Comparative efficacy of probiotic mixture Bifidobacterium longum KABP042 plus Pediococcus pentosaceus KABP041 vs. Limosilactobacillus reuteri DSM17938 in the management of infant colic: a randomized clinical trial.

We aimed to compare the efficacy of Bifidobacterium longum KABP042 + Pediococcus pentosaceus KABP041 (BL + PP) vs. Limosilactobacillus reuteri DSM17938 (LR) in alleviating the symptoms of infant colic, as commercially available formulations. A randomized, multicenter, parallel, single-blind (investigator) trial was conducted in 112 colicky infants diagnosed as per Rome IV criteria and randomly allocated to receive BL + PP orally (109 colony-forming units [CFU]/day, n = 55) or LR (108 CFU/day, n = 57) for 21 days. Primary study outcomes were percentage of responders (≥ 50% reduction in crying and fussing time from baseline, as reported by parents in a structured diary) and daily crying and fussing time (minutes/day) on days 7, 14, and 21 after randomization. Study groups were comparable at baseline. Responder rate was significantly higher in BP + PP group vs. LR group at days 7 (61.1% vs. 37.5%, p = 0.013) and 14 (84.6% vs. 59.3%, p = 0.004). Crying and fussing time (median [IQR]) became significantly lower in BL + PP group vs. LR group on day 7 (119 [60-210] vs. 180 [110-270]; p = 0.028), day 14 (60.0 [30-105] vs. 120 [60-180]; p = 0.017), and day 21 (29 [0-85] vs. 67 [30-165]; p = 0.011). No significant differences were found in the number of adverse events between the groups. CONCLUSION: The specific formulation of B. longum KABP042 and P. pentosaceus KABP041 achieved a higher response rate and a larger reduction in crying and fussing time in colicky infants. Both probiotic interventions were well tolerated. TRIAL REGISTRATION: The study was retrospectively registered as NCT05271747 on February 28th, 2022. WHAT IS KNOWN: • L. reuteri DSM17938 (LR) is the most researched probiotic strain for infant colic against placebo in randomized, controlled clinical trials, and is recommended in various guidelines. A novel probiotic combining strains B. longum KABP042 and P. pentosaceus KABP041 (BL + PP) has also demonstrated efficacy in infant colic against placebo. WHAT IS NEW: • This randomized study provides the first direct comparison of two probiotics for infant colic. BL + PP seems to be superior to LR in reducing crying time.

Awareness and Self-Reported Knowledge and Training on Nutrition in Older People among Primary Care Practitioners.

OBJECTIVES: To assess the awareness and training of primary care physicians on nutrition in older patients. DESIGN: Observational, real-world data survey. SETTING: Primary Care. PARTICIPANTS: One hundred sixty-two physicians, generalists and specialists, working in primary care. MEASUREMENTS: Participants received an online questionnaire with 18 questions concerning the importance of nutrition, degree of knowledge, needs, and training in nutrition. The results were evaluated using univariate descriptive analysis, with a percentage for each chosen answer. Logistic regression models were used to evaluate if answers were related to training in nutrition and professional experience. RESULTS: 43.2% of participants reported that nutrition is very important in individuals over 65 years old, and 90% were aware of the importance of nutrition in healthy aging. Nutritional problems affect 30 to 50% of patients, according to 44.7% of participants. 89.2% agree about the need for nutritional assessment in older patients; however, the professionals believe they should be better prepared. Two out of three respondents consider the training received in nutrition during their undergraduate course or continuing medical education as deficient. Time of professional practice was mainly associated with conceptual facts, while continuing medical education did with practical issues, mainly the use of screening and diagnostic tools [FRAIL (OR: 3.16; 95%IC: 1.55-6.46), MNA-SF (OR: 6.455; 95%IC: 2.980-13.981) and SARC-F (OR: 3.063; 95%IC: 1.284-7.309)]. CONCLUSION: Although primary care professionals are aware of the importance of nutrition in older patients, there are still gaps in daily practice that could be improved by developing educational strategies.

AGREEMENT BETWEEN DIFFERENT EQUATIONS TO ESTIMATE OSMOLARITY OF PARENTERAL NUTRITION SOLUTIONS.

BACKGROUND: our aim was to measure the osmolality of several PN formulas at different component concentrations to determine if equations described in literature to calculate osmolarity accurately predict osmolalality in other experimental conditions different than these used to develop them. METHODS: osmolality of 12 different types of PN solutions, 9 for central and 3 for peripheral perfusion were measured by using freezing point depression in cross-sectional study. We evaluated the agreement (Pearson correlation test) and differential bias between measured osmolality and calculated osmolarity for three different equations described in the literature: Pereira Da Silva, ASPEN Practice Manual and ASPEN guidelines. RESULTS: mean ± SD osmolality of PN solutions was 1789 ± 256 (range 1 540 - 2 372) and 751 ± 64 mOsm/kg (range 689 - 817) for central and peripheral infusion, respectively. The osmolality of PN formulations was mainly due to glucose (r = 0.975) and amino acids (r = 0.948). All studied equations had a good correlation in the bivariate analysis (p = 0.000). All equations had a trend to underestimate the osmolality compared with the measured value. However, ASPEN guidelines equation overestimated the osmolality for peripheral PN. CONCLUSIONS: measurement of osmolality of peripheral PN solutions is important to reduce the risk of phlebitis. The different equations described previously show a good correlation between them although in general underestimate the osmolality.

Objetivo: nuestro objetivo era medir la osmolaridad de varias fórmulas de nutrición parenteral (NP) compuestas por diferentes componentes para determinar si las ecuaciones para calcular la osmolaridad de la solución, descritas en la literatura, predicen su osmolalidad en la práctica clínica. Método: se midió mediante osmometría la osmolalidad de 12 fórmulas de NP diferentes: 9 para acceso venoso central y 3 para acceso periférico, en un estudio transversal. Se analizó el acuerdo (test de correlación de Pearson) y las diferencias entre la osmolalidad medida y la osmolaridad calculada mediante tres fórmulas diferentes: ecuación de Pereira Da Silva, ecuación del manual de práctica clínica de ASPEN y ecuación de las guías de ASPEN. Resultados: la media ± desviación estándar de las soluciones era 1.789 ± 256 (rango 1.540 ­ 2.372) y 751 ± 64 mOsm/kg (rango 689 ­ 817) para perfusión central y periférica, respectivamente. La osmolalidad era debida principalmente a la glucosa (r = 0,975) y a los aminoacidos (r = 0,948). Todas las ecuaciones presentaban una buena correlación en el análisis bivariante (p = 0,000). Todas las ecuaciones tendían a infraestimar la osmolalidad, en comparación con el valor medido. Sin embargo, la ecuación de las guías de la ASPEN sobreestimaba la osmolalidad de las NP periféricas. Conclusiones: conocer la osmolaridad de la solución de NP periférica es importante para reducir el riesgo de flebitis. Las diferentes ecuaciones descritas en la literatura muestran una buena correlación entre ellas, aunque en general infraestiman la osmolalidad.

[The introduction of gluten into the infant diet. Expert group recommendations]. / La introducción del gluten en la dieta del lactante. Recomendaciones de un grupo de expertos.

At present there is a degree of uncertainty regarding when, how and in what form gluten should be introduced into the infant diet. For years the recommendations of the ESPGHAN Committee on Nutrition have prevailed, which include avoiding early introduction, before 4 months, and late, after 7 months, and gradually introducing gluten into the diet while the infant is being breastfed, with the aim of reducing the risk of celiac disease, diabetes and gluten allergy. However, 2 independent studies published in The New England Journal of Medicine in October 2014 reached the conclusion that the age of introduction of gluten does not modify the risk of developing celiac disease, and that breastfeeding at any age does not confer protection against celiac disease development. On the other hand, according to available scientific evidence, the introduction of foods other than breast milk or formula into the infants diet is generally recommended around 6 months of age, since the introduction before 4 months could be associated with an increased risk of food allergy and autoimmune diseases, and delaying it beyond 7 months would not have a protective effect. In this context, a group of experts has considered it appropriate to produce a consensus document based on the current scientific evidence and present general recommendations for daily clinical practice on the introduction of gluten into the diet.

Home enteral nutrition in Spain; NADYA registry 2011-2012.

OBJECTIVE: To describe the results of the home enteral nutrition (HEN) registry of the NADYA-SENPE group in 2011 and 2012. MATERIAL AND METHODS: We retrieved the data of the patients recorded from January 1st 2011 to December 31st 2012. RESULTS: There were 3021 patients in the registry during the period from 29 hospitals, which gives 65.39 per million inhabitants. 97.95% were adults, 51.4% male. Mean age was 67.64 ± 19.1, median age was 72 years for adults and 7 months for children. Median duration with HEN was 351 days and for 97.5% was their first event with HEN. Most patients had HEN because of neurological disease (57.8%). Access route was nasogastric tube for 43.5% and gastrostomy for 33.5%. Most patients had limited activity level and, concerning autonomy, 54.8% needed total help. Nutritional formula was supplied from chemist's office to 73.8% of patients and disposables, when necessary, was supplied from hospitals to 53.8% of patients. HEN was finished for 1,031 patients (34.1%) during the period of study, 56.6% due to decease and 22.2% due to recovery of oral intake. CONCLUSIONS: Data from NADYA-SENPE registry must be explained cautiously because it is a non-compulsory registry. In spite of the change in the methodology of the registry in 2010, tendencies regarding HEN have been maintained, other than oral route.

Objetivos: Describir los resultados del registro de nutrición enteral domiciliaria (NED) del grupo NADYASENPE de los años 2011 y 12. Material y métodos: Se recopilaron los datos introducidos en el registro desde el 1 de enero de 2011 al 31 de diciembre de 2012. Resultados: Hubo 3021 pacientes en el registro durante el periodo, procedentes de 29 hospitales, lo que da una prevalencia de 65,39 casos por millón de habitantes. 97.95% fueron adultos, 51,4% varones. La edad media fue 67,64 ± 19,1 años y la mediana 72 años para los adultos y 7 meses para los niños. La duración media de la NED fue 351 días y para el 97,5% fue el primer episodio con NED. La mayoría de pacientes tenían NED por una enfermedad neurológica (57,8%). La vía de acceso fue sonda nasogástrica para el 43,5% y gastrostomía para el 33,5%. La mayoría de pacientes tuvieron un nivel de actividad física limitado y, respecto a la autonomía, 54,8% necesitaba ayuda total. La fórmula de nutrición se suministró desde las oficinas de farmacia para el 73,8% y los fungibles, cuando fueron necesarios, desde los hospitales para el 53,8%. La NED se suspendió en 1.031 pacientes (34,1%) durante el periodo de estudio, 56,6% debido a fallecimiento y 22,2% debido a recuperación de la vía oral. Conclusiones: Los datos del registro NADYA-SENPE deben ser interpretados con precaución ya que se trata de un registro voluntario. A pesar del cambio de metodología del registro en 2010, las tendencias en NED se han mantenido, salvo la importancia cuantitativa de la vía oral.

[Home parenteral nutrition in Spain 2011 and 2012; a report of the home and ambulatory artificial nutrition group NADYA]. / Nutrición Parenteral Domiciliaria en España 2011 y 2012: informe del grupo de nutrición artificial domiciliaria y ambulatoria NADYA.

OBJECTIVE: To report the data of the Home Parenteral Nutrition (HPN) registry of the NADYA-SENPE working group for the years 2011 and 2012. METHODOLOGY: We compiled the data from the on-line registry introduced by reviewers of NADYA group responsible for monitoring of NPD introduced by since January 1, 2011 to december 31, 2012. Included fields were: age, sex, diagnosis and reason for HPN, access path, complications, beginning and end dates, complementary oral or enteral nutrition, activity level, autonomy degree, product and fungible material supply, withdrawal reason and intestinal transplant indication. RESULTS: Year 2010: 184 patients from 29 hospitals , representing a rate of 3.98 patients/million inhabitants/ year 2011, with 186 episodes were recorded NPD . During 2012, 203 patients from 29 hospitals , representing a rate of 4.39 patients/million inhabitants/year 2012 , a total of 211 episodes were recorded NPD . CONCLUSIONS: We observe an increase in registered patients with respect to previous years.Neoplasia remains as the main pathology since 2003. Although NADYA is consolidated registry and has been indispensable source of information relevant to the understanding of the progress of Home Artificial Nutrition in our country, there is ample room for improvement. Especially that refers to the registration of pediatric patients and the registration of complications.

Objetivo: Comunicar los datos del registro de Nutrición Parenteral Domiciliaria (NPD) del grupo de trabajo NADYA-SENPE de los años 2011 y 2012. Material y métodos: Recopilación de los datos del registro "on-line" introducidos por los colaboradores del grupo NADYA responsables del seguimiento de la NPD desde el 1 de enero de 2011 al 31 de diciembre de 2012 dividido por años naturales. Resultados: Año 2010: Se registraron 184 pacientes, procedentes de 29 hospitales, lo que representa una tasa de 3,98 pacientes/millón habitantes/año 2011, con 186 episodios de NPD. Durante el año 2012 se registraron 203 pacientes, procedentes de 29 hospitales, lo que representa una tasa de 4,39 pacientes/millón habitantes/año 2012, con un total de 211 episodios de NPD. Conclusiones: Se observa un aumento progresivo de los pacientes registrados respecto a años anteriores. El principal grupo patológico sigue siendo oncológico ocupando el primer lugar desde 2003. Aunque el registro NADYA es un registro consolidado y ha sido y es fuente imprescindible de información relevante para el conocimiento de los avances de la Nutrición Artificial Domiciliaria en nuestro país, queda un amplio margen para la mejora. En especial lo que hace referencia al registro de pacientes pediátricos y al registro de las complicaciones.

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.

[The registry of home artificial nutrition and ambulatory of the Spanish Society of Parenteral and Enteral Nutrition; SWOT analysis]. / El registro de Nutrición Artificial Domiciliaria y Ambulatoria de la Sociedad Española de Nutrición Parenteral y Enteral; análisis DAFO.

OBJECTIVE: To evidence by means of a SWOT-R analysis performed by an expert consensus the most worrying characteristics of the register on Home-based and Outpatient Artificial Nutrition. MATERIAL AND METHODS: SWOT-R analysis with expert consensus. We requested the participation of the active members of the NADYA group within the last 5 years with the premise of structuring the SWOT-R based on the characteristics of the NADYA registry from its beginning. RESULTS: 18 experts from hospitals all over Spain have participated. The internal analysis seems to be positive, presenting the registry as having important resources. The external analysis did not show a great number of threats, there are very potent factors, "the voluntariness" of the registry and the "dependence on external financing". The opportunities identified are important. The recommendations are aimed at stabilizing the system by decreasing the threats as one of the main focus of the strategies to develop as well as promoting the items identified as opportunities and strengths. CONCLUSIONS: The analysis shows that the NADYA register shows a big potentiality for improvement. The proposed recommendations should be structured in order to stay on the track of development and quality improvement that has characterized the NADYA register from the beginning.

[Incidence of catheter-related infection and associated risk factors in hospitalized patients with parenteral nutrition]. / Incidencia de infección asociada a catéter y factores de riesgo relacionados en pacientes hospitalizados con nutrición parenteral.

INTRODUCTION: The most severe complication of parenteral nutrition (PTN) is catheter-related infection (CRI). OBJECTIVES: To study the incidence rate and factors associated to CRI. MATERIAL AND METHODS: 271 patients followed at the Nutrition Unit for 6 months. The composition of the PTN was calculated according to the metabolic demands. 20.3% received a lipid solution enriched with omega-3 fatty acids (SMOF Fresenius Kabi®) and 79.7% with olive oil (Clinoleic Baxter®). RESULTS: The rate of CRI was 25 per 1,000 days of PTN (55 patients: 61.7±17.8 years, 60.3% males, 29.3±10.6 days of hospital stay and 10.4% mortality). Coagulase-negative Staphylococcus was the most frequently isolated microorganism. There were no differences by age, gender, mortality, or composition of the PTN between patients with or without infection. The patients treated with omega-3 received more calories with the PTN, at the expense of higher intake of glucose and lipids. However, the rate of infection was similar, although there was a not significant trend towards a lower infection rate when using the omega-3 composition (14.5% vs. 23.1%, respectively, p = 0.112). The duration of the nutritional support was higher in patients with CRI (13.0 ± 9.7 vs. 9.3 ± 8.1, p = 0.038). Total mortality (16.9%) was independent of the presence or absence of CRI (10.4% vs. 18.7%, p = 0.090) or of the use of omega-3 lipids or olive oil in the PTN (10.9% vs. 18.5%, p = 0.125). CONCLUSION: Patients submitted to PTN have a high rate of CRI. The presence of infection is related to the duration of the PTN, being independent of the age, gender, and composition of the solution. The use of omega-3 lipid solutions may be beneficial although further studies are needed to confirm this.

[Pilot study of intravenous fluid therapy management in adult patients at a tertiary care hospital]. / Estudio piloto sobre el manejo de la fluidoterapia intravenosa en pacientes adultos de un hospital de tercer nivel.

UNLABELLED: The purpose of intravenous fluid therapy (IFT) is to maintain or restore internal equilibrium by administering fluids and/or different electrolyte components. Its correct use and the prevention of complications arising from their misuse depend on the knowledge of the medical team on this subject. We analyzed this issue in different clinical areas of a tertiary hospital. MATERIAL AND METHODS: We performed a descriptive cross-sectional pilot study via a questionnaire given to physicians specializing in internal medicine (IM) and digestive system surgery (SDS) who perform clinical practice in hospital units with unit dose drug dispensing system. We designed an anonymous questionnaire with 25 questions relative to knowledge of theory and practices, as well as the opinion of physicians regarding IFT. We evaluated the association between nominal qualitative variables with the Chi-square or Fisher's exact test. The behavior of the quantitative variables was assessed using the t-student test. The analysis of the data was generated using SAS/STAT, Version 9. RESULTS: 28 questionnaires were collected from 13 surgeons and 15 digestive interns. Over 40% of specialists considered further education in IFT a necessity , especially regarding its prescription (SDS: 61.54%, IM: 71.43%). No statistically significant differences were found between the specialties in terms of perceived frequency of complications associated with IFT or in the frequency indication with the exception of hypovolemic shock, which is considered to be more prevalent in gastrointestinal surgery (p = 0.046). 90% of professionals prefer an individualized prescription. Statistically significant differences in terms of scores in the area of knowledge, with IM physicians achieving the highest scores (p = 0.014). There were also differences in attitude but they are not significant (p = 0.162). Knowledge of intravenous fluid increases with years of clinical experience (Spearman correlation coefficient = 0.386, p = 0.047). CONCLUSIONS: The professionals who prescribe IFT perceive the need to design IFT training programs, together with the production of guides and consensus protocols.

[Home parenteral nutrition in infants and children in a tertiary level hospital between 1993 and 2009]. / Nutrición parenteral domiciliaria en niños en un hospital terciario entre los años 1993 y 2009.

UNLABELLED: Home parenteral nutrition (HPN) has a key role in the management of permanent or transient intestinal failure in the pediatric patient. Although its use is not without complications. We review our experience since the beginning of the program in 1993. PATIENTS AND METHODS: Longitudinal and retrospective study of the clinical records from 25 infants and children (11 boys, 14 girls) who received HPN in this period. If a patient received HPN in periods separated more than 3 months we consider a different episode. In this way, 32 episodes were described. Quantitative data are presented as mean or median and qualitative as frequency. Complications are presented as complication rate per 1,000 days of HPN. RESULTS: 16 patients started HPN younger than 1 year. Total length of HPN was 9,986 days, median 174 days (range 7 to 2,444 days). Main indication was short bowel syndrome (n = 6); motility disorders (n = 6); chronic diarrhea (n = 5), malnutrition (n = 3) and other causes (n = 5). 47 catheters were used; mean length 212.5 days, median 120 days (range: 7 to 930). Most of central venous catheters were tunnelled catheters (n = 42); subcutaneous ports (n=3) and in two cases periferically inserted central catheters (PICCS). Complication rate per 1,000 days of HPN was: 3.4 for catheter-related infections, 0.1 for obstruction; 0.9 for leakage, and 0.1 for accidental removal. Most common microorganisms were Staphylococcus coagulase negative (47%), Gram negative bacteria (21%), Staphylococcus aureus (15%), fungi (9%) and others in 9%. Parenteral nutrition-associated liver disease was present in 4 patients. 21 patients were weaned off HPN, 3 patients deceased because of underlying disease, 2 patients underwent intestinal transplantation, while 5 patients continue in the program. CONCLUSIONS: Every year two new patients enter in the program. 65% of patients were weaned off HPN. Infectious complications were the most frequent (rate 3.4 infections per 1,000 days of HPN). Mean length of HPN was 174 days, and 120 days for catheters.

[Recommended intake of calcium and vitamin D: positioning of the Nutrition Committee of the AEP]. / Recomendaciones de ingesta de calcio y vitamina D: posicionamiento del Comité de Nutrición de la Asociación Española de Pediatría.

Both calcium and vitamin D are essential nutrients with a crucial role in bone health, although in recent years there has been much controversy about the contributions required from both molecules to ensure adequate health. For vitamin D, in a short time, we have seen how it has gone from a recommendation of 400 IU daily, to 200 IU and again to 400 IU, with some statements that not only its influence on skeletal tissue has been taken into account, but also on the development of chronic diseases, which has led to new expectations. Our goal is to provide an update to paediatricians on this issue and propose recommendations for intake in the light of the latest information. For vitamin D the Committee proposes an intake of 400 IU/day in children under 1 year and 600 IU/day after that age.

[Micronutrient supplementation in parenteral nutrition in Spanish hospitals]. / Utilización de micronutrientes en nutrición parenteral en los hospitales Españoles.

Several years ago, it was recommended not to add vitamins or oligoelements to parenteral nutrition (PN) solutions and to administer them immediately after the addition of the micronutrients to avoid their decay. Nowadays, it has been observed that with multilayer bags, ternary mixtures and sunlight protection vitamins degradation is minimal. Daily intake of micronutrients is necessary in the critically ill, malnourished or long-term PN patients. Aiming at knowing the schedules of use of micronutrients in PN in Spanish hospitals and the way PN bags are prepared regarding the factors conditioning their stability, we undertook a telephone survey to the pharmacists in charge of PN at the different hospitals. We compared the data obtained with those from other surveys performed in 2001 and 2003. Pharmacists from 97 hospitals answered the questionnaire (answer rate 88%). The hospital sizes ranged 104-1728 beds. As compared to the data form preceding years, we observed a better adequacy to the current recommendations, although there are still 30% of the hospitals that administer micronutrients on an every other day basis independent of the clinical situation of the patients. In most of the hospitals, multilayer bags are used and/or sunlight protection and ternary mixtures. According to these results showing the different criteria for administering vitamins and oligoelements in PN solutions, it seems necessary to elaborate consensus documents that adapt to the reality of the diverse practices besides promoting the performance of well-designed clinical studies establishing the requirements under special clinical situations.

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.

[Importance of water in the hydration of the Spanish population: FESNAD 2010 document]. / Importancia del agua en la hidratación de la población española: documento FESNAD 2010.

For any healthy individual, thirst is an appropriate sign to drink water, except for babies, sportsmen, and most of ill and elderly people. In these instances, it is convenient to schedule appropriate times to drink water since great demands and the physiological mechanisms that determine thirst in these situations may condition water unbalances with important consequences for health and the physical and intellectual performance. The human body has a number of mechanisms that allow keeping constant the water content by adjusting intakes and wastes. Water balance is determined by intake (consumed water, beverages, and water contained in foods) and wastes (urine, stools, the skin, and expired air from the lungs). Failure of these mechanisms and subsequent impairments in water balance may produce severe disarrangements that may threaten somebody's life. In the present document, we analyze the evidences regarding the factors conditioning water needs in the different life stages and physiological situations, as well as the consequences of water unbalance under different situations. A proper hydration may be achieved by feeding and the use of water and other liquids. Although water is the beverage by excellence and represents the ideal way of restoring the losses and get hydrated, we should be aware that, from the very beginning, we have sought other liquid sources with hydration properties. In the last decades we have increased the consumption of different beverages, with a proliferation of sugar-containing beverages. Since excessive sugar consumption has been related to obesity and other chronic conditions, it is evident that the use of these caloric beverages should be rationalized, especially in children. In this document all the considerations regarding hydration are presented and different recommendations are exposed.

[Blood-stream catheter related infection in inpatient children receiving parenteral nutrition]. / Incidencia de bacteriemia asociada a catéter en niños hospitalizados que reciben nutrición parenteral.

UNLABELLED: Blood-stream catheter related infection is the most severe complication in patients carrying a central venous catheter. Parenteral nutrition (PN) use seems to be a risk factor for developing a catheter-related infection (CRI). MATERIAL & METHODS: In order to know the incidence of CRI in children to further implement policies to reduce nosocomial infection, we review all charts of children (1 month to 17 years) who received parenteral nutrition while in hospital. All episodes of fever + positive blood culture were recorded. Infection rate was defined as number of episodes/1000 Parenteral nutrition days. RESULTS: 48 positive blood cultures was obtained from 120 patients. Infection rate was 37.8/1000 days. Incidence was significantly higher in infants and toddlers (52% vs 29.8%, p = 0.016). Most frequent organisms were coagulase negative Staph. (56.8%), Gram negative bacilli (20.8%), Staph aureus (12.5%) and fungus (12.5%). No difference in incidence were found according to the underlying disease or the length of PN use. CONCLUSIONS: Infection rate in our PN inpatient patients was significantly higher. PN may represent a risk factor for developing a CRI. Specific measurements and policies need to be implemented to overcome present situation.

[Calcium intake and bone mineral density in a group of Spanish school-children]. / Ingesta de calcio y densidad mineral ósea en una población de escolares españoles (estudio CADO).

INTRODUCTION: There are limited data available on bone mass status in Spanish children and or whether the differences are associated with diet/hygiene habits or geographical variability. SUBJECTS AND METHODS: To determine this association a cross-sectional study was carried out in three different areas (northern, central and southern Spain) and included 1176 schoolchildren between 5 and 12 years old, randomly selected from schools in those areas. Bone density of the distal phalanges was measured by bone ultrasound. We examine the correlations between these data and calcium and vitamin D intake, physical activity and bone mass index. RESULTS: Of the 1176 children initially included, 1035 nutritional questionnaires were completed and bone ultrasound data were obtained on 991 of them. Eighteen percent of girls and 13% of boys had a calcium intake below 800 mg per day. More than 70% of children have a daily vitamin D intake under 2.5 mcg. Age and exercise showed a direct linear relationship with bone mineral density, and an inverse one for overweight. CONCLUSIONS: Both high physical activity and high calcium intake were associated with a higher bone mineral density, while overweight showed the opposite effect. Diet habits and exercise must be considered the main strategies to prevent adult osteoporosis during childhood.