ABSTRACT
Complementary feeding (CF) is defined as the feeding of infants that complements breastfeeding, or alternatively, feeding with a breast milk substitute, and is a process that is more than simply a guide as to what and how to introduce foods. The information provided by healthcare professionals must be up-to-date and evidence-based. Most of the recommendations that appear in the different international guidelines and position papers are widely applicable, but some must be regionalized or adapted to fit the conditions and reality of each geographic zone. The Nutrition Working Group of the Latin American Society for Pediatric Gastroenterology, Hepatology and Nutrition (LASPGHAN) summoned a group of experts from each of the society's member countries, to develop a consensus on CF, incorporating, whenever possible, local information adapted to the reality of the region. The aim of the present document is to show the results of that endeavor. Utilizing the Delphi method, a total of 34 statements on relevant aspects of CF were evaluated, discussed, and voted upon.
Subject(s)
Gastroenterology , Infant , Child , Female , Humans , Cocos , Consensus , Latin America , Infant Nutritional Physiological PhenomenaABSTRACT
No disponible
Subject(s)
Humans , Child Nutrition , Epigenesis, Genetic , Epigenomics , DNA Methylation/genetics , Histones/physiology , Nucleosomes/physiology , RNA Interference/physiologyABSTRACT
No disponible
Subject(s)
Humans , Infant , Cysts/metabolism , Cysts/pathology , Gastrointestinal Hemorrhage/blood , Fever/diagnosis , Ultrasonography/methods , Cysts/complications , Cysts/diagnosis , Gastrointestinal Hemorrhage/complications , Fever/complications , Ultrasonography/instrumentationABSTRACT
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.
Subject(s)
Enteral Nutrition/statistics & numerical data , Registries , White People , Child , Child Nutritional Physiological Phenomena , Child, Preschool , Enteral Nutrition/trends , Female , Gastrostomy , Hospitals , Humans , Infant , Internet , Intubation, Gastrointestinal , Male , Nervous System Diseases/diet therapy , Parenteral Nutrition, Home , Patient Discharge , Prospective Studies , SpainABSTRACT
BACKGROUND AND OBJECTIVE: Acquired methemoglobinemia (MHb) induced in infants by intake of vegetables is a condition uncommonly reported in the literature. The purpose of the present study was to study new vegetables involved and other epidemiological risk factors. METHODS: Seventy-eight cases of diet-induced MHb seen in Pamplona from 1987 to 2010 are reported. Infant characteristics were collected, and a case-control study was conducted using as controls 78 age- and sex-matched infants selected at the same geographic area. Bivariate logistic regression analyses were performed to detect factors involved in MHb occurrence. Nitrate levels were tested in natural vegetables used to prepare purées. RESULTS: A clear relation was found between MHb and use of borage (Borago officinalis) (OR 5.2; 95% CI 1.1-24.6) and maybe chard (Beta vulgaris var cicla) (OR 2.0; 95% CI 0.4-8.7), time from preparation to use (OR 17.4, 95% CI 3.5-86.3 if the purée had been prepared 24-48 hours before and OR 24.9, 95% CI 3.3-187.6 if prepared >48 hours before), and breast-feeding (OR 10.4; 95% CI 1.9-57.2). Tests confirmed that vegetables with the highest nitrate levels were borage (n = 15), with mean nitrate levels of 3968 mg/kg, and chard (n = 17), with mean levels of 2811 mg/kg. CONCLUSIONS: The main associated factors were shown to be time from purée preparation to use (>24 hours), use of certain vegetables (borage and chard), and breast-feeding. Nitrate levels in both vegetables implicated as etiological factors in acquired MHb are high.
Subject(s)
Beta vulgaris/adverse effects , Borago/adverse effects , Diet/adverse effects , Methemoglobinemia/etiology , Nitrates/adverse effects , Vegetables/adverse effects , Beta vulgaris/chemistry , Borago/chemistry , Breast Feeding , Case-Control Studies , Child, Preschool , Female , Humans , Infant , Logistic Models , Male , Nitrates/analysis , Risk Factors , Spain , Vegetables/chemistryABSTRACT
BACKGROUND: The incidence of IgE-mediated cow's milk allergy (CMA) has increased over the last few years. There are several genetic and environmental risk factors that may be related to this allergy and the subsequent allergic march (AM). METHODS: A prospective, cohort study was conducted in patients recruited into the study between 1998 and 2002. Information on clinical variables and complementary tests, perinatal and obstetric factors and the type of hydrolysed formula used was recorded. A cross sectional study on the prevalence of allergic diseases in this cohort was performed in 2004. RESULTS: We compared IgE-mediated CMA patients with non-IgE-mediated CMA patients and found that IgE-mediated CMA is associated with caesarean delivery (OR = 2.14 95% CI: 1.02-4.49), duration of breast feeding (>2 months, OR = 4.14; 95% CI: 2.17-7.89) and the use of supplementary artificial formula whilst breast feeding (OR = 2.86; 95% CI: 1.33-6.13). The factors associated with AM in IgE-mediated CMA patients were caesarean delivery (OR = 0.42; 95% CI: 0.19-0.92) and the use of more extensively hydrolysed high grade hydrolysates (+EH/HGH) (OR = 0.44; 95% CI: 0.20-0.98), both as protective factors. CONCLUSIONS: Caesarean delivery is demonstrated as being a risk factor for IgE-mediated CMA, but it does not increase the risk of AM in these infants. The use of +EH/HGH appears to protect IgE-mediated CMA patients from eventually developing AM.
Subject(s)
Cesarean Section/adverse effects , Hypersensitivity/etiology , Milk Hypersensitivity/etiology , Breast Feeding , Cohort Studies , Cross-Sectional Studies , Female , Humans , Immunoglobulin E/blood , Infant , Male , Multivariate Analysis , Pregnancy , Prospective StudiesABSTRACT
Rare diseases (RD) are receiving increasing attention within both the scientific community and society in general. Many RDs are diagnosed during paediatric age and affect the patient throughout his life, but they can also be diagnosed during adult age. Advances in the biochemical, molecular and genetic diagnosis of these diseases are proving essential in improving clinical understanding and therapeutic possibilities. However, their low prevalence makes it difficult to develop suitable medicines for treatment and it is necessary to implement specific social and health protection programs for these medicines, which are called orphan medicines (OM). In general these serious, chronic diseases involving a high degree of disability are difficult to diagnose. For better diagnosis and monitoring it is necessary to develop reference units at the state level that will improve our knowledge of these pathologies. RDs have a direct repercussion on both the family, which in many cases becomes the carer, and on society, which must develop specific social, health and educational programs to support these patients. In short, RDs form a significant challenge of coordination for the scientific community and for society given their significant specific weight in the development of health care in our setting.
Subject(s)
Rare Diseases , HumansABSTRACT
The DQ2 heterodimer, encoded by the human leukocyte antigen (HLA)-DQA1*05-DQB1*02 alleles, is the major genetic susceptibility factor for celiac disease (CD). However, the risk associated to HLA alleles varies among populations. While DRB1*03 is almost the only CD susceptibility allele in Northern Europe with a homozygote frequency of around 30%, CD in south European countries is also associated with the DRB1*07, and DRB1*03 homozygotes patients are rare. Some authors have suggested that DQB1*02-DRB1*03/DQB1*02-DRB1*03 and DQB1*02-DRB1*03/DQB1*02-DRB1*07 may confer different risk susceptibility to CD. This hypothesis, however, has not been demonstrated in a recent family-based study carried out in Finland, suggesting that the proposed differences in risk may be secondary to stratification burdens of case-control studies. To assess this issue, we have investigated the effect of different haplotypes carried trans to DQB1*02-DRB1*03 as additional factors for CD in Spain, using two statistical approaches, a case-control study and a family-based study. We found that DQB1*02-DRB1*03/DQB1*02-DRB1*03 and DQB1*02-DRB1*03/DQB1*02-DRB1*07 were the only combinations that showed a strong and independent association to CD. We did not observe any difference in susceptibility risk conferred by DQB1*02-DRB1*03 and DQB1*02-DRB1*07 when carried trans to DQB1*02-DRB1*03, suggesting that variation in HLA haplotype frequencies among populations may not represent real differences in risk to CD development. We also confirmed a gene dosage effect of the DQB1*02-DRB1*03 haplotype estimating that DQB1*02 homozygotes are at fivefold increased risk for CD compared with DQB1*02 heterozygotes. This risk is conferred by the second copy of the DQB1*02 allele and it seems to be independent of the DQA1.
Subject(s)
Celiac Disease/genetics , Celiac Disease/immunology , HLA Antigens/genetics , HLA-DQ Antigens/genetics , HLA-DR Antigens/genetics , Case-Control Studies , Female , Gene Dosage , Gene Frequency , Genetic Complementation Test , Genetic Predisposition to Disease , HLA-DQ beta-Chains , HLA-DRB1 Chains , Haplotypes , Heterozygote , Homozygote , Humans , Male , Risk Factors , SpainABSTRACT
Las Enfermedades Raras (ER) vienen siendo objetode atención cada vez mayor tanto dentro de la comunidadcientífica como en la sociedad en general. Muchasde ellas se diagnostican en la edad pediátrica y acompañanal paciente durante toda su vida, pero tambiénpueden ser diagnosticadas en la edad adulta.El avance en el diagnóstico bioquímico, moleculary genético de estas enfermedades está siendo fundamentalpara mejorar la comprensión clínica y las posibilidadesterapéuticas. Sin embargo, la baja prevalenciadificulta el desarrollo de medicamentos adecuadospara el tratamiento y se hace necesario la implementaciónde programas socio-sanitarios específicos de proteccióna estos medicamentos denominados medicamentoshuérfanos (MH).En general, se trata de enfermedades de difícildiagnóstico, graves, crónicas y con un alto grado deinvalidez. Para su mejor diagnóstico y seguimiento sehace necesario desarrollar unidades de referencia anivel estatal que mejoren nuestro conocimiento sobreestas patologías. Las ER repercuten de forma directa,tanto en la familia que se convierte en muchos casosen sus cuidadores como en la sociedad que tiene quedesarrollar programas socio-sanitarios y educativosespecíficos de apoyo a estos enfermos.En definitiva, las ER suponen un importante retode coordinación para la comunidad científica y para lasociedad dado su importante peso específico en eldesarrollo de la atención médica en nuestro medio
Rare diseases (RD) are receiving increasing attentionwithin both the scientific community and societyin general. Many RDs are diagnosed during paediatricage and affect the patient throughout his life, but theycan also be diagnosed during adult age.Advances in the biochemical, molecular and geneticdiagnosis of these diseases are proving essential inimproving clinical understanding and therapeutic possibilities.However, their low prevalence makes it difficultto develop suitable medicines for treatment and itis necessary to implement specific social and healthprotection programs for these medicines, which arecalled orphan medicines (OM).In general these serious, chronic diseases involvinga high degree of disability are difficult to diagnose.For better diagnosis and monitoring it is necessary todevelop reference units at the state level that willimprove our knowledge of these pathologies. RDs havea direct repercussion on both the family, which in manycases becomes the carer, and on society, which mustdevelop specific social, health and educational programsto support these patients.In short, RDs form a significant challenge of coordinationfor the scientific community and for societygiven their significant specific weight in the developmentof health care in our setting
Subject(s)
History, 21st Century , Humans , Male , Female , Adult , Child , Rare Diseases/epidemiology , Rare Diseases/history , Rare Diseases/drug therapy , Orphan Drug Production/methods , Quality of Life , Rare Diseases/diagnosis , Rare Diseases/etiology , Social Responsibility , Public Health/history , Public Health/methodsABSTRACT
La nutrición enteral ha demostrado su eficacia como tratamiento para inducir la remisión de la enfermedad de Crohn en pediatría. Se ha sugerido diversos mecanismos implicados en esta respuesta, como el reposo intestinal, la disminución del contacto con antígenos, la modulación de la flora intestinal y la modificación de la respuesta inflamatoria a través de la nutrición enteral. Además, existe una interrelación clara entre estos factores inflamatorios y diversas hormonas relacionadas con el crecimiento que, en la edad pediátrica, son muy importantes y hacen que el retraso en dico crecimiento sea uno de los problemas más importantes en la enfermedad de Crohn. Las dietas utilizadas con este fin son: elementales, oligopeptídicas y poliméricas. El paciente pediátrico con esta enfermedad ideal para recibir este tratamiento como primera alternativa es aquel con: brote leve-moderado, afectación del íleon terminal y colon ascendente, afectación nutricional, retraso puberal y/o de crecimiento, ausencia de enfermedad perianal y rechazo a la toma de corticoides
Enteral nutrition (EN) is an effective treatment to induce clinical remission in pediatrics Crohn Disease (CD). Several mechanisms can be involve inthis response: gut rest, antigen decrease contact in the intestine brush border, intestinal floar modulation, and most recently the decrease of inflammatory factors have been involved with several important growth hormones related to growth in childhood. In fact, puberal and growth delay are the most important problems in CD. We can use several diets in CD: elemental, oligopetidique and polymeric. The ideal conditions to indicate EN in Pediatrics CD are: slight-moderate outbreak, ileon and right large intestine affectation, nutritional damage, puberal and/or growth delay, absence of perianal illness and when the corticoid treatment is rejected
Subject(s)
Male , Female , Child , Humans , Inflammatory Bowel Diseases/diet therapy , Inflammatory Bowel Diseases/diagnosis , Enteral Nutrition , Crohn Disease/diet therapy , Diet , Growth Disorders/complications , Glutamine/therapeutic use , Infant Nutritional Physiological Phenomena/physiology , Inflammatory Bowel Diseases/epidemiology , Inflammatory Bowel Diseases/therapy , Enteral Nutrition/methods , Enteral Nutrition/trendsABSTRACT
No disponible
Subject(s)
Humans , Metabolism, Inborn Errors/diet therapy , Metabolism, Inborn Errors/metabolism , Clinical ProtocolsABSTRACT
No disponibe (AU)
Subject(s)
Adolescent , Adult , Female , Male , Child , Humans , Metabolism, Inborn Errors/diet therapy , Metabolism, Inborn Errors/diagnosis , Metabolism, Inborn Errors/epidemiology , Tyrosine/metabolism , Thiazoles/therapeutic use , Phenylalanine/therapeutic use , Fat Soluble Vitamins/therapeutic use , Calcium/therapeutic use , Phosphorus/therapeutic use , Calcitriol/therapeutic use , Homocystinuria/complications , Homocystinuria/diagnosis , Homocystinuria/therapy , Enzyme Activation , Methionine/metabolism , Infant Nutritional Physiological Phenomena/educationABSTRACT
El tratamiento nutricional de los errores innatos del metabolismo (EIM) constituye en la actualidad el pilar más importante en el manejo global de estas enfermedades. Nuestra intervención dietética no sólo debe intentar asegurar un adecuado crecimiento y desarrollo del niño sino que, al mismo tiempo, tenemos que programar un enfoque nutricional específico según el defecto metabólico del que se trate. En este artículo (segundo de cinco partes) y el siguiente abordamos los aspectos diatéticos y nutricionales de algunos de los trastornos más frecuentes que afectan el metabolismo de los aminoácidos (AU)
Subject(s)
Female , Child, Preschool , Infant , Male , Humans , Metabolism, Inborn Errors/diagnosis , Metabolism, Inborn Errors/diet therapy , Metabolism, Inborn Errors/epidemiology , Diet/methods , Amino Acids/metabolism , Phenylalanine/administration & dosage , Phenylalanine/therapeutic use , Thyroxine/administration & dosage , Thyroxine/therapeutic use , Child Nutritional Physiological Phenomena , Nutritional Physiological Phenomena/education , Bottle Feeding , Phenylketonuria, Maternal/diagnosis , Phenylketonuria, Maternal/epidemiology , Phenylketonuria, Maternal/diet therapy , Phenylketonurias/diagnosis , Phenylketonurias/diet therapyABSTRACT
Se revisa la situación de la lactancia materna en nuestra comunidad en el intervalo comprendido entre 1986 y 1993. Para ello se estudian dos grupos de neonatos navarros totalmente comparables entre sí, que proceden de nuestra principal maternidad. Se comparan las cifras de prevalencia de los diversos tipos de lactancia en el momento del alta de maternidad y de modo mensual hasta el sexto mes de vida. Del presente trabajo pueden extraerse las siguientes conclusiones: 1. La categoría de lactancia materna vigente en Navarra es el tipo I de la OMS.2. La lactancia materna se sigue abandonando de modo precoz y masivo a lo largo del primer semestre de vida en Navarra siendo sus cifras indetectables al sexto mes.3. Apenas existen diferencias significativas entre las cifras del año 1986 y 1993 (AU)
Subject(s)
Pregnancy , Female , Infant , Humans , Infant, Newborn , Breast Feeding/statistics & numerical data , Hospitals, Maternity/statistics & numerical data , Spain/epidemiology , Prevalence , Mother-Child Relations , Infant CareABSTRACT
The state of breast-feeding in our autonomous community between 1986 and 1993 is reviewed. Two comparable Navarrese neonatal groups from our main maternity hospital are studied. The prevalence of the different types of breast-feeding at the time of discharge from the maternity hospital is compared, as well as monthly rates until the sixth month of life. The following conclusions can be drawn from this study: 1. The category of breast-feeding in Navarra is type 1 of the WHO. 2. Breast-feeding is abandoned in an early and massive way throughout the first six months of life in Navarra, with figures for this practice being undetectable by the sixth month. 3. There are barely any significant differences between the figures for 1986 and 1993.
ABSTRACT
No disponible
Subject(s)
Female , Infant , Male , Humans , Seizures, Febrile/etiology , Length of Stay/statistics & numerical data , Meningitis/complications , Urinary Tract Infections/complicationsABSTRACT
Heat shock proteins (HSP) are thought to play a role in the immune response making probable their contribution to celiac disease (CD). We studied the polymorphisms in the 5' regulatory region of the HSP70-1 gene and performed genomic HLA-DQ and -DR typing in 128 CD patients and 94 healthy controls from Navarra (Spain). The frequency of the C allele of the HSP70-1, characterized by the intermediate electrophoretic mobility of DNA, was significantly increased among CD patients (64.5% vs 37.2%. p <1 x 10(-7)). When subjects were stratified by the HLA II genotype, differences were statistically significant between DR3-negative or DR3-DQB1*02-negative CD patients and matched controls. Homozygosity for the DQB1*02 allele was present in 48.4% of CD patients and 12.8% of controls (OR = 6.4; CI:3.1 to 13.8; p <1 x 10(-7)). Similar increased risk was observed for DQB1*02/*02, DRB1*03/-, or DRB1*03/07 patients. Furthermore, those individuals expressing the classical HLA alleles in CD (DQB1*02/*02, DRB1*03/*07) who also carried the HSP70-1 CC genotype were twelve times more likely to develop the disease than the matched controls. We therefore conclude that although HSP70-1 gene does not seem to be primarily associated with CD, it might be a component of the high risk haplotype, playing a role as an additional predisposing gene for the disease.
