RESUMO
INTRODUCCIÓN: La prevalencia de anquiloglosia ha sido estimada alrededor del 4% de los recién nacidos vivos. Se desconoce la situación a nivel nacional. MATERIAL Y MÉTODOS: Estudio multicéntrico, observacional, prospectivo en el que participaron 6 hospitales asturianos. Durante 3 meses se exploró a todos los recién nacidos los días domingo, martes y jueves. Para el diagnóstico de anquiloglosia se utilizaron los criterios de Coryllos y Hazelbaker. RESULTADOS: Se exploró a 667 recién nacidos. La prevalencia de anquiloglosia fue del 12,11% (IC 95%: 9,58-14,64). El 62% eran varones. Uno de cada 4 niños con anquiloglosia tenía antecedentes familiares de frenillo lingual corto. Según la clasificación de Coryllos el tipo II fue el más frecuente (54%). CONCLUSIONES: La prevalencia de anquiloglosia en Asturias fue 2 o 3 veces superior a la esperada. Es necesario unificar los criterios diagnósticos, así como realizar estudios para conocer su asociación con dificultades en la lactancia u otros problemas posteriores
INTRODUCTION: The prevalence of ankyloglossia has been estimated at around 4% of live births. Its prevalence at national level is unknown. MATERIAL AND METHODS: Multicenter, prospective observational study. Six hospitals in Asturias took part. All newborns were examined on Sundays, Tuesdays and Thursdays for 3 months. Coryllos and Hazelbaker criteria were used to diagnose ankyloglossia. RESULTS: The prevalence in the 667 newborns examined was 12.11% (95% CI: 9.58 to 14.64), of whom 62% were male. One in 4 children with ankyloglossia had a family history. According to Coryllos' classification, type II was the most common (54%). CONCLUSIONS: The prevalence of ankyloglossia in Asturias was 2 to t3 times higher than expected. The diagnostic criteria for ankyloglossia needs to be unified, and further studies are required to determine the association with breastfeeding difficulties and other health problems
Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Freio Labial/anormalidades , Freio Lingual/anormalidades , Aleitamento Materno/estatística & dados numéricos , Estudos Prospectivos , Triagem NeonatalRESUMO
INTRODUCTION: The prevalence of ankyloglossia has been estimated at around 4% of live births. Its prevalence at national level is unknown. MATERIAL AND METHODS: Multicenter, prospective observational study. Six hospitals in Asturias took part. All newborns were examined on Sundays, Tuesdays and Thursdays for 3 months. Coryllos and Hazelbaker criteria were used to diagnose ankyloglossia. RESULTS: The prevalence in the 667 newborns examined was 12.11% (95% CI: 9.58 to 14.64), of whom 62% were male. One in 4 children with ankyloglossia had a family history. According to Coryllos' classification, type II was the most common (54%). CONCLUSIONS: The prevalence of ankyloglossia in Asturias was 2 to t3 times higher than expected. The diagnostic criteria for ankyloglossia needs to be unified, and further studies are required to determine the association with breastfeeding difficulties and other health problems.
Assuntos
Anormalidades da Boca/epidemiologia , Anquiloglossia , Feminino , Humanos , Recém-Nascido , Estudos Longitudinais , Masculino , Prevalência , Estudos Prospectivos , Espanha/epidemiologiaRESUMO
Introducción y objetivos: Las enfermedades como la fibrosis quística (FQ) que asocian malabsorción de grasas, precisan de suplementación de vitaminas liposolubles para evitar su deficiencia. El objetivo de nuestro objetivo fue conocer el estado de las vitaminas A, D y E en pacientes pediátricos y adultos con FQ. Pacientes y métodos. Estudio multicéntrico descriptivo y transversal, realizado en cinco hospitales nacionales, 126 pacientes con FQ sin agudización respiratoria, con edades entre 5 y 38 años. Los niveles de retinol y a-tocoferol se compararon con la población de referencia NHANES para establecer 3 categorías: deficientes (< P5), normales (P5-P95) y elevados (>P95); se consideró deficiencia de vitamina D si los niveles de 25 OH vitamina D fueron menores de 30 ng/ml. Resultados: La mediana de edad fue 14,2 años. El 51% eran varones y un 13% suficientes pancreáticos. El 56% presentaba deficiencia de al menos una vitamina liposoluble. La más frecuente fue la vitamina D (48%), seguida de la E (16%) y por último la vitamina A (11%). Los suficientes pancreáticos tenían niveles de vitamina D más elevados que los insuficientes. La proporción de pacientes con algún grado de deficiencia fue mayor en los pacientes adultos y sus niveles de vitamina D fueron más bajos. Conclusiones: A pesar de recibir una suplementacion adecuada, más de la mitad de los pacientes no alcanzaron niveles óptimos de vitaminas liposolubles. La función pancreática y la edad son dos factores a tener en cuenta a la hora de analizar el estatus vitamínico de estos pacientes
Introduction and objectives: Pancreatic insufficiency and fat and bile malabsoption render individuals with Cystic Fibrosis (CF) at risk for fat-soluble vitamin malabsoption. Our objective was to determine the status of vitamins A, D and E in pediatric and adult patients with CF. Patients and methods. Descriptive cross-sectional study. 126 patients without pulmonary exacerbation, aged between 5 and 38, were recruited in five national Cystic Fibrosis units. Retinol and a-tocopherol levels were compared with NHANES reference values to establish 3 categories: deficient (< P5), Normal (P5- P95) and elevated (> P95), vitamin D was considered deficient if 25 OH vitamin D < 30 ng/ml. Results: The median age was 14.2 years. 51% were male and 13% pancreatic sufficient. 56% had at least one vitamin deficiency. The most frequent was vitamin D (48%), followed by E (16%) and finally vitamin A (11%). Pancreatic sufficient had higher vitamin D levels than insufficient. The proportion of patients with any degree of vitamin deficiency was greater in adults and their vitamin D levels were lower. Conclusions: Despite adequate supplementation, more than half of patients did not reach optimal vitamins levels. Pancreatic status and age were two factors to take into account when analyzing vitamin status of these patients
Assuntos
Humanos , Masculino , Feminino , Lactente , Pré-Escolar , Criança , Adolescente , Deficiência de Vitaminas/epidemiologia , Vitaminas Lipossolúveis/análise , Fibrose Cística/fisiopatologia , Deficiência de Vitamina A/epidemiologia , Deficiência de Vitamina D/epidemiologia , Avaliação Nutricional , Estado NutricionalRESUMO
Introducción: Evaluar la seguridad y la eficacia de la inducción de tolerancia oral mediante pauta rush en pacientes con alergia a proteínas de leche de vaca persistente. Material y métodos: Estudio prospectivo realizado en 3 hospitales españoles. Se incluyó a niños mayores de 3 años con alergia IgE-mediada a proteínas de leche de vaca, a los que se administraron dosis crecientes de leche durante 5 días, desde 1 cc al 1% hasta 200 cc de leche pura en régimen de hospital de día. Las reacciones adversas a la administración de leche fueron registradas y se trataron atendiendo a la clasificación de Clark. Se realizó seguimiento clínico durante 2 años. Se determinaron los niveles de IgE específica basales y a los 6, 12 y 24 meses. Resultados: Se incluyó a 18 niños (13 varones) entre 3 y 14 años (media 5,96). De 271 dosis administradas, 55 presentaron algún tipo de reacción. Un 84% de las mismas fueron leves. Al finalizar el protocolo, el 100% presentaba algún grado de tolerancia (39% total). Tras 2 años, el 72% de los pacientes realizaba una dieta sin restricción de productos lácteos. Dos pacientes presentaron pérdida de la tolerancia alcanzada. Se observó un descenso significativo de los niveles de IgE específica a leche de vaca y α-lactoalbúmina a los 24 meses, y de caseína a los 6, 12 y 24 meses respecto de los niveles basales. Conclusiones: La desensibilización mediante pauta rush es una opción terapéutica eficaz y segura a medio plazo para pacientes con alergia persistente a proteínas de leche de vaca (AU)
Objective: The aim of this study was to evaluate the safety and efficacy of oral rush desensitization in children with cow milk allergy. Material and methods: Prospective study. We included IgE-mediated cow milk allergy children over 3 years in 3 Spanish hospitals. Increasing doses of cow milk for 5 days from 1 cc of 1% to 200cc of pure milk were administered. Clinical follow-up was conducted and we compared specific IgE levels at onset, 6, 12 and 24 months after desensitization. Results: We included 18 children (13 males) between 3 and 14 years (mean 5.96). A total of271 doses were administered; there were 55 adverse reactions (84% mild). At the end of the protocol, 100% showed some degree of tolerance (39% total). Full tolerance was achieved in 72%of patients after two years. Two children failed to achieve tolerance. There was a significant decrease in the levels of specific IgE to cow milk and alpha-lactalbumin at 24 months, and to casein at 6, 12 and 24 months, compared to baseline. Conclusions: Oral rush desensitization is a safe and effective therapeutic option for patients with persistent cow milk allergy to medium term (AU)
Assuntos
Humanos , Masculino , Feminino , Pré-Escolar , Criança , Adolescente , Hipersensibilidade a Leite/terapia , Dessensibilização Imunológica/métodos , Proteínas do Leite/efeitos adversos , Indução de Remissão , Segurança do PacienteRESUMO
OBJECTIVE: The aim of this study was to evaluate the safety and efficacy of oral rush desensitization in children with cow milk allergy. MATERIAL AND METHODS: Prospective study. We included IgE-mediated cow milk allergy children over 3 years in 3 Spanish hospitals. Increasing doses of cow milk for 5 days from 1 cc of 1% to 200 cc of pure milk were administered. Clinical follow-up was conducted and we compared specific IgE levels at onset, 6, 12 and 24 months after desensitization. RESULTS: We included 18 children (13 males) between 3 and 14 years (mean 5.96). A total of 271 doses were administered; there were 55 adverse reactions (84% mild). At the end of the protocol, 100% showed some degree of tolerance (39% total). Full tolerance was achieved in 72% of patients after two years. Two children failed to achieve tolerance. There was a significant decrease in the levels of specific IgE to cow milk and alpha-lactalbumin at 24 months, and to casein at 6, 12 and 24 months, compared to baseline. CONCLUSIONS: Oral rush desensitization is a safe and effective therapeutic option for patients with persistent cow milk allergy to medium term.
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Dessensibilização Imunológica/métodos , Hipersensibilidade a Leite/imunologia , Hipersensibilidade a Leite/terapia , Adolescente , Criança , Pré-Escolar , Dessensibilização Imunológica/efeitos adversos , Feminino , Seguimentos , Humanos , Estudos Longitudinais , Masculino , Boca , Estudos Prospectivos , Resultado do TratamentoRESUMO
La hipertransaminasemia es un motivo frecuente de consulta en Pediatría, en algunas ocasiones aparecerá en el contexto del estudio de una enfermedad hepática, pero principalmente la encontraremos como hallazgo casual tras realizar una analítica por cualquier otro motivo. La mayoría de los pacientes con elevación de las transaminasas podrán ser manejados de forma ambulatoria. Sin embargo, puede ser la forma de presentación de una enfermedad hepática grave por lo que no debemos olvidar los signos y síntomas de alarma. La utilización de guías o protocolos, como el que exponemos a continuación, puede mejorar la atención de estos pacientes a la hora de realizar un diagnóstico preciso y evitar pruebas o tratamientos innecesarios (AU)
Hypertransaminasemia is a relatively frequent problem observed in children. It can occur in the context of liver disease, but must of the times appears to be an accidental finding in a blood check test for other reasons. Most patients can be managed in primary settings, but we must take into account several warning signs indicative of several liver diseases. The employment of clinical protocols or guidelines such as the indicated in this paper may improve patient management in order to obtain adequate diagnosis ant to prevent unnecessary secondary tests and iatrogenia (AU)
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Humanos , Masculino , Feminino , Criança , Transaminases/sangue , Hepatite/diagnóstico , Hepatite Crônica/diagnóstico , Colestase/diagnóstico , Insuficiência Hepática/diagnóstico , Doença Aguda , Padrões de Prática Médica , Procedimentos Desnecessários , Testes de Função Hepática , Biomarcadores/análise , BiópsiaRESUMO
Introducción y objetivos: Conocer la prevalencia de sobrepeso en pacientes pediátricos con fibrosis quística (FQ) y su importancia como factor de resistencia insulínica diabetogénica y riesgo de hipertrigliceridemia. Material y métodos: Ciento nueve pacientes con FQ (47% varones) de 5-18 años se calificaron por su índice de masa corporal (IMC): desnutridos, normales o con sobrepeso. Se determinaron colesterol, triglicéridos y proteína C reactiva (PCR), glucohemoglobina y los índices HOMA-IR y QUICKI y en la sobrecarga oral de glucosa (SOG) su índice insulinogénico e ISI composite y áreas bajo la curva (ABC) de glucosa e insulina. Resultados: Seis pacientes (5,5%) tenían sobrepeso. Su edad, distribución sexual y base genética son similares al resto; aunque la proporción de suficientes pancreáticos (3/6; 50%) es superior (p=0,003). Los trastornos glucídicos no son más frecuentes que en el resto; pero la insulina basal, HOMA-IR, y la insulina durante la SOG (pico máximo y ABC) identifican su hiperinsulinismo, diferenciándolos de los otros dos grupos. Todos los pacientes muestran en la SOG respuesta insulínica tardía, sin diferencias en los índices derivados. Conclusiones: Entre los pacientes FQ con sobrepeso no hay mayor incidencia de trastornos glucídicos pero sí de hiperinsulinismo y resistencia insulínica, con el consiguiente riesgo añadido a la tendencia diabetogénica inherente a estos pacientes(AU)
Aim: To determine the prevalence of overweight in paediatric patients with cystic fibrosis (CF) and to analyse its role as diabetogenic insulin resistance factor and risk of hypertriglyceridaemia. Patients and methods: A total of 109 CF patients (47% males) between 5 and 18 years were divided into 3 groups according to body mass index (BMI): underweight, normal and overweight. Total cholesterol, triglycerides, C- reactive protein (CRP), glycosylated haemoglobin, HOMA-IR and QUICKI index were determined. Insulinogenic index, ISI composite and areas under the curve (AUC) for glucose and insulin were obtained by oral glucose tolerance test (OGTT). Results: Six patients (5.5%) were overweight. All groups had similar distribution by age, sex and CFTR mutation, although the proportion of pancreatic sufficient (3/6, 50%) was higher in overweight patients (P=.003). The prevalence of glycaemic disorders was similar between groups. Baseline insulin, HOMA-IR, and insulin during the OGTT (peak and AUC) were higher in overweight patients. All patients had a delayed insulin response in OGTT. Conclusions: Overweight CF patients do not have a higher incidence of glycaemic disorders, but their hyperinsulinism and insulin resistance may be additional diabetogenic risk factors(AU)
Assuntos
Humanos , Masculino , Feminino , Pré-Escolar , Criança , Adolescente , Resistência à Insulina , Fibrose Cística/complicações , Obesidade/complicações , Índice de Massa Corporal , Hiperinsulinismo/epidemiologia , Estudos RetrospectivosRESUMO
AIM: To determine the prevalence of overweight in paediatric patients with cystic fibrosis (CF) and to analyse its role as diabetogenic insulin resistance factor and risk of hypertriglyceridaemia. PATIENTS AND METHODS: A total of 109 CF patients (47% males) between 5 and 18 years were divided into 3 groups according to body mass index (BMI): underweight, normal and overweight. Total cholesterol, triglycerides, C- reactive protein (CRP), glycosylated haemoglobin, HOMA-IR and QUICKI index were determined. Insulinogenic index, ISI composite and areas under the curve (AUC) for glucose and insulin were obtained by oral glucose tolerance test (OGTT). RESULTS: Six patients (5.5%) were overweight. All groups had similar distribution by age, sex and CFTR mutation, although the proportion of pancreatic sufficient (3/6, 50%) was higher in overweight patients (P=.003). The prevalence of glycaemic disorders was similar between groups. Baseline insulin, HOMA-IR, and insulin during the OGTT (peak and AUC) were higher in overweight patients. All patients had a delayed insulin response in OGTT. CONCLUSIONS: Overweight CF patients do not have a higher incidence of glycaemic disorders, but their hyperinsulinism and insulin resistance may be additional diabetogenic risk factors.
Assuntos
Fibrose Cística/complicações , Fibrose Cística/metabolismo , Resistência à Insulina , Sobrepeso/etiologia , Sobrepeso/metabolismo , Adolescente , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Hipertrigliceridemia/complicações , Hipertrigliceridemia/metabolismo , Masculino , Sobrepeso/epidemiologia , Prevalência , Fatores de RiscoRESUMO
Introducción y objetivos. La importancia de un óptimo estado nutricional en la fibrosis quística es bien conocida, ya que incide en la mortalidad y en la función pulmonar de estos pacientes. Nuestro objetivo fue evaluar el estado nutricional de una muestra de pacientes pediátricos con fibrosis quística. Pacientes y métodos. Estudio multicéntrico descriptivo y transversal, se reclutó en cinco hospitales universitarios nacionales, 109 pacientes con fibrosis quística sin agudización respiratoria, con edades entre 5 y 18 años. Se clasificaron según el índice de masa corporal en: desnutridos, normales y sobrepeso. Análisis estadístico: ANOVA de un factor. Pruebas post-hoc de Bonferroni. Resultados. La edad media fue de 12,65 ± 3,21 años, el47% eran varones. Catorce pacientes (13%) estaban desnutridos, 89 (82%) tenían un estado nutricional normal y 6pacientes (5%) presentaban sobrepeso. Su edad, distribución sexual, base genética son similares en todos los grupos; aunque la proporción de suficientes pancreáticos (3/6; 50%)fue superior (p = 0,003) en los pacientes con sobrepeso. Los valores medios de peso, talla e índice de masa corporal expresados como puntuación Z fueron: -0,62 ± 0,78; -0,20± 1,18 y -0,32 ± 0,84 DS, respectivamente. Si analizamos los distintos datos antropométricos según el sexo y edad de los pacientes no encontramos diferencias estadísticamente significativas entre los mismos. Conclusiones. A pesar de los avances en el tratamiento, un porcentaje no desdeñable de pacientes con fibrosis quística presentan desnutrición. Por otra parte, las pautas de estilo de vida actuales y el soporte nutricional agresivo, podrían suponer en un pequeño porcentaje de casos la aparición de problemas nutricionales por exceso (AU)
Introduction and objectives. The importance of an adequate nutritional state in cystic fibrosis is well known and it is also known that it has an effect on the mortality and lung function of these patients. Our aim was to know nutritional status of a sample of pediatric cystic fibrosis patients. Patients and methods. Descriptive cross-sectional study.109 patients without pulmonary exacerbation, aged between5 and 18, were recruited in five national cystic fibrosis units. Were divided into 3 groups according body mass index: malnourished, normal and overweight. Statistical analysis: oneway ANOVA, Bonferroni Post-hoc tests. Results. The mean age was 12.65 ± 3.21 years, 47% were male. Fourteen patients (13%) were malnourished, 89 (82%)had normal nutritional status, and 6 patients (5%) were overweight. All groups had similar distribution by age, sex and CFTR mutation, although proportion of pancreatic sufficient (3/6, 50%) was higher in overweight patients (p=0.003). Mean weight, height and body mass index(expressed as Z score) were: -0.62 ± 0.78; -0.20 ± 1.18 and -0.32 ± 0.84 DS respectively. We dont find differences in anthropometric data when we analyze by sex and age of the patients. Conclusions. Despite advances in treatment, a significant percentage of cystic fibrosis patients are malnourished. Moreover, current lifestyle and nutritional support, could lead in a small percentage of patients the appearance of overnutrition problems (AU)
Assuntos
Humanos , Masculino , Feminino , Pré-Escolar , Criança , Adolescente , Transtornos da Nutrição Infantil/epidemiologia , Fibrose Cística/complicações , Avaliação Nutricional , Estado Nutricional , Apoio Nutricional/métodos , Desnutrição/epidemiologiaRESUMO
No disponible
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Humanos , Masculino , Feminino , Lactente , Hipersensibilidade a Leite/dietoterapia , Hipersensibilidade Alimentar/dietoterapia , Dessensibilização Imunológica/métodos , Imunoterapia/métodos , Intolerância à Lactose/terapiaRESUMO
La aspiración de cuerpo extraño es relativamente frecuente en Pediatría. Su potencial gravedad y la posible aparición de secuelas pulmonares, hace recomendable un diagnóstico y tratamiento precoz. Estos se basan en la historia clínica minuciosa y dirigida, que es el principal determinante para la realización de una broncoscopia rígida, que a su vez es la técnica considerada de elección para el tratamiento de estos pacientes. Se ha de tener un alto índice desospecha puesto que en la mayoría de los casos el episodio de atragantamiento puede pasar desapercibido en primera instancia. El propósito de este artículo es presentar un caso de aspiración de cuerpo extraño, revisando la literatura con el fin de evaluar los métodos diagnósticos y terapéuticos actualmente disponibles (AU)
Foreign body aspiration is relatively frequent in pediatrics. It is recommended an early diagnosis and treatment due to its potential severity and the possibility of pulmonary consequences. They are based on one hand on the directed and detailed clinical history, which is the main determinant to make a rigid bronchoscopy, which is considered to be the treatment of choice in these patients. A high index of suspicion is needed because in most cases the choking episode may not be noticed. The purpose of this article is to report a clinical case, and review the literature to evaluate the diagnostic and therapeutic procedures (AU)
Assuntos
Humanos , Masculino , Lactente , Migração de Corpo Estranho/complicações , Broncoscopia/métodos , Obstrução das Vias Respiratórias/etiologia , EngasgoRESUMO
A pesar de los constantes avances en la medicina perinatal, la prevalencia de los niños con parálisis cerebral infantil no ha disminuido en los últimos 20 años. La patología gastrointestinal constituye uno de los principales problemas de estos y otros pacientes con discapacidades neurológicas. El manejo multidisciplinar de estos pacientes, por parte de neurólogos, gastroenterólogos, enfermeras, dietistas y otros especialistas, contribuye a una mejora sustancial de su calidad de vida y la de sus cuidadores. En este artículo discutiremos sobre los métodos diagnósticos y las opciones terapéuticas disponibles para los principales problemas nutricionales y gastrointestinales en los pacientes con discapacidades neurológicas: el reflujo gastroesofágico, el estreñimiento y los trastornos de la deglución (AU)
Recent data suggest that, contrary to initial expectations with improvements in perinatal medicine, the prevalence of cerebral palsy has not decreased over the last 20 years. Gastrointestinal disorders are a major chronic problem in most of children with cerebral palsy and in children with neurodevelopmental disabilities. A multidisciplinary approach, with input from neurologists, gastroenterologists, nurses, dieticians and other specialists, can make a major contribution to the medical wellbeing and quality of life of these children and their caregivers. This article focuses on diagnostic methods and therapeutic options available for major nutritional and gastrointestinal problems in patients with neurological disabilities: gastroesophageal reflux, constipation and swallowing disorders (AU)
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Humanos , Masculino , Feminino , Criança , Gastroenteropatias/epidemiologia , Paralisia Cerebral/complicações , Refluxo Gastroesofágico/complicações , Constipação Intestinal/complicações , Transtornos de Deglutição/complicaçõesRESUMO
La pancreatitis aguda es una entidad poco frecuente en niños respecto a los adultos, aunque algunos estudios recientes sugieren un incremento de su incidencia. Una vez estabilizado el paciente, el tratamiento se basa en el soporte nutricional. La escasez de estudios prospectivos realizados en pacientes pediátricos obliga a los clínicos a actuar basándose en guías validadas para los adultos. El objetivo de este trabajo es tratar de revisar los conocimientos sobre el soporte nutricional en pacientes pediátricos con pancreatitis aguda y proponer una guía de actuación en el manejo de estos pacientes (AU)
Acute pancreatitis occurs less frequently in children compared with adults. However, recent studies have suggested that its incidence may be increasing. Once it is diagnosed the treatment of these patients is based on nutrition support. There are few prospective studies in children, therefore the physicians are obliged to use validated adult guides. Our objective is to review the knowledge on nutrition support in pediatric patients with acute pancreatitis and suggest a guide for the management of these patients (AU)
Assuntos
Humanos , Masculino , Feminino , Criança , Fenômenos Fisiológicos da Nutrição Infantil/fisiologia , Pancreatite Necrosante Aguda/complicações , Pancreatite Necrosante Aguda/diagnóstico , Pancreatite Necrosante Aguda/terapia , Nutrição Enteral/instrumentação , Nutrição Enteral/métodos , Nutrição Enteral , Nutrição Parenteral/instrumentação , Nutrição Parenteral/métodos , Nutrição Parenteral , Aminoácidos/administração & dosagem , Carboidratos/administração & dosagem , Gorduras/administração & dosagemRESUMO
Recent data suggest that, contrary to initial expectations with improvements in perinatal medicine, the prevalence of cerebral palsy has not decreased over the last 20 years. Gastrointestinal disorders are a major chronic problem in most of children with cerebral palsy and in children with neurodevelopmental disabilities. A multidisciplinary approach, with input from neurologists, gastroenterologists, nurses, dieticians and other specialists, can make a major contribution to the medical wellbeing and quality of life of these children and their caregivers. This article focuses on diagnostic methods and therapeutic options available for major nutritional and gastrointestinal problems in patients with neurological disabilities: gastroesophageal reflux, constipation and swallowing disorders.
Assuntos
Paralisia Cerebral/complicações , Deficiências do Desenvolvimento/complicações , Gastroenteropatias/etiologia , Doenças do Sistema Nervoso/complicações , Algoritmos , Criança , Transtornos da Nutrição Infantil/etiologia , Refluxo Gastroesofágico/etiologia , Gastroenteropatias/diagnóstico , Gastroenteropatias/terapia , HumanosRESUMO
Objetivo: Conocer la situación de la enfermedad de Kawasaki en nuestro medio. Pacientes y métodos: Se revisaron de forma retrospectiva, entre 1995 y 2007, a los niños que cumplían los criterios diagnósticos de la enfermedad de Kawasaki en su forma completa o incompleta, en el Hospital Universitario Central de Asturias. Se realizó un análisis descriptivo de los datos. Resultados: Revisamos un total de 19 pacientes. El 84%fueron menores de 3 años y el 57% varones. La incidencia anual fue de 8,4 casos/100.000 niños menores de 5 años. El 31% (todos varones) presentaron alteraciones en la ecocardiografía inicial; sin embargo, todos se normalizaron en controles posteriores. No se registraron aneurismas. El75% presentaron una PCR >5 mg/dl y hasta el 77% una VSG>50 mm/h. Solo 2 niños no respondieron a gammaglobulinai .v., requiriendo una segunda dosis. Conclusiones: La enfermedad de Kawasaki presenta en nuestro medio una incidencia semejante a la comunicada en Europa y Estados Unidos. Las complicaciones coronarias son más frecuentes en varones y en pacientes con fiebre prolongada (AU)
Objective: The aim of this study was to analyze the incidence and clinical spectrum of Kawasakis disease in children attended in our hospital. Patients and methods: Retrospective review of all children with Kawasakis disease evaluated in the department of Pediatric of Hospital Central (Asturias), between 1995and 2007.Results: Nineteen patients with Kawasakis disease were analyzed. 84% were younger than 3 years and 57% men. The annual incidence rate in our health area was estimated at8.4 cases per 100,000 children < 5 years. 31 % (all male)showed abnormalities in the initial echocardiography, none that included coronary aneurysms, all them were normalized in later controls. Blood analysis showed alterations of high ESR (77% of cases) and C-reactive protein (75%). Only2 children did not respond to IV gamma globulin requiring a second dose. Conclusions: The annual incidence rate for Kawasakis disease in our area was similar to that in Europe and the United States. Coronary aneurysms were more common in men and in patients with prolonged fever (AU)