RESUMO
Exclusive enteral nutrition (EEN) has been shown to be more effective than corticosteroids in achieving mucosal healing in children with Crohn´s disease (CD) without the adverse effects of these drugs. The aims of this study were to determine the efficacy of EEN in terms of inducing clinical remission in children newly diagnosed with CD, to describe the predictive factors of response to EEN and the need for treatment with biological agents during the first 12 months of the disease. We conducted an observational retrospective multicentre study that included paediatric patients newly diagnosed with CD between 2014-2016 who underwent EEN. Two hundred and twenty-two patients (140 males) from 35 paediatric centres were included, with a mean age at diagnosis of 11.6 ± 2.5 years. The median EEN duration was 8 weeks (IQR 6.6-8.5), and 184 of the patients (83%) achieved clinical remission (weighted paediatric Crohn's Disease activity index [wPCDAI] < 12.5). Faecal calprotectin (FC) levels (µg/g) decreased significantly after EEN (830 [IQR 500-1800] to 256 [IQR 120-585] p < 0.0001). Patients with wPCDAI ≤ 57.5, FC < 500 µg/g, CRP >15 mg/L and ileal involvement tended to respond better to EEN. EEN administered for 6-8 weeks is effective for inducing clinical remission. Due to the high response rate in our series, EEN should be used as the first-line therapy in luminal paediatric Crohn's disease regardless of the location of disease and disease activity.
Assuntos
Doença de Crohn/terapia , Nutrição Enteral , Adolescente , Criança , Doença de Crohn/diagnóstico , Doença de Crohn/metabolismo , Feminino , Humanos , Masculino , Indução de Remissão , Estudos RetrospectivosRESUMO
INTRODUCTION: Paediatric malnutrition during hospital admission is a prevalent comorbidity, which it is estimated around 31.4% in our environment, and could influence the clinical outcomes of paediatric patients. OBJECTIVE: The aim of this study was to describe the malnutrition risk in hospitalised children using STAMP (Screening Tool for the Assessment of Malnutrition in Paediatrics), and to study its relationship with clinical outcomes. METHODS: A single-centre, analytical and prospective study was conducted on children aged 1 month to 15 years hospitalised in a tertiary hospital between October and December 2017. An analysis was made of the clinical data and anthropometric measurements (weight, height, Waterlow weight classification). Patients were classified according to STAMP, which is a validated screening tool used to classify the risk of paediatric malnutrition during hospital admission. Multivariate statistical analysis was used to identify predictive variables of illness severity. RESULTS: An analysis was made on a total of 200 patients (55% male), with a median age of 15.8 months (IQR 2.5-42.8), and a median length of stay of 3 days (IQR 1-18 days). Almost half (48.3%) of them had high risk of malnutrition at admission (STAMP ≥4), and 48.2% showed medium risk (STAMP 2-3). A higher STAMP score was associated with longer length of hospital stay (P<.01) and greater severity (P<.01). Multivariable analysis showed that STAMP could be a predictor of illness severity (OR 1.48, 95% CI: 1.18-1.86, P<.01). CONCLUSIONS: Nearly 50% of hospitalised children have a high risk of malnutrition at admission according to the STAMP screening tool. Risk of malnutrition at admission measured according to STAMP nutritional screening was associated with a longer length of stay and greater severity of illness. It is important to evaluate the risk of malnutrition as this could be related to illness severity.
Assuntos
Hospitalização , Desnutrição/diagnóstico , Estado Nutricional , Índice de Gravidade de Doença , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Estudos Longitudinais , Masculino , Desnutrição/complicações , Análise Multivariada , Prognóstico , Estudos Prospectivos , Medição de RiscoRESUMO
Infant colic is a prevalent physiological event of healthy children under 3 months of age which can disrupt the child's home environment. Despite its benign natural history, sometimes requires a therapeutic approach. Numerous therapeutical lines have been proposed although its pathogenesis remains unknown and multifactorial. The gut microbiota plays an important role in the infant colic. Several studies have shown less bifidobacteria and lactobacilli in infant colic meanwhile Escherichia, Klebsiella, Serratia, Vibrio, Yersinia and Pseudomonas are more prominent in colon. The probiotic strain L. reuteri DSM 17938, when administered once daily to 108 cfu / day, seems to have the most scientific evidence up to date in the treatment of infant colic, without significant side effects.
El cólico del lactante es un evento fisiológico prevalente en niños sanos menores de 3 meses capaz de perturbar el entorno familiar. A pesar de su naturaleza benigna y autorresolutiva, en algunas ocasiones, requiere un abordaje terapéutico. Se han propuesto numerosas líneas terapéuticas aunque su etiopatogenia sigue siendo desconocida y multifactorial. La microbiota intestinal tiene un papel importante en el cólico. Varios estudios muestran que los lactantes con cólicos tienen menos bifidobacterias y lactobacilos y más Escherichia, Klebsiella, Serratia, Vibrio, Yersinia y Pseudomonas en el colon. La cepa probiótica L. reuteri DSM 17938 administrada una vez al día a 108 ufc/día es la que más evidencia científica tiene hasta el momento en el tratamiento del cólico del lactante, sin observarse efectos secundarios.