ABSTRACT
The central nervous system damage is associated with a major dysfunction of gastrointestinal tract, whose magnitude is variable. The rehabilitation of disabled children should be confronted by a multi-professional team and beginning the most early as possible, with the aim of impacting so positive on morbidity and mortality associated with their condition. Enteral nutrition is a valuable tool when the indication is right, the first approach is to establish the form of food safer and less expensive according to the clinical circumstances of each case. When the nutritional rehabilitation can be achieved in the short term, the nutrition through probes both gastric as post-pyloric, are alternative for quick and easy access, often in stages prior to establish definitive food routes.
El daño del sistema nervioso central se asocia a una disfunción importante del tracto gastrointestinal, cuya magnitudes variable. La rehabilitación del niño discapacitado debe ser enfrentada por un equipo multiprofesional e iniciada lo más precozmente posible, con el objetivo de impactar de manera positiva en la morbimortalidad asociada a su condición. La nutrición enteral es una herramienta valiosa cuando la indicación es la adecuada, la primera aproximación es establecer la forma de alimentación más segura y menos costosa de acuerdo a las condiciones clínicas de cada caso. Cuando la rehabilitación nutricional se puede alcanzar en un corto plazo, la nutrición a través de sondas tanto gástricas como post pilóricas, son alternativas de fácil y rápido acceso, en muchas ocasiones en etapas previas a establecer rutas de alimentación definitivas.
Subject(s)
Humans , Child , Nervous System Diseases/complications , Intubation, Gastrointestinal/methods , Enteral Nutrition/methods , Esophageal Motility Disorders/therapy , Nervous System Diseases/therapy , Gastroesophageal Reflux , Enteral Nutrition/adverse effects , Patient Selection , Pylorus , Esophageal Motility Disorders/etiologyABSTRACT
Children with neurological disabilities are a healthcare problem with a growing incidence and require a multidisciplinary team for a proper manage. They frequently show swallowing disorders (sD) that must be suspected, diagnosed and treated by specialists. The sD study has several tools that have evolved over time. One of such tools is the fiberoptic endoscopic evaluation of swallowing (Fees). Since its appearance 20 years ago up to our days, Fees has been validated for the study of pharyngeal swallow. Fees are a standardized and systematic study that permits to evaluate the swallowing process through a direct visualization of the upper airways with a nasal flexible endoscopy. Besides the proper equipment, it also requires a full knowledge of pediatric anatomy and training, which can limit its use. It can be easily transported. It does not use radioactive elements which permit repeated and safe use in children. Along with diagnosis, Fees also provides treatment and management recommendations for patients.
Los niños con limitaciones neurológicas son un problema de salud cuya incidencia va en aumento y requiere de un equipo multidisciplinario para su manejo. Frecuentemente presentan trastornos de la deglución (TD) que deben ser sospechados, diagnosticados y manejados por especialistas. En el estudio de los TD existen distintas herramientas que han ido evolucionando en el tiempo. Uno de estos es el estudio endoscópico de la deglución (Fees), que desde su aparición hace 20 años a la actualidad es un examen que ha sido validado para el estudio de la deglución faríngea. La Fees es un estudio estandarizado y sistemático que a través de la visualización directa de las vía aérea superior con un endoscopio flexible nasal, permite la evaluación de la deglución al observar el paso de alimentos. Además del equipo adecuado, requiere un conocimiento acabado de la anatomía pediátrica y entrenamiento por parte del especialista lo que pueden limitar su uso y es fácilmente transportable no utiliza elementos radioactivos lo que permite su uso repetido y seguro en niños. Junto con realizar un diagnóstico la Fees permite entregar las recomendaciones de tratamiento y manejo para el paciente.
Subject(s)
Humans , Child , Endoscopy/methods , Nervous System Diseases/complications , Fiber Optic Technology , Deglutition Disorders/diagnosis , Deglutition/physiologyABSTRACT
Unstable mutations or amplification of DNA tandem repeats sequences constitute a new kind of genetic alteration discovered in the 90's that cause hereditary diseases. This mutation has been found inside or near important genes involved in the normal neurological function in human beings. In some cases, the presence of the amplification causes altered expression of the genes, their inactivation or the synthesis of a protein with new functions. Some common characteristics of these diseases are that they affect the central nervous system and are degenerative in nature. Most of them show genetic anticipation meaning that the severity of the manifestations increases in each generation and appear at an earlier age. In most cases, the severity of the symptoms is positively correlated with the size of the amplification. Twenty illnesses caused by this kind of mutations have been identified so far. Briefly, this work reviews the current knowledge about this topic.