ABSTRACT
OBJECTIVE: The objective of this study was to analyze whether patients undergoing esophageal atresia (EA) surgery benefit from a cross-disciplinary follow-up program, based on current clinical guidelines, implemented in our institution. MATERIALS AND METHODS: An observational, analytical, retrospective study of patients undergoing EA surgery from 2012 to 2022 was carried out. The results of a joint pediatric surgery and gastroenterology consultation program -which was implemented in 2018 and applies a protocol based on the new ESPGHAN-NASPGHAN guidelines- were analyzed. Patients were divided according to whether they had been treated before or after 2018. Quantitative variables -follow-up losses, anti-reflux treatment initiation and duration, and enteral nutrition initiation- and qualitative variables -prevalence of gastroesophageal reflux, anti-reflux surgery, respiratory infections, anastomotic stenosis, re-fistulizations, dysphagia, impaction episodes, need for gastrostomy, and endoscopic results- were compared. RESULTS: 38 patients were included. 63.2% had gastroesophageal reflux. 97.4% received anti-reflux treatment in the first year of life, with treatment being subsequently discontinued in 47.4%. Discontinuation time decreased by a mean of 24 months following program implementation (p< 0.05). A 4.6-fold increase in the frequency of pH-metries was noted following program implementation. The protocol standardized endoscopies in asymptomatic patients when they turn 5 and 10 years old. 25 endoscopies with biopsy were carried out after 2018, with histological disorders being detected in 28% of them. The number of follow-up losses significantly decreased following protocol implementation (p< 0.05). CONCLUSIONS: Digestive-surgical cross-disciplinary follow-up of EA patients has a positive impact on patient progression. Applying the guidelines helps optimize treatment and early diagnosis of complications.
OBJETIVOS: El objetivo de este estudio es analizar si los pacientes intervenidos de atresia de esófago (AE) se benefician de un programa de seguimiento multidisciplinar, basado en las guías clínicas actuales, implantado en nuestro centro. MATERIAL Y METODOS: Estudio retrospectivo, observacional y analítico incluyendo los pacientes intervenidos de AE entre 2012 y 2022. Se analizaron los resultados de la implantación en 2018 de un programa de consultas conjuntas de gastroenterología y cirugía pediátrica aplicando un protocolo basado en las nuevas guías ESPGHAN-NASPGHAN. Se dividieron a los pacientes tratados antes y después de 2018 y se compararon las variables cuantitativas: pérdidas de seguimiento, inicio y duración del tratamiento antirreflujo e inicio de nutrición enteral, y cualitativas: prevalencia de reflujo gastroesfoágico, realización de cirugía antirreflujo, infecciones respiratorias, estenosis de la anastomosis, refistulizaciones, disfagia, episodios de impactación, necesidad de gastrostomía y resultados de las endoscopias. RESULTADOS: Se incluyeron 38 pacientes. Un 63,2% presentaron reflujo gastroesofágico. El 97,4% tomaron tratamiento antirreflujo el primer año de vida que posteriormente se retiró en el 47,4%. El tiempo de retirada se redujo una media de 24 meses tras la aplicación del programa (p< 0,05). Se realizaron 4,6 veces más pHmetrías tras la implantación del programa. El protocolo estandarizó la realización de endoscopias en pacientes asintomáticos al cumplir 5 y 10 años. Se realizaron 25 endoscopias con tomas de biopsia después de 2018, detectando alteraciones histológicas en un 28%. El número de pérdidas de seguimiento se redujo de forma significativa tras la implantación del protocolo (p< 0,05). CONCLUSIONES: El seguimiento multidisciplinar digestivo-quirúrgico de los pacientes con AE genera un impacto positivo en su evolución. La aplicación de las guías facilita la optimización del tratamiento y el diagnóstico precoz de las complicaciones.
Subject(s)
Esophageal Atresia , Gastroesophageal Reflux , Tracheoesophageal Fistula , Humans , Child , Child, Preschool , Esophageal Atresia/diagnosis , Esophageal Atresia/surgery , Esophageal Atresia/complications , Retrospective Studies , Gastroesophageal Reflux/diagnosis , Gastroesophageal Reflux/epidemiology , Gastroesophageal Reflux/surgery , Gastrostomy/adverse effectsABSTRACT
Objetivos: El objetivo de este estudio es analizar si los pacientesintervenidos de atresia de esófago (AE) se benefician de un programade seguimiento multidisciplinar, basado en las guías clínicas actuales,implantado en nuestro centro. Material y métodos: Estudio retrospectivo, observacional y analí-tico incluyendo los pacientes intervenidos de AE entre 2012 y 2022. Seanalizaron los resultados de la implantación en 2018 de un programa deconsultas conjuntas de gastroenterología y cirugía pediátrica aplicandoun protocolo basado en las nuevas guías ESPGHAN-NASPGHAN. Sedividieron a los pacientes tratados antes y después de 2018 y se compararon las variables cuantitativas: pérdidas de seguimiento, inicio y duracióndel tratamiento antirreflujo e inicio de nutrición enteral, y cualitativas:prevalencia de reflujo gastroesfoágico, realización de cirugía antirreflujo,infecciones respiratorias, estenosis de la anastomosis, refistulizaciones,disfagia, episodios de impactación, necesidad de gastrostomía y resul-tados de las endoscopias. Resultados: Se incluyeron 38 pacientes. Un 63,2% presentaronreflujo gastroesofágico. El 97,4% tomaron tratamiento antirreflujo el primer año de vida que posteriormente se retiró en el 47,4%. El tiempo deretirada se redujo una media de 24 meses tras la aplicación del programa(p< 0,05). Se realizaron 4,6 veces más pHmetrías tras la implantacióndel programa. El protocolo estandarizó la realización de endoscopiasen pacientes asintomáticos al cumplir 5 y 10 años. Se realizaron 25endoscopias con tomas de biopsia después de 2018, detectando alteraciones histológicas en un 28%. El número de pérdidas de seguimiento seredujo de forma significativa tras la implantación del protocolo (p< 0,05). Conclusiones: El seguimiento multidisciplinar digestivo-quirúrgicode los pacientes con AE genera un impacto positivo en su evolución.(AU)
Objective: The objective of this study was to analyze whether patients undergoing esophageal atresia (EA) surgery benefit from a cross-disciplinary follow-up program, based on current clinical guidelines,implemented in our institution. Materials and methods: An observational, analytical, retrospectivestudy of patients undergoing EA surgery from 2012 to 2022 was carriedout. The results of a joint pediatric surgery and gastroenterology consultation program which was implemented in 2018 and applies a protocolbased on the new ESPGHAN-NASPGHAN guidelines were analyzed.Patients were divided according to whether they had been treated before or after 2018. Quantitative variables follow-up losses, anti-refluxtreatment initiation and duration, and enteral nutrition initiation andqualitative variables prevalence of gastroesophageal reflux, anti-refluxsurgery, respiratory infections, anastomotic stenosis, re-fistulizations,dysphagia, impaction episodes, need for gastrostomy, and endoscopicresults were compared. Results: 38 patients were included. 63.2% had gastroesophagealreflux. 97.4% received anti-reflux treatment in the first year of life, withtreatment being subsequently discontinued in 47.4%. Discontinuationtime decreased by a mean of 24 months following program implementation (p< 0.05). A 4.6-fold increase in the frequency of pH-metries wasnoted following program implementation. The protocol standardizedendoscopies in asymptomatic patients when they turn 5 and 10 years old. 25 endoscopies with biopsy were carried out after 2018, with histologicaldisorders being detected in 28% of them. The number of follow-up lossessignificantly decreased following protocol implementation (p< 0.05). Conclusions: Digestive-surgical cross-disciplinary follow-up of EApatients has a positive impact on patient progression. Applying the guidelines helps optimize treatment and early diagnosis of complications.(AU)
Subject(s)
Humans , Male , Female , Postoperative Period , Esophageal Atresia/surgery , Aftercare/methods , Gastroesophageal Reflux , Esophageal Atresia/drug therapy , Esophageal Atresia/prevention & control , General Surgery , Pediatrics , Retrospective Studies , Interdisciplinary Research , Disease Prevention , Esophagus/surgeryABSTRACT
Introduction. Gastrocecal transit time (GCTT) can be measured by exhaled hydrogen after lactulose intake (lactulose-eH2 test). The objectives were to assess whether it is possible to carry out this test in critically ill children with and without mechanical ventilation (MV) and to analyze whether the results are consistent with clinical findings. Methods. Patients admitted to the Pediatric Intensive Care Unit (PICU) for more than 3 days were included. Those with gastrointestinal disease prior to admission were excluded. A modified technique to obtain eH2 from the ventilator tubes was performed. Results. Sixteen patients (37.5% boys) with a median age of 19 (5-86.5) months were included. Five patients (31.2%) were breathing spontaneously but lactulose-eH2 test could not be performed while it could be performed successfully in the 11 patients with MV. Seven patients (63.3%) did not show an eH2 peak. The other 4 showed a median time of 130 min (78.7-278.7 min) from lactulose intake to a 10 ppm eH2 peak. Children with an eH2 peak had intestinal movements earlier [6.5 (1.5-38.5) versus 44 (24-72) hours p = 0.545]. Conclusion. Although the designed adaption is useful for collecting breath samples, lactulose-eH2 test may not be useful for measuring GCTT in critically ill children.
Subject(s)
Breath Tests/methods , Critical Illness , Gastrointestinal Transit/physiology , Hydrogen/analysis , Lactulose/analysis , Adolescent , Child , Feasibility Studies , Female , Humans , Infant , Male , Pilot Projects , Respiration, ArtificialABSTRACT
Las infecciones agudas del tracto respiratorio inferior son las más frecuentes en la edad pediátrica; aproximadamente el 1,5% de ellas son neumonías. La incidencia de la neumonía es difícil de establecer, al tratarse de un proceso benigno sin obligación oficial de declararse, aunque se estima en 15-40/1.000 niños al año, según la edad. Las neumonías son la principal causa de morbilidad respiratoria en el mundo y la tercera causa de muerte en los países desarrollados. Su resolución es habitual, aunque en ciertas ocasiones la evolución clínica y radiológica no es favorable a pesar de realizar un tratamiento supuestamente adecuado, lo que obliga a llevar a cabo una sistemática diagnóstica para intentar aclarar las causas de esta evolución anormal a fin de realizar un tratamiento correcto (AU)
Acute lower respiratory tract infections (LRTIs) are the most common infections in children; approximately 1.5% of those infections are pneumonias. It is difficult to establish the incidence of pneumonia since it is a benign process with no official reporting obligation, but it is estimated that there are 15 to 40cases per thousand children and year according to age. Pneumonias are the main cause of respiratory morbidity worldwide and the third cause of death in developed countries; commonly, resolution is the norm. However, in some cases the clinical and radiological evolution is not favourable in spite of a supposedly appropriate treatment. In those cases, a systematic diagnosis is required in order to clarify the causes of the abnormal evolution and establish a correct treatment (AU)
Subject(s)
Humans , Male , Female , Child , Pneumonia/complications , Clinical Protocols , Risk Factors , Pneumonia/epidemiology , Immune System Diseases/complications , Infections/complications , Radiography, ThoracicABSTRACT
El síndrome aspirativo recurrente es una causa importante de patología broncopulmonar. En su etiopatogenia intervienen alteraciones de la deglución, la presencia de reflujo gastroesofágico y la aspiración de saliva. Debido a su presentación clínica variable y a la inexistencia de criterios diagnósticos específicos, frecuentemente pasa desapercibido. El tratamiento debe plantearse en función del mecanismo implicado, evaluando los posibles factores predisponentes en cada paciente. Presentamos el caso de una niña que fue remitida a la consulta de neumología tras sufrir episodios respiratorios de repetición, con una inadecuada respuesta al tratamiento. Se hace una revisión exhaustiva de esta patología en el contexto pediátrico con el fin de definir una norma de actuación diagnóstica adecuada, evitar la realización de pruebas complementarias excesivas e inapropiadas y llevar a cabo una terapia dirigida y fundamentada (AU)
Recurrent aspiration syndrome is an important cause of bronchopulmonary pathology. Its etiopathogenesis involves wallowing alterations, the presence of gastroesophageal reflux and the aspiration of saliva. Because of its variable clinical presentation and the absence of specific diagnostic criteria, it often goes unnoticed. The treatment should be determined according to the mechanism involved, thereby evaluating the potential predisposing factors in each patient. We present the case of a girl who is referred to the Pneumology Department because of recurrent respiratory episodes and a poor response to the treatment. An in-depth review is conducted of this pathology in the field of paediatrics, with the aim of defining rules for adequate diagnostic action, there by trying to avoid excessive and inappropriate additional tests, and providing a targeted and justified therapy (AU)
Subject(s)
Humans , Female , Child, Preschool , Pneumonia, Aspiration/epidemiology , Deglutition Disorders/epidemiology , Pneumonia, Aspiration/etiology , Gastroesophageal Reflux/complications , Recurrence , Radiography, Thoracic , Oxygen Inhalation TherapyABSTRACT
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