Contrapruebas en el diagnóstico y seguimiento de niños con alergia alimentaria / Challenge test for diagnosis and follow-up of children with food allergy

Background: The prevalence of food allergy increased worldwide in the last century. In Chile we became aware of this increase 10-15 years ago, after an epidemiological transition on health. Aim : To assess the most frequent clinical presentations of food allergy, results of circulating immunologlobulins (total IgE, specific IgE and IgG4 against cow's milk) and usefulness of a standardized challenge test. Patients and methods : Cross sectional assessment of 49 patients with cow's milk allergy (9 months - 8 years of age), diagnosed at INTA, University of Chile between 1991-2001. Results: All patients had cow's milk allergy and 37 percent of them were additionally intolerant to other allergens. Seventy eight percent had digestive symptoms and 84 percent had non digestive symptoms. The cause of consultation was a non-digestive manifestation in 16 percent of cases. At least one of the immunoglobulins (total IgE total, specific IgE or IgG4) was over the cut off point in 92 percent of patients. Between 1990-1995 six patients were diagnosed with cow's milk allergy and malabsorption syndrome. Suppression of the specific allergen resulted in disappearance of symptoms in 78 percent of patients; when a second dietary modification was necessary 87 percent of cases showed a good response. Thirty five of 56 challenge tests performed were done at home, by relatives, in a non-controlled fashion. All of them were aimed to determine the desensitization of the child. Conclusions: Digestive and non-digestive manifestations were observed in these patients with food allergy. Although not designed to assess laboratory tests, results show that serum immunoglobulin determinations were helpful in guiding diagnosis. Mothers and relatives should be educated to accept diagnostic challenges and avoid carrying out non-controlled challenges

Experiencia nacional en el manejo del síndrome de intestino corto en niños / National experience in the management of short intestine syndrome in children

En un estudio retrospectivo, colaborativo, se analizó la evolución hasta 90 días después de la resección intestinal de 14 niños con intestino corto registrados en 7 hospitales (6 estatales) chilenos entre los años 1989 y 1995. La causa de la resección fue en 6 casos atresia intestinal, en 5 enterocolitis necrosante y en 3, vólvulo y se realizó, en casi todos, en el período de recién nacido. Los pacientes eran preferentemente prematuros (10/14) al nacer y de sexo masculino (10/14). Todos requirieron hospitalización prolongada (mínimo 3 meses), alimentación parenteral, principalmente por vía venosa central a través de catéteres venosos corrientes Arrow (n=14) o especiales Broviac-Hickman (n=9), Porth-a-cath (n=3) y Silastic (n=2) con volúmenes variables de alimentación enteral. Las complicaciones fueron frecuentes, debidas a causas técnicas, metabólicas, sepsis relacionadas a cateter y colestasia. El costo promedio de la alimentación parenteral para el grupo estudiado fue de $10.162 diarios (U$25). Es necesario contar con equipos especializados y normas adecuadas para el manejo de los niños con intestino corto

Enfermedad metabólica ósea del prematuro / Bone metabolic disease in premature

La enfermedad metabólica ósea del prematuro (EMOP) es un desorden comúnmente reconocido, caracterizado por falla en la mineralización ósea en prematuros en crecimiento e incluye una amplia variedad de trastornos que van desde una leve desmineralización (osteopenia) a una enfermedad ósea severa con fracturas (raquitismo)