Weaning children from prolonged enteral nutrition: A position paper.

Enteral nutrition (EN) allows adequate nutritional intake in children for whom oral intake is impossible, insufficient or unsafe. With maturation and health improvements, most children ameliorate oral skills and become able to eat orally, therefore weaning from EN becomes a therapeutic goal. No recommendations currently exist on tube weaning, and practices vary widely between centres. With this report, the French Network of Rare Digestive Diseases (FIMATHO) and the French-Speaking Group of Paediatric Hepatology, Gastroenterology and Nutrition (GFHGNP) aim to develop uniform clinical practice recommendations for weaning children from EN. A multidisciplinary working group (WG) encompassing paediatricians, paediatric gastroenterologists, speech-language therapists, psychologists, dietitians and occupational therapists, was formed in June 2018. A systematic literature search was performed on those published from January 1, 1998, to April 30, 2020, using MEDLINE. After several rounds of e-discussions, relevant items for paediatric tube weaning were identified, and recommendations were developed, discussed and finalized. The WG members voted on each recommendation using a nominal voting technique. Expert opinion was applied to support the recommendations where no high-quality studies were available.

Successful clinical treatment of child stroke using mechanical embolectomy.

BACKGROUND: Stroke in childhood is less common than stroke in adults, but recent study estimate incidences up to 13/100,000. Mortality is decreasing but morbidity remains very high, with variable effects for two thirds of patients. Recent guidelines for optimal treatment in childhood stroke recommend advise against the use of thrombolysis, except for specific research protocols. There is no recommendation about intra-arterial thrombolysis or mechanical embolectomy. Various investigators have published cases of mechanical embolectomy in adult stroke, and a few cases of children are also reported. PATIENT: We report a case of mechanical embolectomy 6 hours after a basilar artery occlusion in a healthy 7-year-old child. RESULT: He presented a successful medical outcome and had made a complete recovery. CONCLUSION: This patient and the 10 published pediatric cases suggest mechanical embolectomy can be successfully used to treat basilar artery occlusion in children with coordination of neurology and interventional radiology services.