Analysis of the Spanish national registry for pediatric home enteral nutrition (NEPAD): implementation rates and observed trends during the past 8 years.

BACKGROUND/OBJECTIVES: The home enteral nutrition (HEN) provides nutritional support to children with chronic diseases who are nutritionally compromised and allows them to be discharged more quickly from hospitals. In 2003, a web-based registry (Nutrición Enteral Pediátrica Ambulatoria y Domiciliaria, Pediatric Ambulatory and Home Enteral Nutrition -NEPAD-) was created with the objective of gathering information about pediatric HEN practices in Spain. AIM: The aim of this study was to report the implementation of the NEPAD (Nutrición Enteral Pediátrica Ambulatoria y Domiciliaria, Pediatric Ambulatory and Home Enteral Nutrition) registry of pediatric HEN in Spain and to analyze data evolution trends from 2003 to 2010. SUBJECTS/METHODS: The data from the Spanish NEPAD registry were analyzed according to the following variables: demographic data, diagnosis, indication for HEN, nutritional support regime and administration route. RESULTS: Over the study period, 952 patients (1048 episodes) from 20 Spanish hospitals were included in the NEPAD registry. The most frequent indication for HEN was decreased oral intake (64%), and neurological disease was the most prevalent illness. HEN was delivered via a nasogastric tube in 573 episodes (54.7%), by gastrostomy in 375 episodes (35.8%), oral feeding in 77 episodes (7.3%) and by jejunal access in 23 episodes (2.2%). Significant differences in the mode of administration were observed based on the pathology of the child (χ(2), P<0.0001). The cyclic feeding was the most widely used technique for the administration of HEN. Most of the patients used a pump and a polymeric formula. Transition to oral feeding was the primary reason for discontinuation of this type of support. CONCLUSIONS: Since the NEPAD registry was established in Spain, the number of documented patients has increased more than 25-fold. Many children with chronic illness benefit from HEN, mainly those suffering from neurological diseases.

Consensus on paediatric enteral nutrition access: a document approved by SENPE/SEGHNP/ANECIPN/SECP.

Standardization of clinical procedures has become a desirable objective in contemporary medical practice. To this effect, the Spanish Society of Parenteral and Enteral Nutrition (SENPE) has endeavoured to create clinical practice guidelines and/or documents of consensus as well as quality standards in artificial nutrition. As a result, the SENPE´s Standardization Team has put together the "Document of Consensus in Enteral Access for Paediatric Nutritional Support" supported by the Spanish Society of Pediatric Gastroenterology, Hepatology and Nutrition (SEGHNP), the National Association of Pediatric and Neonatal Intensive Care Nursery (ANECIPN), and the Spanish Society of Pediatric Surgery (SECP). The present publication is a reduced version of our work; the complete document will be published as a monographic issue. It analyzes enteral access options in the pediatric patient, reviews the levels of evidence and provides the team-members' experience. Similarly, it details general and specific indications for pediatric enteral support, current techniques, care guidelines, methods of administration and complications of each enteral access. The data published by the American Society for Parenteral and Enteral Nutrition (ASPEN) and several European Societies has also been incorporated.

Complicaciones de los accesos enterales en el niño / No disponible

No disponible

Calprotectina fecal como marcador diferencial entre patología gastrointestinal orgánica y funcional / No disponible

Introducción: la determinación de calprotectina en heces seestá afianzando en los últimos años como un marcador no invasivopara el diagnóstico diferencial entre patología gastrointestinalorgánica y funcional. Su uso es útil sobre todo en niños que requierenanestesia general para una colonoscopia. El objetivo deeste estudio es evaluar la sensibilidad y utilidad de la calprotectinafecal (CPF) en pacientes pediátricos con signos y síntomas sugestivosde enfermedad inflamatoria intestinal (EII) con el fin de evitartécnicas invasivas innecesarias y poder discriminar entre patologíagastrointestinal orgánica y funcional.Material y métodos: se determinó la concentración de calprotectinamediante enzimoinmunoanálisis en una única muestrade heces de 47 niños (edad media: 10,1 años) con algún síntomade patología gastrointestinal sugestivo de organicidad. Trece niñosfueron diagnosticados de patología funcional y 34 de patologíaorgánica. Entre estos, 15 con EII y el resto con patologías orgánicasde distinto origen (no-EII). Se incluyeron 13 niños sanoscomo controles.Resultados: el grupo de niños con EII presentó valores deCPF [mediana (rango interquartil); 1.219 μg/g (322-2.967)] significativamentemás altos que el grupo con patología gastrointestinalfuncional [20 μg/g (16-25); p < 0,0001], el grupo con patologíaorgánica no-EII [113 μg/g (36-193); p = 0,002] y el control[25 μg/g (19-32); p < 0,0001]. Las concentraciones también fueronmás altas en el grupo de niños con patología orgánica no-EIIrespecto al grupo con patología funcional (p = 0,002) y al control(p = 0,004). No hubo diferencias entre el grupo control y los niñoscon patología funcional (p = 0,264).Discusión: la CPF es un marcador sensible, pero no específico,que permite seleccionar pacientes con EII, que requieren colonoscopiapara el diagnóstico definitivo y evitar así pruebas invasivasa pacientes con patología gastrointestinal funcional

Introduction: there is growing evidence showing the importanceof the fecal calprotectin assay in differentiating organic fromfunctional gastrointestinal disease. It is a simple, non-invasive biomarkerthat is especially useful in children, who may require generalanesthesia for colonoscopy. The aim of this study was to assessthe use and sensitivity of fecal calprotectin (FCP) in pediatricpatients with signs and symptoms of IBD to avoid unnecessary invasivetechniques and to distinguish between organic and functionalgastrointestinal pathology.Material and methods: a single stool sample was collectedfrom 47 children (mean age: 10.1 years) referred for non-specificgastrointestinal symptoms suggestive of organicity. On the basisof clinical criteria 13 children had functional bowel disorders and34 had organic gastrointestinal disease, 15 with IBD and 19 withother organic (non-IBD) gastrointestinal conditions. Thirty healthychildren were included as controls. Calprotectin concentrationswere measured by enzyme immunoassay.Results: children with IBD had FCP levels [median (interquartilerange); 1,219 μg/g (322-2,967 μg/g)] higher than children withfunctional gastrointestinal disease [20 μg/g (16-25 μg/g); p <0.0001], those with organic non-IBD disease [113 μg/g (36-193μg/g); p = 0.002], and healthy children [25 μg/g (19.2-32.5 μg/g);p < 0.0001]. Fecal calprotectin concentration also was significantlyhigher in children with organic (non-IBD) disease as compared tocontrols (p = 0.004) and children with functional pathology (p =0.002). FCP levels were similar in controls and children with functionalgastrointestinal disease (p = 0.264).Discussion: CPF is a sensitive, but not disease-specific, markerto identify patients with IBD who should undergo diagnosticcolonoscopy, and to avoid unnecessary invasive procedures in patientswith functional gastrointestinal disorders (AU)

Calprotectina fecal como marcador diferencial entre patología gastrointestinal orgánica y funcional / Fecal calprotectin as a biomarker to distinguish between organic and functional gastrointestinal disease

Objetivo. La determinación de calprotectina en heces ha emergido en los últimos áños como un marcador no invasivo para el diagnóstico diferencial entre patología gastrointestinal orgánica y funcional. Su uso es útil sobre todo en niños que requieren anestesia general para una colonoscopia. El objetivo de este estudio es evaluar la utilidad de la calprotectina fecal (CPF) en la detección de enfermedad inflamatoria intestinal (EII) en niños con síntomas gastrointestinales inespecíficos. Diseño experimental. Se determinó la concentración de calprotectina mediante enzimoinmunoanálisis en una única muestra de heces de 47 niños (edad media: 10,1 años) con algún síntoma de patología gastrointestinal. Trece niños fueron diagnosticados de patología funcional y 34 de patología orgánica. Entre éstos, 15 con EII y el resto con patologías orgánicas de distinto origen (no-EII). Se incluyeron 13 niños sanos como controles. Resultados. El grupo de niños con EII presentó valores de CPF [mediana (rango interquartil); 1219 mg/g (322-2967)] significativamente más altos que el grupo con patología gastrointestinal funcional [20 mg/g (16-25); p<0,0001], el grupo con patología orgánica no-EII [113 mg/g (36-193); p=0,002] y el control [25 mg/g (19-32); p<0,0001]. Las concentraciones también fueron más altas en el grupo de niños con patología orgánica no-EII respecto al grupo con patología funcional (p=0,002) y al grupo control (p=0,004). No hubo diferencias entre el grupo control y los niños con patología funcional (p=0,264). Conclusiones. La CPF es un marcador sensible, pero no específico, que permite seleccionar pacientes con EII, que requieren colonoscopia para el diagnóstico definitivo y evitar así pruebas invasivas a pacientes con patología gastrointestinal funcional

Objective. Growing evidences show the importance of the fecal calprotectin assay in differentiatin organic from functional gastrointestinal disease. It is a simple and non-invasive biomarker, specially usefull in children, who may require general anaesthesia for colonoscopy. The aim of this study was to assess the use of fecal calprotectin (FCP) to detect inflammatory bowel disease (IBD) in children with non-specific gastrointestinal symptoms. Methods. A single stool sample was collected from 47 children (mean age: 10.1 years) referred for non-specific gastrointestinal symptoms. On the basis of clinical criteria, 13 children had functional bowel disorders and 34 had organic gastrointestinal pathology, of these 15 with IBD and 19 with other organic (non-IBD) gastrointestinal disease. Thirty healthy children were included as controls. Calprotectin concentrations were measured by an enzimeimmunoassay. Results. Children with IBD had FCP levels [median (interquartile range); 1219 mg/g (322-2967)] higher than children with functional gastrointestinal disease [20 mg/g](16-25); p<0.0001], those with organic non-IBD disease [113 mg/g (36-193); p=0.002] and than healthy children [25 mg/g (19.2-32.5); p<0.0001]. Calprotectin concentration also was significantly higher in children with organic (non-IBD) disease compared with controls (p=0.004) and children with functional pathology (p=0.002). FCP levels were similar in controls and children with functional gastrointestinal disease (p=0.264). Conclusion. CPF is a sensitive, but not disease specific marker, to distinguish patients with EII, who shouyld undergo diagnositc colonoscopy, and to avoid unnecesary invasive procedures in patients with functional gastrointestinal disorders

[Fecal calprotectin as a biomarker to distinguish between organic and functional gastrointestinal disease]. / Calprotectina fecal como marcador diferencial entre patología gastrointestinal orgánica y funcional.

INTRODUCTION: There is growing evidence showing the importance of the fecal calprotectin assay in differentiating organic from functional gastrointestinal disease. It is a simple, non-invasive biomarker that is especially useful in children, who may require general anesthesia for colonoscopy. The aim of this study was to assess the use and sensitivity of fecal calprotectin (FCP) in pediatric patients with signs and symptoms of IBD to avoid unnecessary invasive techniques and to distinguish between organic and functional gastrointestinal pathology. MATERIAL AND METHODS: A single stool sample was collected from 47 children (mean age: 10.1 years) referred for non-specific gastrointestinal symptoms suggestive of organicity. On the basis of clinical criteria 13 children had functional bowel disorders and 34 had organic gastrointestinal disease, 15 with IBD and 19 with other organic (non-IBD) gastrointestinal conditions. Thirty healthy children were included as controls. Calprotectin concentrations were measured by enzyme immunoassay. RESULTS: Children with IBD had FCP levels [median (interquartile range); 1,219 microg/g (322-2,967 microg/g)] higher than children with functional gastrointestinal disease [20 microg/g (16-25 microg/g); p < 0.0001], those with organic non-IBD disease [113 microg/g (36-193 microg/g); p = 0.002], and healthy children [25 microg/g (19.2-32.5 microg/g); p < 0.0001]. Fecal calprotectin concentration also was significantly higher in children with organic (non-IBD) disease as compared to controls (p = 0.004) and children with functional pathology (p = 0.002). FCP levels were similar in controls and children with functional gastrointestinal disease (p = 0.264). DISCUSSION: CPF is a sensitive, but not disease-specific, marker to identify patients with IBD who should undergo diagnostic colonoscopy, and to avoid unnecessary invasive procedures in patients with functional gastrointestinal disorders.

[Home enteral nutrition in Spain. Results of the register of the Spanish Society of Pediatric Gastroenterology, Hepatology and Nutrition in 2003]. / Nutrición enteral domiciliaria en España. Resultados del registro de la Sociedad Española de Gastroenterología, Hepatología y Nutrición Pediátrica del año 2003.

INTRODUCTION: The number of children receiving prolonged home enteral nutrition (HEN) is increasing. However, precise information on the incidence and prevalence of HEN in Spain is lacking. Consequently, the Spanish Society of Pediatric Gastroenterology, Hepatology and Nutrition created a patients' register (NEPAD). The aim of the present study was to analyze the results of the first year of the NEPAD register (2003). MATERIAL AND METHODS: The NEPAD is an on-line register that gathers information on the indications for HEN, route of access, type of diet and duration of nutritional support. Quantitative data are expressed as mean and standard deviation, and qualitative data as percentages. RESULTS: In 2003, 124 children from 6 hospitals were registered. The mean age at the beginning of HEN was 3.6 years. The underlying disease was gastrointestinal in 20%, neurological or mental retardation in 20%, cystic fibrosis in 14.5%, tumor in 11%, innate error of metabolism in 10%, congenital cardiac disease in 6%, severe primary malnutrition in 6%, and other causes in 13%. A nasogastric tube was used as the first route of access in 56%, and gastrostomy was used in 42%. Sixty percent of the children received continuous nocturnal enteral nutrition and 90% used an infusion pump. The type of feeding consisted of blenderized natural food in 14%, polymeric pediatric formula in 50%, and infant formulae in 18%. On December 31st, 84 children continued to receive enteral nutrition (68%). CONCLUSIONS: Despite the efforts made to maintain the on-line national register, it has been underused in its first year of existence (2003). Patients with gastrointestinal or neurological diseases constitute the main group of patients in the register. There is a slight preference for the use of nasogastric tube over gastrostomy.

Nutrición enteral domiciliaria en España. Resultados del registro de la Sociedad Española de Gastroenterología, Hepatología y Nutrición Pediátrica del año 2003 / Home enteral nutrition in Spain. Results of the register of the Spanish Society of Pediatric Gastroenterology, Hepatology and Nutrition in 2003

Introducción: Cada vez es mayor el número de niños que reciben alimentación de forma prolongada en su domicilio a través de una sonda o de una ostomía. Sin embargo, no disponemos de datos precisos de prevalencia e incidencia de esta técnica de soporte nutricional. Por esta razón, desde la Sociedad Española de Gastroenterología, Hepatología y Nutrición Pediátrica se propició la creación de un registro de pacientes (Nutrición Enteral Pediátrica Ambulatoria y Domiciliaria, NEPAD) cuyos datos del primer año de actividad se comunican en este artículo. Material y métodos: El registro NEPAD es un registro en red que recoge datos anuales sobre las indicaciones, vías de acceso, tipo de dieta y duración del soporte. Los datos cuantitativos se expresan como media y desviación estándar, y los cualitativos como porcentajes. Resultados: En el registro correspondiente al año 2003, se introdujeron los datos de 124 niños procedentes de seis hospitales. La edad media de inicio fue de 3,6 años. La patología de base fue una enfermedad gastrointestinal en el 20 %, una enfermedad neurológica o retraso mental en el 20 %, fibrosis quística en el 14,5 %, enfermedad oncológica en el 11 %, error innato del metabolismo en el 10 %, cardiopatía congénita en el 6 %, malnutrición energético-proteica primaria grave en el 10 % y otras causas en el resto. Se utilizó una sonda nasogástrica como primera vía de acceso en el 56 % de los casos y una gastrostomía en el 42 %. El 60 % recibió nutrición enteral continua nocturna, y el 90 % usó una bomba de infusión. En cuanto al tipo de alimentación, recibió alimentos naturales el 14 %, fórmulas poliméricas pediátricas el 50 % y fórmulas infantiles el 36 %. A 31 de diciembre, 84 niños continuaban con nutrición enteral (68 %). Conclusiones: A pesar del esfuerzo que supone el mantenimiento de un registro nacional, durante su primer año de funcionamiento (2003) ha sido infrautilizado. Los pacientes con enfermedades gastrointestinales o neurológicas constituyen el principal grupo de pacientes. Existe un ligero predominio de pacientes con sonda nasogástrica sobre las gastrostomías

Introduction: The number of children receiving prolonged home enteral nutrition (HEN) is increasing. However, precise information on the incidence and prevalence of HEN in Spain is lacking. Consequently, the Spanish Society of Pediatric Gastroenterology, Hepatology and Nutrition created a patients' register (NEPAD). The aim of the present study was to analyze the results of the first year of the NEPAD register (2003). Material and methods: The NEPAD is an on-line register that gathers information on the indications for HEN, route of access, type of diet and duration of nutritional support. Quantitative data are expressed as mean and standard deviation, and qualitative data as percentages. Results: In 2003, 124 children from 6 hospitals were registered. The mean age at the beginning of HEN was 3.6 years. The underlying disease was gastrointestinal in 20 %, neurological or mental retardation in 20 %, cystic fibrosis in 14.5 %, tumor in 11 %, innate error of metabolism in 10 %, congenital cardiac disease in 6 %, severe primary malnutrition in 6 %, and other causes in 13 %. A nasogastric tube was used as the first route of access in 56 %, and gastrostomy was used in 42 %. Sixty percent of the children received continuous nocturnal enteral nutrition and 90 % used an infusion pump. The type of feeding consisted of blenderized natural food in 14 %, polymeric pediatric formula in 50 %, and infant formulae in 18 %. On December 31st, 84 children continued to receive enteral nutrition (68 %). Conclusions: Despite the efforts made to maintain the on-line national register, it has been underused in its first year of existence (2003). Patients with gastrointestinal or neurological diseases constitute the main group of patients in the register. There is a slight preference for the use of nasogastric tube over gastrostomy

Diagnóstico por laparotomía de tuberculosis abdominal / Laparotomic diagnosis of abdominal tuberculosis

No disponible

Gastritis eosinofílica y estenosis hipertrófica de píloro / Eosinophilic gastritis and pyloric estenosis

Paciente intervenido quirúrgicamente de estenosis hipertrófica de píloro, con reaparición de clínica después de un período asintomático. El caso obliga a su estudio hasta llegar al diagnóstico de gastritis eosinofílica. Se realiza una revisión de esta entidad: síntomas, métodos diagnósticos y tratamiento. (AU)