Early decision of gastrostomy tube insertion in children with severe developmental disability: a current dilemma.

BACKGROUND: Healthcare professionals advise earlier gastrostomy tube (GT) placement in children with severe developmental disabilities, marked feeding disorders and risk of malnutrition. However, a delay in acceptance of the procedure by parents/guardians is the main issue of concern. The present study aimed to investigate: (i) parental satisfaction with GT feeding and whether parents/carers would have accepted earlier GT placement and (ii) subsequent nutritional outcome. METHODS: Twenty-six disabled children with GT feeding were recruited. A structured questionnaire by telephone was held to record parental perceptions of GT (mainly satisfaction with the procedure and patient management). A longitudinal study (0-6-12 months) was designed to investigate anthropometric outcome. Nutritional support mode and GT-related complications were also recorded. RESULTS: Parents/carers showed high satisfaction (91%). Furthermore, 87% recognised that they would have accepted an earlier placement of the GT had they anticipated the outcome. Patient management and family dynamics were acknowledged to have improved considerably. Nutritional assessment demonstrated a positive trend in weight. Height improved significantly 6 months post-implantation (P = 0.045) and body mass index improved after 12 months (P = 0.041). When comparing nutritional outcome between children in whom the GT was placed before 18 months of age and those in whom it was placed later, height was found to improve significantly in the first group (P = 0.04). CONCLUSIONS: Most parents/carers would have agreed to earlier GT feeding of their children had they acknowledged its benefits. Although nutritional response was positive, it was less so than the parental perception of children's overall improvement. Growth rates were significantly increased when GT was placed early in life.

[Solid ovarian tumors in childhood]. / Tumores sólidos de ovario en la infancia.

We evaluate our experience in solid ovarian tumors at the Children's Hospital La Fe. The main aims of the study were finding out relevant clinical data for a correct clinical approach, and the optimal surgical attitude in order to obtain tumor relieving with preservation of fertility when possible. A review of 28 girls under 14 years with solid ovarian tumors was carried out. Previous history, initial symptoms and signs, analytical and radiological explorations, treatment and evolution were analysed. 17 benign and 11 malignant tumors were found. Main clinical data were acute abdominal pain and palpation of a mass. Surgery was performed in all of them: salpyngo-oophorectomy in 23 and oophorectomy in 5, with tumoral resection. All patients survive, with periodic follow-up. We remark the frequency of acute abdominal pain as initial symptom of an ovarian tumor, and the importance of a surgical attitude that, intending to be curative, would preserve fertility.

[Our experience in portal cavernomatosis in childhood: cross-sectional study and analysis of results]. / Nuestra experiencia en cavernomatosis portal en la infancia: estudio transversal y análisis de resultados.

A retrospective and transversal study of our patients with portal cavernomatosis is developed, with the aim of comparing the evolution and the present status of the patients that have undergone different therapeutical approaches. Between 1975 and 1995, 15 patients with portal cavernomatosis have been treated. Personal history, signs and symptoms at the moment of diagnosis, and treatment were analyzed. Now, the controls have been made by physical examination and ECO-Doppler of the espleno-portal system. In 6 cases the absence of bleeding made surgery unnecessary. In the 9 patients with digestive haemorrhage, it could be controlled pharmacologically, with a later surgical approach. Now, all non-operated and 6 operated patients show splenomegaly, without bleeding. The ECO-Doppler shows colateral flow, the splenomegaly in the non-operated and the surgical shunts and the hepatofugal circulation in the operated patients. Looking at our results, we believe that prophylactic surgery is not indicated. In those cases of digestive bleeding, surgery after the complete resolution of the acute disease shows good results at a short and long term.

[Pancreatitis and pancreatic pseudocysts in children: a 12-year review]. / Pancreatitis y pseudoquistes pancreáticos en la infancia: revisión en 12 años.

Pancreatitis in children is uncommon, but can be associated with severe morbidity rates. Eleven patients (14 months to 9.5 years of age) with acute pancreatitis and one patient with chronic idiopathic pancreatitis beginning the second year of life, were treated over a 11-year period. Half of them had history of blunt abdominal trauma. The most frequent clinical presentations included abdominal pain and vomiting. Diagnosis of pancreatic injury was suggested by hypera-amylasemia, being the computerized tomography scan the most useful radiologic investigation. Medical treatment consisted of intravenous fluids, nasogastric suction and total parenteral nutrition. One third of the patients developed pancreatic pseudocysts (4); spontaneous resolution after observation and conservative therapy occurred in two and the others were treated by surgery. Ranson and Imrie scores can help predicting the severity of this disease in children; three of four pancreatic pseudocysts were judged to have severe pancreatitis by this criteria.