Manejo hospitalario de desnutrición severa en pediatría

La desnutrición se define como aquella condición patológica, inespecífica, sistémica y potencialmente reversible que resulta de la deficiente utilización de los nutrimientos por las células de los organismos.1 De acuerdo con la Sociedad Americana de Nutrición Enteral y Parenteral (ASPEN, por sus siglas en inglés) se precisa como un desequilibrio entre el requerimiento y gasto energético, lo cual resulta en un déficit acumulativo de energía, proteína o micronutrientes que afectan de forma negativa el crecimiento, desarrollo y otros resultados relevantes en la población pediátrica. En cuanto a su severidad, de acuerdo con la Organización Mundial de la Salud (OMS), se clasifica según su puntuación Z en leve, moderada y severa.2

Nutritional benefits in pediatric patients with percutaneous endoscopic gastrostomy placement

Gastrostomy is an enteral nutrition option. Indications for its placement are diverse, among them, the alteration in the mechanics of swallowing, frequently present in patients with neurological diseases. Nutritional recovery is the objective in these patients evaluating the nutritional status after the placement of a PEG in the pediatric population. This is a retrospective cohort conducted to evaluate nutritional recovery in pediatric patients with PEG placement. It was performed using anthropometric and biochemical parameters before and after placement. Forty-seven subjects were included, from which weight, height, and upper arm circumference were obtained, to evaluate nutritional recovery using BMI or W/L according to age. Significant nutritional improvement was demonstrated in a population of 39 patients, who had a mean follow-up of 7 months. In our population, PEG is an enteral nutrition strategy that has a significant positive impact on nutritional status in a mean of 7 months after its placement. Therefore, considering the evolution time of these patients will guide the clinician in making decisions regarding surveillance and monitoring parameters of the nutritional status.

Procedimientos diagnósticos para enfermedad hepática crónica: más allá del lactante

La hepatopatía crónica es un síndrome clínico-patológico de causa diversa, con alteraciones clínicas, bioquímicas e histológicas del hígado, persistente durante tres meses o más. Se caracteriza por diversos grados de inflamación crónica o necrosis hepatocelular.Las enfermedades crónicas del hígado representan un desafío para el pediatra. La atresia de vías biliares y los síndromes hereditarios (colestasis intrahepática) que evolucionan a cirrosis, son las más frecuentes en los lactantes.La hepatopatía crónica, en pacientes pediátricos, con frecuencia se infradiagnostica porque es asintomática en estadios tempranos y distintas causas pueden tener un cuadro similar. 

Lactobacillus acidophilus LB: a useful pharmabiotic for the treatment of digestive disorders

Dysbiosis, a loss of balance between resident bacterial communities and their host, is associated with multiple diseases, including inflammatory bowel diseases (nonspecific chronic ulcerative colitis and Crohn's disease), and digestive functional disorders. Probiotics, prebiotics, synbiotic organisms and, more recently, pharmabiotics, have been shown to modulate the human microbiota. In this review, we provide an overview of the key concepts relating to probiotics, prebiotics, synbiotic organisms, and pharmabiotics, with a focus on available clinical evidence regarding the specific use of a unique pharmabiotic, the strain Lactobacillus acidophilus LB (Lactobacillus boucardii), for the management of gastrointestinal disorders. Since it does not contain living organisms, the administration of L. acidophilus LB is effective and safe as an adjuvant in the treatment of acute diarrhea, chronic diarrhea, and antibiotic-associated diarrhea, even in the presence of immunosuppression.

Blastocystis Hominis and Chronic Abdominal Pain in Children: Is there an Association between Them?

Chronic abdominal pain has many etiologies, one of them being parasites. The aim of this study was to find an association between chronic abdominal pain in children and Blastocystis hominis (Bh). Clinical files of patients with Bh and functional abdominal pain were reviewed. A comparison was made between patients who showed an improvement of their symptoms and those who did not. Out of the 138 patients who had functional abdominal pain and Bh, 37 patients did not receive any treatment (26.8%), while 101 received it and were treated with different antimicrobial agents (73.2%); regarding the improvement of symptoms, a statistically significant difference (p < 0.001) was observed. Chronic abdominal pain in children has different etiologies; however, we have documented through this work that it is appropriate to provide antimicrobial treatment for patients with Bh and chronic abdominal pain.

Métodos de evaluación de desnutrición intrahospitalaria en niños

OBJETIVO: Describir las distintas herramientas de cribado para el diagnóstico de desnutrición intrahospitalaria y comparar sus diferencias. MATERIAL Y MÉTODO: Estudio comparativo y retrospectivo de búsqueda bibliográfica en las bases de datos Scientific Electronic Library Online (SciELO), Red Informática de Medicina Avanzada (RIMA), Plataforma HIGHWIRE, Literatura Latinoamericana y del Caribe en Ciencias de la Salud (LILACS) y Medline. Las palabras clave de búsqueda fueron: herramientas de cribado nutricional, desnutrición intrahospitalaria y diagnóstico de malnutrición intrahospitalaria. RESULTADOS: Se encontraron seis herramientas de cribado pero ninguna estandarizada para la edad que valoran, miden diferentes parámetros y evalúan de distintas formas el riesgo de desnutrición intrahospitalaria. Ninguna puede considerarse patrón de referencia ni tampoco son comparables entre sí. La sensibilidad y especificidad que publica cada una de las herramientas no sustentan que alguna pruebe mejor o peor pronóstico en niños hospitalizados.CONCLUSIONES: Si bien todas las herramientas estudiadas pretenden orientar la conducta médica para lograr intervenciones dietéticas oportunas, todas son subjetivas y sumamente específicas para el lugar en el que se aplican. Desde luego que se requiere la estandarización que atienda las necesidades propias del lugar en donde van a aplicarse. El Instituto Nacional de Pediatría requiere una herramienta específica para las condiciones en que se labora en este hospital; por tanto, y con base en la variabilidad de las herramientas comparadas, se propone diseñar una herramienta de fácil aplicación que permita evaluar oportuna y rápidamente el riesgo nutricional de nuestros pacientes.PALABRAS CLAVE: Malnutrición; niños hospitalizados.

[Peutz-Jeghers syndrome]

Peutz-Jeghers syndrome is an autonomic dominant disease characterized by hamartomatous polyps and mucocutaneous hyperpigmentation. We present 16 cases; females were more affected. The most common presenting complaints were of gastrointestinal tract. All polyps found were hamartomatous with general distribution through gastrointestinal tract. Endoscopic polypectomy should be carried out for treatment. Radiologic, endoscopic and histologic studies should be conducted for long-term follow-up, because of high risk of malignancy.

[Medico-surgical consensus for management of children with gastroesophageal reflux Acapulco, Mexico 2002]

Gastroesophageal reflux (GER) is a common disease in children less one year old. It is present around 10% of unselected infant population. 40-50% have abnormal 24 h pH monitoring. An early diagnosis and treatment should be done in order to avoid complications.

AIM

To establish the consensus for the diagnosis and treatment of children with GER, to rule out similar diseases avoid the use of unnecessary drugs and the secondary side effects as well as unnecessary surgery.

METHOD

The consensus was done with the participation of general pediatricians, pediatrics gastroenterologist, pediatric surgeons, radiologist and endoscopist. An initial paper was done by pediatric surgeon and pediatric gastroenterologist who submitted to the rest of participants. Second stage: the paper was review through E-mail for all participants who send their suggestions and modifications. A new paper was done and discussed by medical and surgery area. During the Congress of Pediatric Surgery, in an open session was discuss again with the participation of the main authors and all the audience present. Finally, a paper was done and review for the main authors.