ABSTRACT
Hypertransaminasemia is a frequent finding in pediatrics, which could reflect potentially treatable serious disease. The aim of this document is to establish, by reviewing the available evidence, a consensus for an adequate management of hypertransaminasemia, from its detection until the study is complete. To this end, a working group was formed with the participation of members of the Society of Pediatric Gastroenterology, Hepatology and Nutrition (SEGHNP), the Spanish Association of Primary Care Pediatrics (AEPap) and the Spanish Society of Primary Care Pediatrics (SEPEAP). Twenty-one recommendations are established with a marked practical component that will be useful in hospital clinical practice and primary care.
Subject(s)
Pediatrics , Child , Consensus , HumansABSTRACT
No disponible
Subject(s)
Humans , Organizations/trends , Health Consortia , Cooperative Behavior , Professional Staff Committees , PediatricsABSTRACT
La hipertransaminasemia es un hallazgo frecuente en pediatría, puede ser banal o reflejar enfermedad grave potencialmente tratable. El objetivo de este documento es establecer, mediante la revisión de la evidencia disponible, un consenso para un adecuado enfoque práctico desde la detección de la hipertransaminasemia hasta completar su estudio en la edad pediátrica. Para ello, se constituyó un grupo de trabajo con participación de miembros de la Sociedad de Gastroenterología, Hepatología y Nutrición Pediátrica (SEGHNP), Asociación Española de Pediatría de Atención Primaria (AEPap) y Sociedad Española de Pediatría de Atención Primaria (SEPEAP). Se establecieron 21 recomendaciones con el objetivo de que sirvan de utilidad en la práctica clínica habitual tanto en atención primaria como hospitalaria. (AU)
Hypertransaminasemia is a frequent finding in pediatrics, which could reflect potentially treatable serious disease. The aim of this document is to establish, by reviewing the available evidence, a consensus for an adequate management of hypertransaminasemia, from its detection until the study is complete. To this end, a working group was formed with the participation of members of the Society of Pediatric Gastroenterology, Hepatology and Nutrition (SEGHNP), the Spanish Association of Primary Care Pediatrics (AEPap) and the Spanish Society of Primary Care Pediatrics (SEPEAP). Twenty-one recommendations are established with a marked practical component that will be useful in hospital clinical practice and primary care. (AU)
Subject(s)
Humans , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Catastrophic Illness , Pediatrics , Physicians, Primary Care , Non-alcoholic Fatty Liver Disease , TransaminasesABSTRACT
Introducción: Una dieta apropiada en la infancia es fundamental para un crecimiento y desarrollo adecuados, pero también para la prevención del desarrollo de enfermedades no transmisibles. La etapa escolar es transcendental. Una proporción importante de alumnos hacen uso del comedor escolar. Se revisa la situación actual de los comedores escolares, así como la normativa y las guías para los comedores en España y en sus diferentes Comunidades Autónomas.Material y métodos: Se recoge en esta revisión la normativa estatal así como la de cada Comunidad Autónoma referidas a las características de los menús escolares, dejando de lado las relativas a los aspectos que tienen que ver con las instalaciones o las garantías higiénico-sanitarias.Resultados: Existe una normativa estatal sobre los comedores escolares relativamente reciente, aunque al ser una competencia transferida es desarrollada por cada Comunidad Autónoma. Dentro de una cierta heterogeneidad, hacen referencia a la distribución de la dieta y a los alimentos a restringir. Suelen dar pautas, ejemplos de menús diarios y representaciones gráficas. En general, se constata una tendencia hacia la mejoría en la adecuación nutricional, pero todavía con bastante por acordar: modelo de gestión, tipo de supervisión, sostenibilidad y consumo de proximidad, así como los horarios.Conclusiones: Los aportes nutricionales realizados en el comedor escolar son importantes cualitativa y cuantitativamente. Además, el comedor debe cumplir funciones educativas y de equidad social. Aunque en todas las Comunidades Autónomas estas preocupaciones guían el desarrollo de la normativa espcífica, existe gran heterogeneidad en su concreción práctica. (AU)
Introduction: An appropriate diet in childhood is essential for suitable growth and development, but it is also essential for preventing the development of non-communicable diseases in later stages. The School stage is fundamental. A significant proportion of students in Spain make use of the school lunch. We review the current situation in Spain, as well as public policy on school lunch and a nationwide review of specific legislation on each Autonomous Community.Material and methods: National public policy and specific considerations in every Autonomous Community were reviewed. Only considerations on the composition of the school menu were considered.Results: There are relatively recent state regulations but on school lunch menus also specific to each Autonomous Community. In general, and within a certain heterogeneity, they refer to the distribution of the diet and foods to be restricted. They usually provide guidelines, examples of daily menus, and graphic representations. Regarding school menus, there is a trend towards improvement in nutritional adequacy, but there is still room to improve. There are certain aspects related to the best solutions yet to be elucidated: management model, type of supervision, sustainability and local consumption, as well as school lunch schedules.Conclusions: The nutritional contributions made in the school canteens are qualitatively and quantitatively important. In addition, it must fulfill educational and social equity functions. Although these concerns address specific recommendation in every Autonomous Community, there is huge heterogeneity on practical implementations. (AU)
Subject(s)
Humans , Child, Preschool , Child , Adolescent , School Feeding/classification , School Feeding/standards , Nutrition Programs , Spain , Menu Planning , Motor Activity , Pediatric ObesityABSTRACT
Los vómitos incoercibles, asociados o no a gastroenteritis aguda (GEA), son la principal causa de deshidratación en niños, siendo un motivo de consulta frecuente en Atención Primaria (AP). Los posibles efectos secundarios de los antieméticos han dado lugar a una reducción drástica en su uso en las últimas décadas. Desde hace varios años existe experiencia en el uso de ondansetrón con buenos resultados para el tratamiento de los vómitos de repetición asociados a GEA, fundamentalmente en las unidades de urgencia hospitalaria. Su uso en Atención Primaria es mucho más limitado y no se dispone del fármaco en los botiquines de los centros de salud de la mayoría de las comunidades autónomas. El objetivo de esta revisión es analizar la efectividad para esta indicación y los efectos secundarios de ondansetrón y valorar la pertinencia de su uso en Atención Primaria (AU)
Incoercible vomiting associated with acute gastroenteritis (AGE) is the main cause of dehydration in children, being a frequent reason for consultation in primary care. The side effects of antemetics have led to a drastic reduction in their use in recent decades. For several years there has been experience in the use of ondansetron with good results for the treatment of repeated vomiting associated with AGE, mainly in hospital emergency units. Its use in primary care is much more limited and the drug is not available as emergency medication in the majority of the Spanish Primary Care Centers. The objective of this review is to analyze the effectiveness and side effects of ondansetron and assess the relevance of its use in primary care. (AU)
Subject(s)
Humans , Ondansetron/administration & dosage , Antiemetics/administration & dosage , Gastroenteritis/complications , Vomiting/prevention & control , Dehydration/prevention & control , Practice Guidelines as Topic , Ondansetron/adverse effects , Acute Disease , ConsensusABSTRACT
Se define la hipertransaminasemia (HTRA) como la elevación del nivel sérico de una o las dos principales transaminasas, enzimas intracelulares presentes en hepatocitos y otras células, por encima del límite superior de normalidad de una muestra sana y representativa de la población estudiada. Hay una considerable variabilidad biológica, por lo que la determinación de sus límites de normalidad es difícil. Tras revisión de los datos publicados, recomendamos los siguientes: GPT o ALT: >60 U/l en niños y >55 U/l en niñas, para menores de 18 meses, y >40 U/l en chicos y >35 U/l en chicas, para los mayores de 18 meses.GOT o AST: >65 U/l para menores de un año, >55 U/l de 1 a 4 años, >50 U/l de 5 a 8 años y >40 U/l de 9 a 18 años. La HTRA puede revelar una multitud de causas, hepáticas y extrahepáticas, algunas de especial gravedad. Debe considerarse como marcador potencial de patología y ser interpretada en el contexto clínico del paciente. Debe hacerse una búsqueda etiológica activa y de forma escalonada, teniendo en cuenta la edad y las causas más frecuentes. La presencia de datos de alarma implicará la derivación urgente hospitalaria al pediatra gastroenterólogo-hepatólogo. El contexto clínico del paciente es relevante para determinar la prioridad del estudio escalonado y la frecuencia de realización de los controles analíticos. Se diferencian pruebas de primer, segundo y tercer nivel. Su lugar inicial de valoración será en Atención Primaria. Cuando existan datos de alarma, sea persistente e inexplicada, o la patología hallada así lo requiera, el estudio posterior y seguimiento se completará en Atención Especializada (AU)
Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Adolescent , Transaminases/blood , Metabolic Diseases/etiology , Metabolic Diseases/therapy , Follow-Up Studies , Reference Values , Risk FactorsABSTRACT
No disponible
Subject(s)
Humans , Child , Consensus Development Conferences as Topic , Societies, Medical/standards , Breast-Milk Substitutes , Milk Hypersensitivity/immunology , Immunoglobulin E , Hypersensitivity, Immediate/immunology , Enterocolitis/immunology , Proctocolitis/immunology , AlgorithmsABSTRACT
Non-IgE-mediated cow's milk allergy is a frequent disorder in paediatrics. As patients might be seen by professionals from different specialties and levels of expertise, a great variability in diagnostic procedures and disease monitoring is commonly observed. Therefore, four scientific societies involved in its management have developed a consensus document providing specific recommendations related to its prevention, diagnosis, treatment and follow up.
Subject(s)
Milk Hypersensitivity/therapy , Milk Proteins/immunology , Pediatrics , Child , Humans , Milk Hypersensitivity/diagnosis , Milk Hypersensitivity/prevention & control , SpainABSTRACT
INTRODUCTION: the recent economic and financial crisis has affected most Western countries, especially families of low socioeconomic classes. We speculate that worsening of socioeconomic condition associated with the crisis would increase obesity, mainly in disadvantaged families. MATERIAL AND METHODS: cross-sectional study of the 290,111 children aged three to 12 years old attending public school during the term 2014-2015 in Madrid City, by means of a stratified weighted sample randomly chosen, taking into account age (grade), city district and schools. The questionnaire included weight and height (auto-reported), dietary report (weekly frequency of intake), as well as socioeconomic variables. RESULTS: 1,208 questionnaires were evaluated from 64 classes. Half of participants were boys; 42% were younger than five years old, 35% werebetween six and eight years old, and 23% older than eight. Undernutrition was present in 5.0%, and excess of weight (overweight + obesity) in 36.7%. Undernutrition was higher in children under the age of six (9.1%). No relationship was found between undernutrition and the characteristics of the families but was slightly higher in families where both parents were unemployed. Excess of weight was higher in children of non-Spaniard parents (44% vs 32%, p < 0.0001), as well as in those families with economic problems (41% vs 31%, p = 0.0005). Only for meat, grains and dairy, the weekly intake was close to the recommendations. CONCLUSIONS: children from lower income households were at a higher risk of being overweight compared with their peers. Participation in a school-based food aid program may reduce food insecurity for children and their families.
Subject(s)
Economic Recession/statistics & numerical data , Feeding Behavior/psychology , Nutritional Status , Child , Child Nutritional Physiological Phenomena , Child, Preschool , Cross-Sectional Studies , Female , Humans , Male , Obesity/epidemiology , Overweight/epidemiology , Poverty , Spain/epidemiology , Surveys and Questionnaires , Urban PopulationABSTRACT
Introduction: the recent economic and financial crisis has affected most Western countries, especially families of low socioeconomic classes. We speculate that worsening of socioeconomic condition associated with the crisis would increase obesity, mainly in disadvantaged families. Material and methods: cross-sectional study of the 290,111 children aged three to 12 years old attending public school during the term 2014-2015 in Madrid City, by means of a stratified weighted sample randomly chosen, taking into account age (grade), city district and schools. The questionnaire included weight and height (auto-reported), dietary report (weekly frequency of intake), as well as socioeconomic variables. Results: 1,208 questionnaires were evaluated from 64 classes. Half of participants were boys; 42% were younger than five years old, 35% were between six and eight years old, and 23% older than eight. Undernutrition was present in 5.0%, and excess of weight (overweight + obesity) in 36.7%. Undernutrition was higher in children under the age of six (9.1%). No relationship was found between undernutrition and the characteristics of the families but was slightly higher in families where both parents were unemployed. Excess of weight was higher in children of non-Spaniard parents (44% vs 32%, p < 0.0001), as well as in those families with economic problems (41% vs 31%, p = 0.0005). Only for meat, grains and dairy, the weekly intake was close to the recommendations. Conclusions: children from lower income households were at a higher risk of being overweight compared with their peers. Participation in a school-based food aid program may reduce food insecurity for children and their families
Introducción: la reciente crisis económica y financiera que ha afectado a los países occidentales ha sido especialmente más intensa en las familias con menos recursos económicos. Nos preguntamos si el empeoramiento de la situación económica se ha asociado a un aumento en la tasa de obesidad infantil. Material y métodos: estudio transversal de una muestra ponderada que representase a los 290.111 niños de tres a 12 años matriculados en las escuelas públicas de Madrid en el curso 2014-2015. Se utilizó un cuestionario que incluía peso y talla (autorreportados), ingesta dietética (frecuencia semanal de consumo) y variables socioeconómicas. Resultados: se evaluaron 1.208 cuestionarios de 64 clases, repartidos por igual entre niños y niñas. El 42% eran menores de cinco años, el 35% tenía entre seis y ocho años, y el 23% eran mayores de ocho años. Se presentó desnutrición en el 5,0% de la muestra, mientras que se halló exceso de peso (sobrepeso + obesidad) en el 36,7%. El bajo peso fue mayor en los niños < 6 años (9,1%), sin diferencias entre sexos. No se pudo encontrar ninguna correlación entre la desnutrición y las características de las familias, aunque fue ligeramente superior cuando ambos padres estaban en el paro. El exceso de peso fue mayor en hijos de padres no españoles (42% vs. 32%, p < 0,0001), así como en las familias con dificultades económicas (41% vs. 31%, p = 0,0005). La ingesta media semanal correcta solo se encontró en carne, cereales y lácteos. Conclusiones: los niños de familias con un nivel socioeconómico bajo tienen mayor riesgo de padecer un exceso de peso. La participación en comedores escolares podría disminuir la inseguridad alimentaria, especialmente en tiempos de dificultades económicas
Subject(s)
Humans , Male , Female , Child, Preschool , Child , Economic Recession/statistics & numerical data , Feeding Behavior/psychology , Nutritional Status , Child Nutritional Physiological Phenomena , Cross-Sectional Studies , Obesity/epidemiology , Overweight/epidemiology , Poverty , Spain/epidemiology , Surveys and Questionnaires , Urban PopulationABSTRACT
En esta ponencia se exponen las novedades más relevantes en Gastroenterología y Nutrición Pediátrica acaecidas principalmente durante 2017. Dentro del campo tan amplio que comprende esta especialidad, los avances y novedades han sido múltiples, pero hemos creído conveniente centrarnos en aquellos temas de mayor relevancia y frecuencia para el pediatra de Atención Primaria, habiendo seleccionado cuatro apartados: trastornos digestivos funcionales, indicaciones pediátricas de los probióticos, enfermedad celíaca y alimentación complementaria
In this paper the most important progress in Pediatric Gastroenterology and Nutrition occurred mainly during 2017 are presented. Within the field that includes this specialty, the advances and developments have been many, but we thought to focus on those issues of greater relevance and frequency for the primary care paediatrician. Four sections have been selected: Functional gastrointestinal disorders, pediatric indications of probiotics, celiac disease and complementary feeding
