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.

[Pediatric kidney transplants and herpesvirus infections]. / Trasplante renal pediátrico e infecciones por virus del grupo herpes.

Twenty seven children were followed up prospectively after renal transplant for evidence of infection and illness due to cytomegalovirus (CMV), Epstein-Barr virus (EBV) and varicella zoster virus (VZV). Virus shedding and serological status were tested at transplant day, biweekly for two months, monthly for six months and trimestrialy thereafter. Determinations were done by complement fixation test. CMV isolation was established by microscopic examination of urinary cultures. Primary infections were objetivated in 27 cases (18 CMV, 1 EBV, 8 VZV) and reinfection in 3 (2 CMV, 1 VZV). Irreversible allograft rejection related to infection was disclosed in 2 patients (1 primary CMV infection, 1 VZV reinfection). Renal function impairment occurred only with CMV (6 primary and 1 secondary infections). One patient died with CMV over infection.