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1.
Nutr Hosp ; 27(5): 1429-36, 2012.
Article in Spanish | MEDLINE | ID: mdl-23478688

ABSTRACT

BACKGROUND: Malnutrition among hospitalized patients has clinical implications, and interest has arisen to find screening tools able to identify subjects under risk. At present, there is no consensus about the most suitable nutrition screening tool for pediatric patients. AIM: To validate STAMP (Screening Tool for the Assessment of Malnutrition in Pediatrics) pediatric screening tool in Spain. METHODS: Descriptive cross-sectional study of patients admitted to a 3rd level children's hospital with both medical and surgical specialities. During the first 24 hours of admission, STAMP screening tool was applied. For its validation, results were compared with those obtained from a nutritional assessment performed by specialist staff, which included clinical, anthropometric and body composition data. RESULTS: A sample of 250 children was studied. Nutritional assessment identified 64 patients (25.6%) under risk, 40 of whom were malnourished (16%). STAMP classified 48.4% of the patients as being under nutritional risk. This tool showed 75% sensitivity and 60.8% specificity when identifying patients under risk according to nutritional assessment. It showed 90% sensitivity and 59.5% specificity when identifying malnourished patients. COMMENTS: Malnutrition was less frequent than that reported in other European countries, although diagnosis technique was different. STAMP is a simple and useful tool for nutritional screening, avoiding the need to assess all patients on admission in order to identify those under nutritional risk.


Subject(s)
Malnutrition/diagnosis , Nutrition Assessment , Adolescent , Anthropometry , Child , Child, Preschool , Cross-Sectional Studies , Female , Hospitalization , Humans , Infant , Male , Malnutrition/epidemiology , Nutritional Status , Reproducibility of Results , Risk , Spain/epidemiology
2.
Acta pediatr. esp ; 69(11): 501-505, dic. 2011. tab
Article in Spanish | IBECS | ID: ibc-99266

ABSTRACT

Los niños con una enfermedad renal crónica tienen un alto riesgo de desnutrición y requieren un soporte nutricional especializado, sobre todo en un estadio de la enfermedad mayor o igual a 2. La pérdida de función de un órgano metabólicamente tan activo entraña alteraciones en el metabolismo intermediario de los nutrientes, así como en la biodisponibilidad y la pérdida de éstos. El riñón enfermo tiene una pérdida de función progresiva en la que están implicados muchos factores, entre los que el factor nutricional es importante. El retraso de crecimiento es la afectación más importante durante la infancia. La alteración depende del grado de afectación y de la edad del paciente. El riesgo es mayor cuando la enfermedad es congénita, porque durante el primer año la velocidad de crecimiento es muy alta y los requerimientos nutricionales muy elevados y de difícil cobertura. Las alteraciones motoras del tracto gastrointestinal producen anorexia y vómitos que dificultan la ingesta; por ello, estos pacientes frecuentemente requieren suplementación nutricional y una nutrición enteral prolongada mediante gastrostomía, que en general es endoscópica percutánea (AU)


Children with chronic kidney disease are vulnerable to malnutrition, needing specific nutritional support to prevent it, especially when the disease is in a phase greater than 2 the loss of the function of such an active organ metabolically causes alteration in the intermediary metabolism of the nutrients, as well as in the nutrient bioavailability and losses. Several factors are involved in the progressive loss of renal function, and nutritional factors are very important. Growth retardation is the most important affectation during childhood; the alteration depends in the degree of affectation and the patient’s age. The risk is greater when the disease is congenital because during the first year the speed of the growth is very high and the nutritional requirements are very high and of very difficult coverage. The changes in motor skills of the gastrointestinal tract cause anorexia and vomits that cause difficulty in the consumption, due to this reason they frequently need nutritional supplementation and prolonged enteral nutrition through gastrostomy, which is generally percutaneous endoscopic (AU)


Subject(s)
Humans , Male , Female , Child , Renal Insufficiency, Chronic/complications , Child Nutrition Disorders/diet therapy , Nutritional Support/methods , Gastrostomy , Enteral Nutrition , Child Development
3.
Acta pediatr. esp ; 69(10): 455-462, nov. 2011. tab
Article in Spanish | IBECS | ID: ibc-99258

ABSTRACT

La evolución de la nutrición enteral (NE) dentro de la nutrición artificial en pediatría es manifiesta, tanto para el soporte del paciente desnutrido como para tratar patologías específicas, lo que da lugar al concepto de «alimento-medicamento». La indicación básica de la NE se da en el paciente que no consigue la cobertura energético-proteica adecuada con la ingesta oral espontánea. En el presente artículo se revisan las principales enfermedades subsidiarias de beneficiarse de una NE efectiva, así como las vías de acceso a través de las que se administrará la NE en el paciente pediátrico: sondas oro/naso enterales y sondas a través de ostomías. Las modalidades de administración de NE son: continua, intermitente y cíclica. Finalmente, se incide en las complicaciones de la NE, relacionándolas con el tipo de sonda utilizada, el tipo de fórmula y su administración, la edad de instauración de la sonda, y la enfermedad de base y clínica del paciente(AU)


The evolution of the enteral nutrition (EN) in the artificial nutrition in pediatrics is manifested, both for the nutritional support of malnourished patients and in the treatment of specific pathologies, what gives place to the concept of “food medication”. The basic indication of the EN is given to that patient that does not reach the adequate protein energy with the spontaneous oral ingestion. In this article, the main subsidiary diseases which may improve on an effective EN, as well as the routes of access through which the EN will be administered in the pediatric patient: gold probe/naso enteral feeding tubes and feeding through an ostomy are mentioned. The modalities of administration extend across the continuous, intermittent and periodical EN. Finally, we will have on effect on the complications of EN relating them with the type of feeding tube used the type of formula and its administration, the age of implantation of the probe and the base disease and clinical condition of the patient(AU)


Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Enteral Nutrition/methods , Protein-Energy Malnutrition/diet therapy , Nutritional Support/methods , Diet Therapy/methods , Intubation, Gastrointestinal , Gastrostomy
4.
Acta pediatr. esp ; 69(7/8): 333-338, jul.-sept. 2011. tab
Article in Spanish | IBECS | ID: ibc-99452

ABSTRACT

El recién nacido prematuro presenta características nutricionales y funcionales diferenciales que, según el peso al nacimiento y la edad gestacional, serán la base para llevar a cabo su soporte nutricional. Una nutrición precoz y eficaz mejora el pronóstico. El mantenimiento de un crecimiento extrauterino adecuado, el aporte óptimo de energía y el descenso de la morbilidad precoz serán los tres objetivos fundamentales de la nutrición artificial. En este artículo se exponen los requerimientos de energía, líquidos, proteínas, hidratos de carbono y lípidos en este tipo de pacientes. Además de aportar sustrato energético, la nutrición enteral también estimula la mucosa intestinal, influye en la adquisición apropiada de una microbiota y ayuda a conseguir un buen vínculo madre-hijo, así como una adecuada maduración psicomotora. Se revisan los diferentes procedimientos de alimentación, así como la progresión a nutrición enteral total, la intolerancia digestiva en estos pacientes y el tipo de alimentación al alta(AU)


Premature newborns have especial functional and nutritional characteristics that, depending on their birth weight and their gestational age, are the basis to carry out their nutritional support. They need an effective and precocious nutrition in order to improve their outcome. The maintenance of an adequate extra uterine growth, anoptimum energy intake, and a decrease of early morbidity are the main objectives of artificial nutrition. Energy, fluid, proteins, carbohydrates and lipids requirements of this kind of patients are shown in the present article. As well as energetic substrate, the enteral nutrition also stimulates the intestinal mucosa, influencing the acquisition of an appropriate microbiota, and it helps to create an appropriate bond between mother and baby and a suitable psychomotor maturation. The different feeding procedures for these patients are reviewed as well as the progression way to complete enteral feeding, the digestive intolerance and the selection of a diet before hospital discharge(AU)


Subject(s)
Humans , Male , Female , Infant, Newborn , Infant, Premature/growth & development , Infant Nutrition , Enteral Nutrition/methods , Nutritional Support/methods , Infant, Premature, Diseases/prevention & control
5.
Rev. esp. pediatr. (Ed. impr.) ; 66(5): 298-299, sept.-oct. 2010.
Article in Spanish | IBECS | ID: ibc-91726

ABSTRACT

La deficiencia de micronutrientes es la forma de malnutrición más generalizada en el mundo y afecta sobre todo a los niños y a las mujeres adultas. Durante la infancia y adolescencia el déficit de micronutrientes tiene gran trascendencia en el crecimiento y desarrollo neurológico lo que va a trascender en su calidad de vida en la edad adulta. El déficit de Zinc por ejemplo, aparte de influir en la incidencia de infecciones, afecta el crecimiento y hoy se sabe que un tercio de la población mundial es deficitaria de Zinc. En ocasiones el déficit de micronutrientes condiciona mutaciones bacterianas cuya infección condiciona epidemias de patología diversa como ocurrió con la miocardiopatía de Keshan por déficit de selenio y la neuropatía óptica periférica de Cuba en la que se objetivó una mutación del Cocsakie CV9 en relación con déficit de Selenio, vitamina E, α y β carotenos y licopeno. Es importante recordar que en nuestro medio el déficit de micronutrientes es en general subclínico y en ocasiones se ha visto relacionado con manifestaciones patológicas tanto el déficit vitamínico como el déficit de minerales, como ocurre con el déficit vitamínico como el déficit de minerales, como ocurre con el déficit de ácido fólico y los defectos del tubo neural y el déficit de zinc con afectación del crecimiento. Muchas vitaminas juegan un papel importante en el desarrollo de enfermedades crónicas por su papel antioxidante y su participación en la regulación de la metilación, hoy se sabe que además pueden tener efectos inhibitorios de la inflación (α tocoferon, zinc y vitamina A) de la angiogénesis (α-tocopherol, vitamin A, C, y D), osteoartritis (Vitamina c, Ca. Y vitamina D). La ingesta del calcio puede tener efecto en los niveles de colesterol, y al formar compuestos insolubles con la grasa y sales biliares disminuye el contacto entre carcinógenos y mucosa intestinal. Es bien conocido el papel de la vitamina D y el calcio en la densidad ósea disminuyendo la osteoporosis y las fracturas de cadera. Por todo ello se plantea la necesidad de aumentar el aporte de micronutrientes que puede realizarse mediante suplementos o fortificando los alimentos. Aunque está demostrada la reducción de patología con la fortificación de alimentos, en España la fortificación de alimentos es habitual, sin embargo es irregular, la fortificación con ácido fólico por ejemplo en la revisión realizada por Samaniego y cols, es irregular y los diferentes alimentos fortificados aportan entre un 15 y un 430% de la Cantidad diaria recomendada y de ellos, el 75% tenían adición de vitamina B6 y B12. Para determinar la población diana de esta fortificación es necesario conocer la importancia del déficit de micronutrientes en nuestra población pediátrica. La prevalencia de déficit de micronutrientes es menor en Europa y en Estados Unidos que en el resto del mundo, sin embargo en España la prevalencia del déficit de algunos micronutrientes es superior al de los países Europeos, posiblemente debido a la fortificación de alimentos. En España se dispones de pocos datos acerca del aporte de nutrientes, a nivel nacional, casi todos los estudios son locales o Comunitarios (AU)


No disponible


Subject(s)
Humans , Child Nutrition Disorders/etiology , Micronutrients/deficiency , Food, Fortified/analysis , Avitaminosis/complications , Mineral Deficiency
6.
An Pediatr (Barc) ; 70(5): 488-96, 2009 May.
Article in Spanish | MEDLINE | ID: mdl-19427823

ABSTRACT

High blood cholesterol levels represent an important cardiovascular risk factor. Hypercholesterolemia is defined as levels of total cholesterol and low-density lipoprotein cholesterol above 95th percentile for age and gender. For the paediatric population, selective screening is recommended in children older than 2 years who are overweight, with a family history of early cardiovascular disease or whose parents have high cholesterol levels. Initial therapeutic approach includes diet therapy, appropriate physical activity and healthy lifestyle changes. Drug treatment should be considered in children from the age of 10 who, after having followed appropriate diet recommendations, still have very high LDL-cholesterol levels or moderately high levels with concomitant risk factors. In case of extremely high LDL-cholesterol levels, drug treatment should be taken into consideration at earlier ages (8 years old). Modest response is usually observed with bile acid-binding resins. Statins can be considered first-choice drugs, once evidence on their efficacy and safety has been shown.


Subject(s)
Hypercholesterolemia/therapy , Child , Decision Trees , Humans
7.
An. pediatr. (2003, Ed. impr.) ; 70(5): 488-496, mayo 2009. tab, ilus
Article in Spanish | IBECS | ID: ibc-61528

ABSTRACT

La hipercolesterolemia se asocia a un aumento del riesgo de enfermedad cardiovascular precoz y queda definida por unos valores de colesterol total y de colesterol de las lipoproteínas de baja densidad (cLDL) superiores al percentil 95 para la edad y el sexo. En población pediátrica, se recomienda cribado selectivo a partir de los 2 años de edad en los niños con sobrepeso, antecedentes familiares de enfermedad cardiovascular precoz o con padres que presenten hipercolesterolemia. El abordaje no farmacológico incluye tratamiento dietético, actividad física adecuada y estilos de vida saludables. Si tras un tratamiento dietético correcto se mantienen valores muy elevados de cLDL o moderadamente elevados junto con otros factores de riesgo cardiovascular, se recomienda el tratamiento farmacológico a partir de los 10 años. En caso de valores de cLDL extremadamente elevados (>500mg/dl) debe considerarse adelantar el inicio del tratamiento farmacológico a los 8 años. La respuesta al tratamiento con resinas fijadoras de ácidos biliares suele ser modesta. Por seguridad y eficacia, las estatinas pueden considerarse fármacos de primera elección (AU)


High blood cholesterol levels represent an important cardiovascular risk factor. Hypercholesterolemia is defined as levels of total cholesterol and low-density lipoprotein cholesterol above 95th percentile for age and gender. For the paediatric population, selective screening is recommended in children older than 2 years who are overweight, with a family history of early cardiovascular disease or whose parents have high cholesterol levels. Initial therapeutic approach includes diet therapy, appropriate physical activity and healthy lifestyle changes. Drug treatment should be considered in children from the age of 10 who, after having followed appropriate diet recommendations, still have very high LDL-cholesterol levels or moderately high levels with concomitant risk factors. In case of extremely high LDL-cholesterol levels, drug treatment should be taken into consideration at earlier ages (8 years old). Modest response is usually observed with bile acid-binding resins. Statins can be considered first-choice drugs, once evidence on their efficacy and safety has been shown (AU)


Subject(s)
Humans , Hypercholesterolemia/therapy , /therapeutic use , Hyperlipoproteinemia Type II/therapy , Lipoproteins/administration & dosage , Dietary Fats/analysis , Motor Activity , Anticholesteremic Agents/therapeutic use , Bile Acids and Salts
8.
An Pediatr (Barc) ; 65(6): 607-15, 2006 Dec.
Article in Spanish | MEDLINE | ID: mdl-17194329

ABSTRACT

Obesity is a pathologic entity characterized by an increase in fat body mass and is a global public health problem. In Spain, between 1984 (the Paidos study) and 2000 (the enKid study), the prevalence of childhood overweight and obesity increased and significant differences were found among the autonomous communities. Consequently prophylactic measures were implemented throughout the country and in 2005 the Ministry of Health developed the NAOS strategy (strategy for nutrition, physical activity and obesity prevention). Within the medical area of this intervention, primary care pediatricians acquire a key role. Aware of this, the Spanish Association of Pediatrics, through the Nutrition Committee, aims to provide information on the current situation concerning the etiopathogenesis and early identification of at-risk populations. The epidemiology and risk periods in the pediatric age group are reviewed and recommendations on healthy lifestyle are provided, bearing in mind diet and physical activity throughout childhood, with the aim of preventing overweight and obesity.


Subject(s)
Obesity/diagnosis , Obesity/prevention & control , Child , Diet , Early Diagnosis , Humans , Pediatrics , Risk Factors
9.
Rev Neurol ; 39(8): 727-30, 2004.
Article in Spanish | MEDLINE | ID: mdl-15514900

ABSTRACT

INTRODUCTION: Non-ketotic hyperglycinemia is a congenital error in the breakdown of glycine. The most common type is the classical neonatal form, which begins at the age of a few days with symptoms of lethargy, hypotonia, myoclonia, convulsions, apneas and, frequently, ends in death. Survivors usually develop intractable epilepsy and mental retardation. There is no effective treatment for this condition, but trials have been carried out with a therapy that diminishes the levels of glycine, benzoate (BZ), and another that blocks the excitatory effect in N-methyl-D-aspartate receptors: dextromethorphan (DTM). CASE REPORT: We report on the progress of a classical neonatal case, which began at the age of a few hours with hypotonia and stupor, without myoclonias or seizures, but with a suppression wave trace on the electroencephalogram (EEG). Cerebrospinal fluid (CSF) showed glycine levels of 141 micromol/L (the normal level is 6.66 +/- 2.66 micromol/L), with a CSF/plasma ratio of 0.19 (the normal ratio is < 0.02). Treatment was started on the thirteenth day with BZ and DTM, and alertness and eye fixation improved in just three days; at the same time the EEG readings become normal. The glycine level in plasma returned to normal at two months and that in CSF was considerably reduced, although with CSF/plasma levels that were still high. At present the patient is 4 years old, has never had convulsions, EEG results have always been normal, and continues with BZ, DTM, carnitine and diet. The patient has presented a high degree of hypermotoric behaviour, but is currently more attentive and more sociable, has been walking from the age of 35 months and has a quotient in the different areas of development of 40-50. CONCLUSIONS: The clinical progress made by our patient could be said to be anything but negligible, and we therefore recommend that treatment should be started as early as possible after diagnosis.


Subject(s)
Benzoates/therapeutic use , Dextromethorphan/therapeutic use , Excitatory Amino Acid Antagonists/therapeutic use , Hyperglycinemia, Nonketotic/drug therapy , Hyperglycinemia, Nonketotic/physiopathology , Infant, Premature/metabolism , Brain/anatomy & histology , Carnitine/administration & dosage , Child, Preschool , Diet Therapy , Female , Gestational Age , Glycine/blood , Glycine/cerebrospinal fluid , Humans , Hyperglycinemia, Nonketotic/diagnosis , Hyperglycinemia, Nonketotic/pathology , Infant, Newborn , Male , Motor Activity/physiology , Pregnancy , Treatment Outcome
11.
An. esp. pediatr. (Ed. impr) ; 55(3): 256-259, sept. 2001.
Article in Es | IBECS | ID: ibc-1880

ABSTRACT

La malnutrición es el resultado final de una inadecuación entre la ingesta y los requerimientos de un individuo. El riesgo es mayor cuanto mayor es el déficit o cuando se añade un estrés metabólico. Cuando ocurre el decalaje ingesta/requerimientos se utilizan las reservas energeticoproteicas del organismo; por ello, una cuantificación de estas reservas corregiría precozmente las deficiencias, lo cual influye en la evolución de un paciente en caso de enfermedad; además, pueden monitorizarse los resultados de un soporte nutricional agresivo. Desde el punto de vista clínico es obligado conocer y optimizar los métodos de bajo coste y de aplicabilidad en la cabecera del enfermo; entre ellos, la bioimpedancia y antropometría son de gran importancia clínica. Siempre hay que tener en cuenta la variabilidad de la composición corporal a lo largo de la infancia por el crecimiento (AU)


Subject(s)
Child , Humans , Nutrition Assessment , Nutritional Status
12.
Acta pediatr. esp ; 58(3): 160-164, mar. 2000. graf
Article in Es | IBECS | ID: ibc-9715

ABSTRACT

Las cardiopatías congénitas condicionan una serie de alteraciones fisiopatológicas que comprometen el estado nutricional de los niños afectos. La malnutrición es mayor cuando la lesión es cianosante y se intensifica cuando además los pacientes presentan insuficiencia cardiaca o hipertensión pulmonar. Por ello, al establecer el diagnóstico debe valorarse el riesgo nutricional, así como los tiempos de corrección quirúrgica para instaurar un soporte nutricional específico e individualizado, realizado por profesionales dedicados específicamente a esto. Es posible que con frecuencia esté indicado el uso de nutrición enteral; en este caso, si hay distrés respiratorio la vía de elección será una gastrostomía endoscópica percutánea, técnica sencilla y segura que evita la utilización de sonda nasogástrica (AU)


Subject(s)
Female , Infant , Male , Humans , Heart Defects, Congenital/physiopathology , Nutrition Rehabilitation , Heart Defects, Congenital/complications , Heart Defects, Congenital/diet therapy , Preoperative Care/methods , Nutritional Status , Infant Nutrition Disorders/etiology
13.
Nutr Hosp ; 13(3): 138-43, 1998.
Article in Spanish | MEDLINE | ID: mdl-9662955

ABSTRACT

UNLABELLED: Protein restriction in patients with chronic renal failure may be potentially beneficial, however the dangers in growing children of such restrictions must be considered. We analyzed the nitrogen balance in 60 chronic renal failure children (47 male y 13 female) Group A: 36 preadolescents. GFR was 54.5 +/- 25.6 ml/min/1.73 m2. Group B: 24 adolescents. GFR 52.7 +/- 25.4 ml/min/1.73 m2. RESULTS: 55% of patients had a negative balance. 72% preadolescents and 17% of adolescents had positive nitrogen balance A good correlation was found between the range of energy and protein intake and nitrogen balance. CONCLUSIONS: 1. A good correlation was found between nitrogen balance and the range of energy and protein intake but no correlation with the renal function degree. 2. Adolescents had nitrogen balance negative. 3. It is necessary turn-over protein studies in this patients to know the requirements in children with chronic renal failure.


Subject(s)
Hospitalization , Kidney Failure, Chronic/metabolism , Nitrogen/metabolism , Adolescent , Child , Dietary Proteins/administration & dosage , Energy Metabolism , Female , Food Service, Hospital , Humans , Male
14.
An Esp Pediatr ; 48(4): 371-5, 1998 Apr.
Article in Spanish | MEDLINE | ID: mdl-9629794

ABSTRACT

OBJECTIVE: The objective of this study was to evaluate the effect of nucleotide supplements on the incidence, duration and severity of diarrhea in healthy infants. PATIENTS AND METHODS: A total of 3,243 cases were studied. This was an observational cohort study with a 1:1 ratio between infants receiving a nucleotide supplemented/unsupplemented diet. From the start of the study until the infant reached 6 months of age, the infant's mother recorded the duration and severity of each episode of diarrhea. The infant's height and weight were measured at the beginning and at the end of the follow-up period and the nutritional index (NI) was calculated [NI = (actual weight/actual height)/(ideal weight/ideal height)/100]. Data collection was performed during the months of June through December 1996 at 340 pediatric clinics distributed throughout Spain. RESULTS: The study groups were found to be homogeneous and there were no significant differences in age, gender, duration of follow-up, referring pediatric offices, number of siblings, usual residence, habitat or nursery attendance. The incidence of diarrhea was significantly lower (p < 0.001) in the nucleotide supplemented group (11.1%) versus the unsupplemented group (17.4%). Similarly, both the maximum duration of diarrhea (p < 0.05) and the severity of episodes of diarrhea (p < 0.001) were significantly lower in the nucleotide supplemented group. No significant differences were found between the initial and final nutritional indexes within a group nor when comparing the two groups. CONCLUSIONS: Nucleotide supplemented starter formulas reduce the incidence, duration and severity of diarrhea in healthy infants, but weight and height were not affected.


Subject(s)
Diarrhea/diet therapy , Dietary Supplements , Infant Food , Nucleotides/administration & dosage , Cohort Studies , Female , Food, Formulated , Humans , Infant , Infant Nutritional Physiological Phenomena , Infant, Newborn , Male , Nucleotides/therapeutic use
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