42. World Health Organization. Child Growth Standards based on length/height, weight and age. Acta Paediatr Suppl. 2006;450: 76-85.
43. World Health Organization. Child Growth Standards: Methods and Development. Head circumference-for-age, arm circumference-for-age, triceps skinfold-for age and subscapular skinfold-for-age. Geneva; 2007.
44. Duggan MB. Anthropometry as a tool for measuring malnutrition: impact of the new WHO growth standards and reference. Ann Trop Paediatr. 2010;30(1):1-17.
45. Leiva, V, González M. Creación de la consulta de Enfermería Pediátrica en los Centros Infantiles de la Asociación de Roblealto. Rev. Enfermería Actual en Costa Rica. 2012; (22):14.
46. Colombia. Comisión Intersectorial para la Atención Integral de Primera Infancia. Lineamiento Técnico de Salud en la Primera Infancia. Bogotá: DC; 2012.
47. Biesalski HK, Black RE. Malnutrition and the First 1,000 Days of Life: Causes, Consequences and Solutions. World Rev Nutr Diet. 2016; 115:184-192.
48. Vásquez ML. La Enfermería Basada en la Evidencia (EBE) y la gestión del cuidado. Rev Univ. salud. 2014 june; 16(1): 05-08.
49. Varela M, Sanjurjo M, Blanco F. La investigación en enfermería. Rol de la enfermería. Asociación Española de enfermería en Urología. 2012;121 (1): 19-21.
50. Gaviria DL. La evaluación del cuidado de enfermería: un compromiso disciplinar. Invest Educ Enferm. 2009;27(1):24-33.
51. Caro CV. Papel de la investigación en enfermería. Av. Enferm. 2009; 27 (2):11-12.
52. Vásquez ML. La Enfermería Basada en la Evidencia (EBE) y la gestión del cuidado. Rev Univ. salud. 2014 June; 16(1):05-08.
2. Colombia. Ministerio de Salud. Encuesta Nacional de la Situación Nutricional 2015. Bogotá, DC; 2017.
3. Coello P, Ezquerro O, Fargues I, García J, Marzo M, Navarra M, et al. Enfermería Basada en la Evidencia: hacia la excelencia en los cuidados. Madrid; 2004.
4. Manterola C, Asenjo-Lobos C, Otzen T. Jerarquización de la evidencia: Niveles de evidencia y grados de recomendación de uso actual. Rev. chil. infectol. 2014; 31(6): 705-718. DOI: http://dx.doi.org/10.4067/S0716-10182014000600011
5. Birtwhistle R, Pottie K, Shaw E, Dickinson JA, Brauer P, Fortin M, et al. Canadian Task Force on Preventive Health Care: we’re back!. Canadian Family Physician. 2012 Jan; 58:13-15.
6. Canadian Task Force on Preventive Health Care. Putting prevention into practice. Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) Working Group. [Internet]. [consultado 2018 sep. 26] Disponible en: http://canadiantaskforce.ca/ methods/grade.
7. Guyatt G, Oxman A, Vist G, Kunz R, Falck-Ytter Y, Alonso-Coello P, et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ. 2008; 336:924-926.
8. Pérez-Escamilla R, Bermúdez O. Early Life Nutrition Disparities: Where the Problem Begins?. Advances in Nutrition. 2012;3(1):71-72.
9. Pérez-Escamilla R, Kac G. Childhood obesity prevention: a life-course framework. International Journal of Obesity Supplements. 2013;3(S1):S3-S5.
10. Poston L, Caleyachetty R, Cnattingius S, Corvalán C, Uauy R, Herring S, et al. Preconceptional and maternal obesity: epidemiology and health consequences. Lancet Diabetes Endocrinol. 2016 Dec;4(12):1025-1036. DOI: 10.1016/S2213-8587(16)30217-0
11. Veena S, Krishnaveni G, Karat S, Osmond C, Fall C. Testing the fetal overnutrition hypothesis; the relationship of maternal and paternal adiposity to adiposity, insulin resistance and cardiovascular risk factors in Indian children. Public Health Nutrition. 2012;16(09):1656-1666.
12. Perez-Escamilla R, Bermudez O, Buccini G, Kumanyika S, Lutter C, Monsivais P, et al. Nutrition disparities and the global burden of malnutrition. BMJ. 2018; 361:k2252.
13. Shamah-Levy T, Mundo-Rosas V, Morales-Ruan C, Cuevas-Nasu L, Méndez-Gómez-Humarán I, Pérez-Escamilla R. Food insecurity and maternal–child nutritional status in Mexico: crosssectional analysis of the National Health and Nutrition Survey 2012. BMJ Open. 2017jul;7 (7):e014371.
14. Jomaa L, Naja F, Cheaib R, Hwalla N. Household food insecurity is associated with a higher burden of obesity and risk of dietary inadequacies among mothers in Beirut, Lebanon. BMC Public Health. 2017;17(1).
15. Young M, Nguyen P, Gonzalez Casanova I, Addo O, Tran L, Nguyen S, et al. Role of maternal preconception nutrition on offspring growth and risk of stunting across the first 1000 days in Vietnam: A prospective cohort study. PLoS One. 2018 Aug;13(8):e0203201.
16. Gubert MB, Spaniol AM, Segall-Corrêa AM, Pérez-Escamilla R. Understanding the double burden of malnutrition in food insecure households in Brazil. Matern Child Nutr. 2017;13.
17. Schleiff M, Kumapley R, Freeman P, Gupta S, Rassekh B, Perry HB. Comprehensive review of the evidence regarding the effectiveness of community-based primary health care in improving maternal, neonatal and child health: 5. equity effects for neonates and children. J Glob Health. 2017;7(1):010905. DOI: 10.7189/jogh.07.010905
18. Sacks E, Freeman PA, Sakyi K, Jennings MC, Rassekh BM, Gupta S, et al. Comprehensive review of the evidence regarding the effectiveness of community–based primary health care in improving maternal, neonatal and child health: 3. neonatal health findings. J Global Health. 2017;7(1):010903.
19. Melo e Lima TR de, Maia PFC de MD, Valente EP, Vezzini F, Tamburlini G. Effectiveness of an action-oriented educational intervention in ensuring long term improvement of knowledge, attitudes and practices of community health workers in maternal and infant health: a randomized controlled study. BMC Med Educ. 2018 Sep; 18:224.
20. Tran NT, Portela A, Bernis L, Beek K. Developing capacities of community health workers in sexual and reproductive, maternal, newborn, child, and adolescent health: mapping and review of training resources. PLoS One. 2014;9(4):1–9:e94948.
21. Horwood C, Butler L, Barker P, Phakathi S, Haskins L, Grant M, et al. A continuous quality improvement intervention to improve the effectiveness of community health workers providing care to mothers and children: a cluster randomised controlled trial in South Africa. Human Resources for Health. 2017;15:39. DOI:10.1186/s12960-017-0210-7.
22. Waiswa P, Pariyo G, Kallander K, AkuzeJ, Namazzi G, Ekirapa-Kiracho E, et al. Effect of the Uganda Newborn Study on care-seeking and care practices: a cluster-randomised controlled trial. Global Health Action. 2015 Mar;8:24584.
23. Darmstadt GL, Choi Y, Arifeen SE, Bari S, Rhman S, Mannan I, et al. Evaluation of a Cluster-Randomized Controlled Trial of a Package of Community-Based Maternal and Newborn Interventions in Mirzapur, Bangladesh. Belizan JM, ed. PLoS ONE. 2010;5(3):e9696.
24. Balogun OO, O'Sullivan EJ, McFadden A, Ota E, Gavine A, Garner CD, et al. Interventions for promoting the initiation of breastfeeding. Cochrane Database of Syst Rev. 2016 Nov; 11:CD0D1688.
25. Arikpo D, Edet ES, Chibuzor MT, Odey F, Caldwell DM. Educational interventions for improving primary caregiver complementary feeding practices for children aged 24 months and under. Cochrane Database of Syst Rev. 2018 May; 5: CD011768.
26. Waswa L, Jordan I, Herrmann J, Krawinkel M, Keding G. Community-based educational intervention improved the diversity of complementary diets in western Kenya: results from a randomized controlled trial. Public Health Nutr. 2015 Dec;18(18):3406-3419.
27. Agbozo F, Colecraft E, Ellahi B. Impact of type of child growth intervention program on caregivers’ child feeding knowledge and practices: a comparative study in Ga West Municipality, Ghana. Food Sci Nutr. 2015 Dec;4(4):562-572.
28. Salam R, MacPhail C, Das J, Bhutta Z. Effectiveness of Micronutrient Powders (MNP) in women and children. BMC Public Health. 2013;13(Suppl 3):S22.
29. Soofi S, Cousens S, Iqbal S, Akhund T, Khan J, Ahmed I, et al. Effect of provision of daily zinc and iron with several micronutrients on growth and morbidity among young children in Pakistan: a cluster-randomised trial. Lanceta. 2013;382(9886):29-40.
30. Wang J, Chang S, Zhao L, Yu W, Zhang J, Man Q, et al. Effectiveness of community-based complementary food supplement (Yingyangbao) distribution in children aged 6-23 months in poor areas in China. PLoS ONE. 2017;12(3):e0174302.
31. Reinbott A, Schelling A, Kuchenbecker J, JeremiasT, Russell I, Kevanna O, et al. Nutrition education linked to agricultural interventions improved child dietary diversity in rural Cambodia. Br J Nutr. 2016;116(8):1457-1468.
32. Haselow N, Stormer A, Pries A. Evidence‐based evolution of an integrated nutrition‐focused agriculture approach to address the underlying determinants of stunting. Matern Child Nutr. 2016 ;12(Suppl 1):155-168.
33. Bhutta Z, Das J, Rizvi A, Gaffey M, Walker N, Horton S, et al. Evidence‐based interventions for improvement of maternal and child nutrition: what can be done and at what cost?. Lancet. 2013; 382:452–477.
34. Mulmi P, Masters WA, Ghosh S, Namirembe G, Rajbhandary R, Manohar S, et al. Household food production is positively associated with dietary diversity and intake of nutrient-dense foods for older preschool children in poorer families: Results from a nationally-representative survey in Nepal. PLoS ONE. 2017; 12(11): e0186765.
35. Bibiloni M, Fernández J, Pujol N, Martín N, Fernández M, Roca M, et al. Mejora de la calidad de la dieta y del estado nutricional en población infantil mediante un programa innovador de educación nutricional: INFADIMED. Gac Sanit. 2017;31(6):472-477.
36. Bissell K, Baker K, Pember S, Zhang X, Yang Y. Changing the Face of Health Education via Health Interventions: Social Ecological Perspectives on New Media Technologies and Elementary Nutrition Education. Health Commun. 2018 Aug;1-10.
37. Antwi F, Fazylova N, Garcon M, Lopez L, Rubiano R, Slyer J. The Effectiveness of web-based programs on the reduction of childhood obesity in school-aged children: a systematic review. JBI Libr Syst Rev. 2012;10(42 suppl):1-14.
38. Cerda-Muñoz L. Lactancia materna y gestión del cuidado. Rev Cubana Enfermer [Internet]. 2011 Dic [citado 2018 sept 28] ; 27( 4 ): 327-336. Disponible en: http://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S0864-03192011000400010&lng=es.
39. Renault F. Trastornos de la succión-deglución del recién nacido y el lactante. EMC - Pediatría. 2012;47(1):1-7.
40. De la Flor Picado S, Hernández A. Plan de cuidados de enfermería estandarizado en lactancia materna. NURE Inv [Internet]. 2013 [citado 02 oct 2018]; 10(62):1-11. Disponible en: http://www.fuden.es/FICHEROS_ADMINISTRADOR/PROTOCOLO/NURE62_protocolo_lactancia.pdf
41. Herrero M, Moráis A, Pérez J. Valoración nutricional en Atención Primaria, ¿es posible?. Rev Pediatr Aten Primaria. 2011;13:255-269.
42. World Health Organization. Child Growth Standards based on length/height, weight and age. Acta Paediatr Suppl. 2006;450: 76-85.
43. World Health Organization. Child Growth Standards: Methods and Development. Head circumference-for-age, arm circumference-for-age, triceps skinfold-for age and subscapular skinfold-for-age. Geneva; 2007.
44. Duggan MB. Anthropometry as a tool for measuring malnutrition: impact of the new WHO growth standards and reference. Ann Trop Paediatr. 2010;30(1):1-17.
45. Leiva, V, González M. Creación de la consulta de Enfermería Pediátrica en los Centros Infantiles de la Asociación de Roblealto. Rev. Enfermería Actual en Costa Rica. 2012; (22):14.
46. Colombia. Comisión Intersectorial para la Atención Integral de Primera Infancia. Lineamiento Técnico de Salud en la Primera Infancia. Bogotá: DC; 2012.
47. Biesalski HK, Black RE. Malnutrition and the First 1,000 Days of Life: Causes, Consequences and Solutions. World Rev Nutr Diet. 2016; 115:184-192.
48. Vásquez ML. La Enfermería Basada en la Evidencia (EBE) y la gestión del cuidado. Rev Univ. salud. 2014 june; 16(1): 05-08.
49. Varela M, Sanjurjo M, Blanco F. La investigación en enfermería. Rol de la enfermería. Asociación Española de enfermería en Urología. 2012;121 (1): 19-21.
50. Gaviria DL. La evaluación del cuidado de enfermería: un compromiso disciplinar. Invest Educ Enferm. 2009;27(1):24-33.
51. Caro CV. Papel de la investigación en enfermería. Av. Enferm. 2009; 27 (2):11-12.
52. Vásquez ML. La Enfermería Basada en la Evidencia (EBE) y la gestión del cuidado. Rev Univ. salud. 2014 June; 16(1):05-08.