ABSTRACT
Pediatric bowel preparation protocols used before colonoscopy vary greatly, with no identified standard practice. The present clinical report reviews the evidence for several bowel preparations in children and reports on their use among North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition members. Publications in the pediatric literature for bowel preparation regimens are described, including mechanisms of action, efficacy and ease of use, and pediatric studies. A survey distributed to pediatric gastroenterology programs across the country reviews present national practice, and cleanout recommendations are provided. Finally, further areas for research are identified.
Subject(s)
Cathartics/administration & dosage , Colonoscopy/methods , Practice Patterns, Physicians' , Preoperative Care/methods , Adolescent , Cathartics/adverse effects , Child , Child, Preschool , Gastroenterology/methods , Humans , Laxatives/administration & dosage , Laxatives/adverse effects , Pediatrics/methodsABSTRACT
Liver disease is the second most common cause of death in patients with cystic fibrosis (CF). Improvement in surgical techniques, medical management, and imaging modalities has broadened the range of options for treatment of these patients. Medical management with ursodeoxycholic acid and nutritional support may help decelerate the progression of liver disease. A timely evaluation of CF patients with liver involvement for transplantation is important. Such evaluation should not be delayed until signs of hepatic decompensation occur. Combined lung-liver transplant can be considered for patients with advanced pulmonary disease. Pretransplant management of portal hypertension with a portosystemic shunt procedure is an option for patients with well-preserved synthetic liver function. Improvement in lung function after liver transplantation and no significant risk of pulmonary infection with immunosuppressive therapy have been reported. Review of individual center experiences have shown satisfactory survival and improved quality of life for CF patients undergoing liver transplant.
Subject(s)
Cystic Fibrosis/complications , Cystic Fibrosis/surgery , Liver Diseases/etiology , Liver Diseases/surgery , Liver Transplantation , Humans , Liver Diseases/physiopathology , Lung Transplantation , Patient Care PlanningABSTRACT
The policy for Breastfeeding Promotion in Puerto Rico includes as one of its goals, that all hospital in the island become Baby Friendly Hospitals. The authors present a hospital policy model which can be adopted and recommendations for the implementation of this policy are given.
Subject(s)
Breast Feeding , Health Policy , Health Promotion , Lactation/physiology , Public Policy , Female , Hospitals , Humans , Puerto RicoABSTRACT
Between September 1989 and August 1990, Puerto Rico was ranked third in the number of pediatric AIDS cases in the United States. The highest number of pediatric AIDS cases has been identified in high risk metropolitan areas. AIDS usually affects children of mothers with history of intravenous drug user. This work attempts to describe the sociodemographic profile and physical growth pattern of the pediatric aids cases followed at the San Juan Aids Institute between the years 1986 and 1990. The sample consist of 40 living patients diagnosed as AIDS cases. Ninety percent of the cases acquired the disease by perinatal transmission. Intravenous drug use by the mother was the most common risk factor identified (67.5% of the cases). Forty two percent of the mothers were not legally married. Seventy percent of the children were born after the 38th week of gestation with an average weight of 2,954 grams and average height of 50.9 centimeters. Upon classification in any P2 categories (according to CDC criteria for children under 13 years of age), 67.7% of the cases were below the 50th. percentile of weight and 86.9% of the cases were below the 50th. percentile of height.
