The use of amino acid formulas in pediatric patients with allergy to cow's milk proteins: Recommendations from a group of experts.

One of the most common food allergies in children is cow's milk allergy (CMA). In breast-fed infants with CMA, the mother is encouraged to avoid dairy products. If this is not possible, or in formula fed infants, use of hypoallergenic replacement formulas such as extensively hydrolyzed formulas (EHF) is recommended. However, in ∼5% of patients EHFs are not tolerated and/or allergy symptoms can persist. When EHFs are ineffective and in severe forms of CMA, amino acid-based formulas (AAF) should be considered. Six pediatric gastroenterologists with extensive experience in food allergy management reviewed scientific publications and international clinical practice guidelines to provide practical recommendations on AAF. The guidelines reviewed had discrepancies and ambiguities around the specific indications for using formulas as a milk substitute. The panel recommends AAFs as the first therapeutic option in anaphylaxis due to CMA, in acute and chronic severe food protein-induced enterocolitis syndrome, in CMA associated with multiple food allergy, and in cases of eosinophilic esophagitis not responding to an extended exclusion diet or not eating solids. The main benefit of AAF is its absence of residual allergenicity, making it a safe treatment option in severe CMA patients who do not tolerate or respond to an EHF.

Impact of the COVID-19 pandemic on the digitization of routine pediatric practice in Spain: A nationwide survey study.

Introduction: The COVID-19 pandemic forced a change in the working dynamics of all healthcare professionals, leading to the sudden introduction of telemedicine. Although until that moment telemedicine applications had been described in the paediatric age, their use was anecdotal. Objective: To analyse the experience of Spanish paediatricians after the forced digitization of consultations due to the pandemic. Methods: A cross-sectional survey-type study was designed to obtain information from Spanish paediatricians about the changes that took place in the usual clinical practice. Results: 306 health professionals participated in the study Most of them agreed on the use of the internet and social networks during the pandemic, referring to mail or WhatsApp® as usual channels of communication with their patients' families. There was a great agreement among paediatricians that the evaluation of newborns after hospital discharge and establishing methodologies that allow childhood vaccination and the identification of subsidiary patients for face-to-face evaluation were necessary although the limitations of the lockdown. The idea that telephone and digital consultations have optimized the consultation time and that they will probably continue after the end of the pandemic was generally accepted. No changes in adherence to breastfeeding or the start of complementary feeding were referred to, but an increase in the duration of breastfeeding and the appearance of frequent hoaxes in social networks concerning infant feeding were found. Conclusions: It is necessary to analyse the impact of telemedicine in paediatric consultations during the pandemic to evaluate its effectiveness and quality to maintain it in routine paediatric practice.

Purple urine in Berdon syndrome: a rare finding in the clinic laboratory.

INTRODUCTION: Purple Urine Bag Syndrome (PUBS) is a rare disorder seen in elderly persons, wherein the urinary bag and the tubing turn in to purple colour. It is usually seen in patients who are on urinary catheters for a long time. It consists of a change in the colour of the urine that turns purple in a very specific context. CASE REPORT: We report the case of a paediatric female patient with Berdon Syndrome with symptoms consistent with urinary tract infection and purple urine discolouration. Urine test revealed leukocyturia and bacteriuria. DISCUSSION: Several risk factors have been proposed regarding this syndrome. Among them the commonest are female gender, advanced age, kind of diet (increased dietary tryptophan), alkaline urine and diverse situations that leads to urinary retentions which allows bacteria to work on their substrate for a longer time. Although it is a process that is not associated with gravity, recognizing it is important as treatment is simple and can minimize patient and family distress.

COVID-19 Gastrointestinal Manifestations Are Independent Predictors of PICU Admission in Hospitalized Pediatric Patients.

Multicenter study conducted in 15 hospitals including 101 COVID-19 pediatric inpatients aiming to describe associated gastrointestinal (GI) manifestations. GI symptoms were present in 57% and were the first manifestation in 14%. Adjusted by confounding factors, those with GI symptoms had higher risk of pediatric intensive care unit admission. GI symptoms are predictive of severity in COVID-19 children admitted to hospitals.

Assessment of Two Nutritional Screening Tools in Hospitalized Children.

AIM: to evaluate validity and concordance of Screening Tool for the Assessment of Malnutrition in Pediatrics (STAMP) and Screening Tool for Risk On Nutritional status and Growth (STRONGkids) screening tools for assessment of nutritional risk in pediatric inpatients. METHODS: Prospective longitudinal observational multicenter study in children aged 1 month or older admitted as inpatients. Weight, height, cause of admission, demographic data, length of stay, and nutritional interventions were recorded. STAMP and STRONGkids were applied within the first 72 h of admission. Anthropometric measurements were recorded again 12-18 months after admission. RESULTS: Eighty-one patients with median age of 4.1 years completed the study. Agreement between tools was moderate (κ = 0.47). STAMP had a greater tendency to classify patients as high risk (12.3% vs. 2.5%). Both tools showed very weak correlation with height for age. All undernourished patients at the beginning and the end of the study were classified as medium or high risk by STAMP and STRONGkids (100% sensitivity), although specificity was below 50% in all cases. There were no differences in length of stay based on nutritional risk with any of the tools. CONCLUSIONS: STAMP and STRONGkids demonstrated moderate agreement, with high sensitivity but low specificity for the diagnosis of undernutrition. Further studies are required to analyze cost-effectiveness of these tools and nutritional interventions derived from them.

Alergia a las proteínas de leche de vaca no mediada por IgE: documento de consenso de la Sociedad Española de Gastroenterología, Hepatología y Nutrición Pediátrica (SEGHNP), la Asociación Española de Pediatría de Atención Primaria (AEPAP), la Sociedad Española de Pediatría Extrahospitalaria y Atención Primaria (SEPEAP) y la Sociedad Española de Inmunología Clínica, Alergología y Asma Pediátrica (SEICAP) / Non-IgE-mediated cow's milk allergy: Consensus document of the Spanish Society of Paediatric Gastroenterology, Hepatology, and Nutrition (SEGHNP), the Spanish Association of Paediatric Primary Care (AEPAP), the Spanish Society of Extra-hospital Paediatrics and Primary Health Care (SEPEAP), and the Spanish Society of Paediatric ClinicaL Immunology, Allergy, and Asthma (SEICAP)

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[Non-IgE-mediated cow's milk allergy: Consensus document of the Spanish Society of Paediatric Gastroenterology, Hepatology, and Nutrition (SEGHNP), the Spanish Association of Paediatric Primary Care (AEPAP), the Spanish Society of Extra-hospital Paediatrics and Primary Health Care (SEPEAP), and the Spanish Society of Paediatric ClinicaL Immunology, Allergy, and Asthma (SEICAP)]. / Alergia a las proteínas de leche de vaca no mediada por IgE: documento de consenso de la Sociedad Española de Gastroenterología, Hepatología y Nutrición Pediátrica (SEGHNP), la Asociación Española de Pediatría de Atención Primaria (AEPAP), la Sociedad Española de Pediatría Extrahospitalaria y Atención Primaria (SEPEAP) y la Sociedad Española de Inmunología Clínica, Alergología y Asma Pediátrica (SEICAP).

Non-IgE-mediated cow's milk allergy is a frequent disorder in paediatrics. As patients might be seen by professionals from different specialties and levels of expertise, a great variability in diagnostic procedures and disease monitoring is commonly observed. Therefore, four scientific societies involved in its management have developed a consensus document providing specific recommendations related to its prevention, diagnosis, treatment and follow up.

Obesidad infantil: ¿prevención o tratamiento? / Childhood obesity: Prevention or treatment?

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[Uses in gastroenterology]. / Aplicaciones en Gastroenterología.

Nowadays, publications on probiotics have increased exponentially. However they usually are heterogeneous, use diverse strains and doses, and different outcomes, making it difficult to generalize their results. On the basis of the currently available literature, the use of probiotics is supported in the following diseases: acute diarrhea, antibiotic-associated diarrhea, irritable bowel syndrome, necrotizing enterocolitis and inflammatory bowel disease (particularly pouchitis). This paper provides an update of the potential role of probiotics in gastrointestinal diseases, in both pediatric and adult patients.

En los últimos años se ha multiplicado de forma exponencial el número de publicaciones sobre las aplicaciones de los probióticos. Sin embargo, éstas suelen ser heterogéneas, utilizar cepas y dosis muy diversas, así como distintos parámetros de medida, lo que dificulta la generalización de sus resultados. En el momento actual existe un grado de evidencia alto sobre el papel de determinados probióticos en las siguientes entidades: tratamiento diarrea infecciosa aguda, prevención diarrea asociada a antibióticos, síndrome de intestino irritable, prevención de enterocolitis necrotizante y en enfermedad inflamatoria intestinal (pouchitis). En este artículo se presenta una revisión actualizada de la literatura científica sobre el papel potencial del consumo de probióticos en diversas patologías gastrointestinales tanto en pacientes pediátricos como en adultos.

Aplicaciones en Gastroenterología / Uses in gastroenterology

En los últimos años se ha multiplicado de forma exponencial el número de publicaciones sobre las aplicaciones de los probióticos. Sin embargo, éstas suelen ser heterogéneas, utilizar cepas y dosis muy diversas, así como distintos parámetros de medida, lo que dificulta la generalización de sus resultados. En el momento actual existe un grado de evidencia alto sobre el papel de determinados probióticos en las siguientes entidades: tratamiento diarrea infecciosa aguda, prevención diarrea asociada a antibióticos, síndrome de intestino irritable, prevención de enterocolitis necrotizante y en enfermedad inflamatoria intestinal (pouchitis). En este artículo se presenta una revisión actualizada de la literatura científica sobre el papel potencial del consumo de probióticos en diversas patologías gastrointestinales tanto en pacientes pediátricos como en adultos (AU)

Nowadays, publications on probiotics have increased exponentially. However they usually are heterogeneous, use diverse strains and doses, and different outcomes, making it difficult to generalize their results. On the basis of the currently available literature, the use of probiotics is supported in the following diseases: acute diarrhea, antibiotic-associated diarrhea, irritable bowel syndrome, necrotizing enterocolitis and inflammatory bowel disease (particularly pouchitis). This paper provides an update of the potential role of probiotics in gastrointestinal diseases, in both pediatric and adult patients (AU)

High serum retinol and lung function in young patients with cystic fibrosis.

OBJECTIVE: The aim of the present study was to explore the relation between lung function and serum retinol (SR) in cystic fibrosis (CF) patients. METHODS: This was a cross-sectional study conducted in a group of 98 young patients with CF (6.8-22.3 years), after the exclusion of those with pulmonary exacerbation, vitamin A deficiency, or other risks, from an initial group of 124 cases. RESULTS: Data of forced expiratory volume in 1 second (FEV1) were widely scattered (87.7% ± 16.9%). These were similar in the 78 pancreatic insufficient and 11 pancreatic sufficient patients. SR (56.6 ± 18.4 µg/dL) was >2.5th percentile of healthy people in the whole group, although 31 patients were situated above the 97.5th percentile (higher value: 110 µg/dL). The FEV1 was noticeably higher in these than in those within the normal range (93.6 ± 14.0 vs 85.0 ± 17.6 µg/dL; P < 0.05). The z score of SR correlated positively with FEV1 (r = 0.364; P = 0.000), after adjusting data for sex, age, body mass index, and pancreatic function. The odds ratio for a FEV1 >80% is 3.78 in patients with SR above the 97.5th percentile, versus only 0.26 in those within the normal range. There were no cases with retinol toxicity. CONCLUSIONS: FEV1 of young patients with CF correlates positively with SR, regardless of age, pancreatic function, or nutritional condition. Those with a moderately high retinol (up to 110 µg/dL) maintain the best respiratory function (FEV1 ≥80% in >90% of them) without any signs of toxicity.