Situación nutricional y acciones implementadas en niños internados en salas de cuidados intermedios y moderados de un hospital pediátrico de alta complejidad de la ciudad de Buenos Aires / Nutritional status and actions implemented in children admitted to intermediate and moderate care wards of a tertiary-care pediatric hospital in the city of Buenos Aires

Introducción: La malnutrición es un estado de deficiencia o exceso de nutrientes que provoca efectos nocivos y puede alterar el crecimiento aumentando la morbi-mortalidad. Materiales y métodos: estudio retrospectivo, descriptivo. Incluyó niños/as de 1-18 años hospitalizados entre 2016-2018. Se obtuvieron datos de caracterización de la muestra y antropométricos. La herramienta de tamizaje nutricional pediátrico (HTNP) se utilizó para detectar riesgo nutricional y en este subgrupo se analizó: variación de peso, intervención nutricional, complicaciones infecciosas y estadía hospitalaria. El análisis de variables se realizó con SPSS Statistics 20. Resultados: Se evaluaron 745 pacientes, 373 niñas (50,1%). Mediana de edad 7,3 años. Estancia hospitalaria media de 4 días (1-123). Se observó 5,9% emaciados, 56,4% eutróficos, 16,8% sobrepeso y 20,9% obesidad. Con baja talla 13%. Se detectó riesgo nutricional con HTNP en 50,7% de los ingresos. Las patologías de base más frecuentes fueron cardiopatías y neoplasias. En pacientes con riesgo nutricional: estadía hospitalaria media de 5 días, 13,5% cursó con infecciones intrahospitalarias, 68% mantuvo o aumentó de peso durante la internación, 13,5% requirió apoyo nutricional (más utilizado el gavage en 59%). Conclusiones: El niño hospitalizado se encuentra en una situación de vulnerabilidad, por lo que el tamizaje y evaluación nutricional resultan acciones claves para prevenir el deterioro nutricional. En los niños con malnutrición las acciones llevadas a cabo por el Nutricionista Clínico como integrante del equipo de atención, revisten un rol clave para promover y garantizar el derecho de los pacientes a la alimentación adecuada y así mejorar su condición nutricional. (AU)

Introduction: Malnutrition is a state of nutrient deficiency or excess that causes harmful effects and can alter growth increasing morbidity and mortality. Materials and methods: retrospective, descriptive study. Children aged 1-18 years admitted to the hospital between 2016-2018 were included. Sample characterization and anthropometric data were collected. The pediatric nutritional screening tool (PNST) was used to identify nutritional risk and in this subgroup we analyzed: weight variation, nutritional intervention, infectious complications, and length of hospital stay. The analysis of variables was performed with SPSS Statistics 20. Results: 745 patients were evaluated, 373 were girls (50.1%). Median age was 7.3 years. Mean hospital stay was 4 days (1- 123). Among the patients, 5.9% were emaciated, 56.4% eutrophic, 16.8% overweight, and 20.9% obese. Thirteen percent of the patients had short stature. Nutritional risk was detected using HTNP in 50.7% of the admitted patients. The most frequent underlying diseases were heart disease and cancer. In patients at nutritional risk: mean hospital stay was 5 days, 13.5% had hospital-acquired infections, 68% maintained or gained weight during the hospital stay, 13.5% required nutritional support (gavage was the most frequently used in 59%). Conclusions: Hospitalized children are in a vulnerable situation, therefore nutritional screening and evaluation are key actions to prevent nutritional deterioration. In children with malnutrition, the Clinical Nutritionist, as a member of the health care team, plays a key role in promoting and guaranteeing the right of patients to adequate food and thus improve their nutritional condition (AU)

Nutrition gap in children, urban-rural: the key education and food. Colombia, 2015.

OBJECTIVE: To analyze the nutritional situation of children under five years old from both urban and rural areas of Colombia. METHOD: Analytical study, based on cross-sectional data, collected from ENSIN-2015. The sample consisted of 12,256 children aged between 0 and 4 years old. We calculated the prevalence ratios (PR) with their respective 95% confidence interval (95%CI). PR were assessed by binomial regression models with malnutrition or overweight as the dependent variable and geographic area as the explanatory variable. We used context variables to adjust the estimated PR and control the confounder within. RESULTS: Acute malnutrition (weight-for-height) had a prevalence of 1.6%, while overweight had a 5.6% rate. No differences per geographic zone in the weight-for-height indicator were found. Stunted growth - chronic malnutrition - was higher in the rural area (PR = 1.2; 95%CI 1-1.53; p = 0.050). Prevalences adjusted by variables related to structural, social and economic developement showed that both the household chief's educational level and the food insecurity of the area account for malnutrition. CONCLUSION: The height-for-age indicator works better to establish development level. Measures against coverage, relevance and quality of education and access to food can harm the nutritional status of the children.

Tamizaje de riesgo nutricional en el niño hospitalizado: validación de una herramienta elaborada en un hospital de alta complejidad de Ciudad de Buenos Aires / Nutritional risk screening in hospitalized children: validation of a tool developed at a tertiary hospital in the City of Buenos Aires

Introducción: El niño hospitalizado se encuentra en estado de vulnerabilidad nutricional. El tamizaje nutricional permite identificar malnutrición y/o el riesgo de desarrollarla, para realizar un abordaje precoz. El Área de Alimentación del Hospital Garrahan desarrolló la "Herramienta de Tamizaje Nutricional Pediátrico" (HTNP), dada la falta de consenso sobre un estándar de oro y para ajustar criterios a la población asistida. El objetivo de esta investigación fue su validación para niños en cuidados intermedios/ moderados. Métodos: estudio prospectivo, descriptivo y transversal. Entre agosto de 2016 y abril de 2018 se reclutaron niños de 1 a 18 años internados en salas de cuidados intermedios/moderados seleccionadas, que cumplieran los criterios de inclusión. Se aplicaron: la HTNP y la valoración nutricional global subjetiva (VNGS) como prueba de comparación. La HTNP consta de tres criterios: Patología de base y motivo de internación- Disminución de peso- Deterioro de la actitud alimentaria. Se define riesgo nutricional si se cumple con dos criterios. Se analizaron: Sensibilidad, especificidad, valor predictivo positivo (VPP) y valor predictivo negativo (VPN), factibilidad y reproducibilidad. Resultados: Se evaluaron 745 niños (50,1% sexo femenino; mediana de edad: 7,2 años). La HTNP detectó riesgo nutricional en 50,7% (n378) de los niños y la VNGS en 48,7% (n363). La HTNP presentó: Sensibilidad 87,3% (IC95% 83,8-90,9), Especificidad 84,0% (IC95% 80,2-87,8), VPP 83,9% (IC95%: 80,0­87,7) y VPN 87,5% (IC95%: 83,9-91,0). Del análisis de reproducibilidad con dos evaluadores independientes (n42) se obtuvo coeficiente kappa de 0,91 (0,74-1,0) y 0,78 (0,5-1,0) respectivamente. Su implementación llevo un promedio de tres minutos y medio (1-5 minutos). Conclusión: La HTNP es un instrumento simple, reproducible, práctico y factible de implementar para identificar pacientes en riesgo nutricional (AU)

Introduction: Hospitalized children are nutritionally vulnerable. Nutritional screening may identify malnutrition and/or the risk of developing malnutrition in order to start early intervention. The Food Services Area of Garrahan Hospital has developed a "Pediatric Nutritional Screening Tool (PNST) because of the lack of consensus on a gold standard and to finetune the criteria to the care population. The aim of this study was to validate the tool in children in intermediate/moderate care. Methods: A prospective, descriptive, cross-sectional study was conducted. Between August 2016 and April 2018 children from 1 to 18 years of age who met the inclusion criteria were enrolled on selected intermediate/ moderate care wards. The PNST was administered together with the Subjective Global Assessment (SGA) as a comparison test. The PNST consists of three criteria: Underlying disease and reason for admission- Weight loss- Deterioration of eating behavior. A patient was defined as being at nutritional risk was defined if two criteria were met. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV), feasibility, and reproducibility were analyzed. Results: 745 children (50.1% female; median age: 7.2 years) were assessed. The PNST detected nutritional risk in 50.7% (n378) and the SGA in 48,7% (n363) of the children. The PNST showed: Sensitivity 87.3% (95%CI: 83.8-90.9), specificity 84.0% (95%CI: 80.2-87.8), PPV 83.9% (95%CI: 80.0­87.7), and NPV 87.5% (95%CI: 83,9-91,0). In a reproducibility analysis with two independent evaluators (n42) kappa coefficients of 0.91 (0.74-1.0) and 0.78 (0.5-1.0) were obtained, respectively. Administration of the tool took a mean of 3.5 inutes (1-5 minutes). Conclusion: The PNST is a simple, reproducible, practical, and feasible tool to use for the identification of patients at nutritional risk (AU)

Assessment of nutritional status in children with cancer: A narrative review.

A child's appropriate development stems in large part from proper nutrition. Malnutrition is an adverse prognostic factor in children with cancer, and its prevalence is highly variable. Currently, there is no standardized definition and assessment method of nutritional status in pediatric oncology. A complete nutritional assessment includes anthropometry, biochemical, clinical, and dietary assessments. In this article, we explore these methods and suggest practical approaches for pediatric cancer units depending on the levels of care that these can provide. We also advise on the monitoring and follow-up of children with cancer during and after treatment, and discuss potential areas for future research.

Improved care and survival in severe malnutrition through eLearning.

BACKGROUND: Scaling up improved management of severe acute malnutrition (SAM) has been identified as the nutrition intervention with the greatest potential to reduce child mortality but it requires improved operational capacity. OBJECTIVE: To investigate whether an eLearning course, which can be used at scale in resource-poor countries, leads to improved diagnosis, clinical management and survival of children with SAM. DESIGN: A 2-year preintervention and postintervention study between January 2015 and February 2017. SETTING: Eleven healthcare facilities: nine in Ghana, one in Guatemala, and one in El Salvador. INTERVENTION: Scenario-based eLearning course 'Caring for infants and young children with severe malnutrition'. MAIN OUTCOME MEASURES: Identification of children with SAM, quality of care, case-fatality rate. METHODS: Medical record reviews of children aged 0-60 months attending eleven hospitals between August 2014 and July 2016, observations in paediatric wards, and interviews with senior hospital personnel. RESULTS: Postintervention there was a significant improvement in the identification of SAM: more children had the requisite anthropometric data (34.9% (1300/3723) vs 15.9% (629/3953)) and more were correctly diagnosed (58.5% (460/786) vs 47.1% (209/444)). Improvements were observed in almost all aspects of the WHO 'Ten Steps' of case-management, and case-fatality fell from 5.8% (26/449) to 1.9% (14/745) (Post-pre difference=-3.9%, 95% CI -6.6 to -1.7, p<0.001). CONCLUSIONS: High quality, interactive eLearning can be an effective intervention in scaling up capacity building of health professionals to manage SAM effectively, leading to a reduction in mortality.

Nutrition gap in children, urban-rural: the key education and food. Colombia, 2015 / Brecha nutricional en niños, urbano-rural: educación y alimentos, la clave. Colombia, 2015

ABSTRACT OBJECTIVE: To analyze the nutritional situation of children under five years old from both urban and rural areas of Colombia. METHOD: Analytical study, based on cross-sectional data, collected from ENSIN-2015. The sample consisted of 12,256 children aged between 0 and 4 years old. We calculated the prevalence ratios (PR) with their respective 95% confidence interval (95%CI). PR were assessed by binomial regression models with malnutrition or overweight as the dependent variable and geographic area as the explanatory variable. We used context variables to adjust the estimated PR and control the confounder within. RESULTS: Acute malnutrition (weight-for-height) had a prevalence of 1.6%, while overweight had a 5.6% rate. No differences per geographic zone in the weight-for-height indicator were found. Stunted growth - chronic malnutrition - was higher in the rural area (PR = 1.2; 95%CI 1-1.53; p = 0.050). Prevalences adjusted by variables related to structural, social and economic developement showed that both the household chief's educational level and the food insecurity of the area account for malnutrition. CONCLUSION: The height-for-age indicator works better to establish development level. Measures against coverage, relevance and quality of education and access to food can harm the nutritional status of the children.

RESUMEN OBJETIVO: Analizar el estado de nutrición en menores de cinco años de áreas urbanas y rurales en Colombia. MÉTODOS: Estudio analítico, con base en datos de corte transversal, recolectados por la ENSIN-2015. La muestra fue de 12.256 niños colombianos entre cero y cuatro años. Se calcularon razones de prevalencia (RP) y sus respectivos intervalos al 95% de confianza (IC95%). Las RP se obtuvieron de modelos de regresión binomial con el déficit o el exceso, como la variable dependiente y la zona geográfica como la principal explicación. Variables del contexto se utilizaron para ajustar las RP estimadas y limpiar el efecto confusor de éstas. RESULTADOS: La prevalencia de desnutrición aguda (peso/talla) fue de 1,6%, la de exceso de 5,6%. No existieron diferencias por zona geográfica, en el indicador (peso/talla). El retraso talla/edad - desnutrición crónica - fue mayor en la zona rural (RP = 1,2; IC95% 1,00-1,53; p = 0,050). Las prevalencias ajustadas por variables que dan cuenta del desarrollo estructural, social y económico, mostraron que la escolaridad del jefe y la inseguridad alimentaria del hogar explican la desnutrición. CONCLUSIONES: El indicador talla/edad es el mejor para establecer el nivel de desarrollo. Medidas contra la cobertura, pertinencia, calidad en la educación y el acceso a los alimentos impactarán negativamente el estado de nutrición en los niños.

Evaluación del estado nutricional de niños entre 2 y 13 años mediante antropometría según registros del Hospital Rural de Tomás Manuel de Anchorena de La Pampa en marzo 2018 / Evaluation of the nutritional status of children between 2 and 13 years old through anthropometry according to records of the Rural Hospital of Tomás Manuel de Anchorena of La Pampa province in March 2018

La evaluación nutricional tiende a promover la salud, sea reduciendo el riesgo o sea controlando los posibles efectos patológicos relacionados con una alimentación excesiva o insuficiente. Durante el mes de marzo de 2018, en el Hospital rural de Tomás Manuel de Anchorena, se llevó a cabo el control anual de salud en niños de 2 a 13 años. Para ello se utilizaron índices antropométricos que puedan relacionarse con estándares de normalidad según edad y sexo (peso/edad, talla/edad, peso/talla, índice de masa corporal) y se definieron los indicadores: desnutrición, bajo peso, acorde, sobrepeso y obesidad. Se examinaron 50 niños/as, residentes habituales, de 2 a 13 años de edad, con una distribución por sexo de 48% niñas y 52% niños. Se organizaron 3 grupos según edad, 2 a 6 años (28%), 6 a 11 años (54%) y 11 a 13 años (18%). Se obtuvo una prevalencia de desnutrición del 8%, 22% se encontraba acorde a su edad y sexo, sobrepeso 22%, y obesidad del 38%. Comparado con datos del Programa Nacional de Salud Escolar (PROSANE 2015), la prevalencia de obesidad en nuestro trabajo supera muy significativamente el valor provincial (17,9%) y nacional (21,4%). No pasa lo mismo con los demás indicadores (AU)

The nutritional evaluation tends to promote health, either by reducing the risk or by controlling the possible pathological effects related to excessive or insufficient feeding. During the month of March 2018, in the rural Hospital of Tomás Manuel de Anchorena, the annual health control was carried out on children aged 2 to 13. For this, anthropometric indices were used that can be related to normality standards according to age and sex (weight / age, height / age, weight / height, body mass index) and the indicators were defined: malnutrition, low weight, overweight and obesity. 50 children, habitual residents, from 2 to 13 years of age, with a gender distribution of 48% girls and 52% boys were examined. 3 groups were organized according to age, 2 to 6 years (28%), 6 to 11 years (54%) and 11 to 13 years (18%). There was a prevalence of malnutrition of 8%, 22% were according to their age and sex, overweight 22%, and obesity with 38%. Compared with data from the National School Health Program (PROSANE 2015), the prevalence of obesity in our work significantly exceeds the provincial (17.9%) and national (21.4%) values. The same does not happen with the other indicators (AU)

Extended composite index of anthropometric failure in Argentinean preschool and school children.

OBJECTIVE: The Composite Index of Anthropometric Failure (CIAF) can only be applied to children under 5 years of age and does not contemplate obesity. The aim of this study was to propose an Extended CIAF (ECIAF) that combines the characterization of malnutrition due to undernutrition and excess weight, and apply it in six Argentine provinces. DESIGN: ECIAF excludes children not in anthropometric failure (group A) and was calculated from a percentage of children included in malnutrition categories B: wasting only; C: wasting and underweight; D: wasting, stunting and underweight; E: stunting and underweight; F: stunting only; Y: underweight only; G: only weight excess; and H: stunting and weight excess. SETTING: Cross-sectional study conducted in Buenos Aires, Catamarca, Chubut, Jujuy, Mendoza and Misiones (Argentina). PARTICIPANTS: 10 879 children of both sexes aged between 3 and 13·99. RESULTS: ECIAF in preschool children (3 to 4·99 years) was 15·1 %. The highest prevalence was registered in Mendoza (16·7 %) and the lowest in Misiones (12·0 %). In school children (5 to 13·99 years) ECIAF was 28·6 %. Mendoza also recorded the highest rate (30·7 %), while Catamarca and Chubut had the lowest values (27·0 %). In the whole sample, about 25 % of the malnutrition was caused by undernutrition and 75 % by excess weight. CONCLUSIONS: The ECIAF summarizes anthropometric failure by both deficiency and excess weight and it highlights that a quarter of the malnutrition in the Argentine population was caused by undernutrition, although there are differences between Provinces (P < 0·05). ECIAF estimates are higher than those of CIAF or under-nutrition.

Intestinal parasitosis, undernutrition and socio-environmental factors in schoolchildren from Clorinda Formosa, Argentina / Parasitosis intestinal, desnutrición y factores socio-ambientales en niños escolares de Clorinda Formosa, Argentina

ABSTRACT Objective To evaluate intestinal parasitosis, undernutrition and socio-environmental factors in schoolchildren from Clorinda (Formosa, Argentina). Materials and Methods Serial fecal samples and anal swabs of 114 schoolchildren, canine feces and soil samples were analyzed. Body weight and height of 215 schoolchildren were measured and undernutrition was estimated according to the World Health Organization criteria. Socio-environmental variables were assessed by means of a semi-structured questionnaire. Results 78.1% of children were infected by at least one of the 12 species identified and 70.8% had multiple parasitic infections. Blastocystis sp., Giardia lamblia and Enterobius vermicularis were the most prevalent. Additionally, 17.5% of children were infected by at least one geohelminth (e.g. Ascarislumbricoides, Trichuris trichiura, hookworms). 64.3% of canine of canine feces were positive and six parasitic species were found; the most frequent were Ancylostoma caninum, Uncinaria stenocephala and G. lamblia. Furthermore, 37.5% of soil samples showed zoonotic parasites (i.e. Ascaris sp., Toxocara sp.). Finally, 10.0% of the children were undernourished and 85.7% of them had parasites. The risk for parasitosis was higher in children that lived in houses with inadequate solid waste disposal and whose parents were unemployed or had temporary jobs. Conclusions The lack of environmental sanitation, unstable employment of parents and the presence of zoonotic species were the most relevant factors observed. Consequently, these conditions result in an increase of parasitic infections and negatively influence the growth of children.(AU)

RESUMEN Objetivo Evaluar la parasitosis intestinal, la desnutrición y los factores socio-ambientales en escolares de Clorinda (Formosa, Argentina). Materiales y Métodos Se analizaron muestras fecales y escobillados anales seriados de 114 escolares, heces caninas y muestras de suelo. Se midió el peso corporal y la talla de 215 escolares y se evaluó la desnutrición según los criterios de la Organización Mundial de la Salud. Las variables socio-ambientales se evaluaron mediante una encuesta semiestructurada. Resultados El 78,1% de los niños estuvieron parasitados por al menos 1 de las 12 especies identificadas y el 70,8% presentó parasitosis múltiples. Blastocystis sp., Giardia lamblia y Enterobius vermicularis fueron las más prevalentes. Además, el 17,5% de los niños estaban infectados con al menos un geohelminto (e.g. Ascaris lumbricoides, Trichuris trichiura, ancylostomideos). El 64,3% de las heces caninas resultaron positivas y se encontraron seis especies parasitarias; las más frecuentes fueron Ancylostoma caninum, Uncinaria stenocephala y G. lamblia. Además, el 37,5% de las muestras de suelo mostraron parásitos zoonóticos (i.e. Ascaris sp., Toxocara sp.). Finalmente, el 10% de los niños estaban desnutridos y el 85,7% de ellos resultaron parasitados. El riesgo de parasitosis fue mayor en los niños que vivían en casas con eliminación inadecuada de desechos sólidos y cuyos padres estaban desempleados o tenían empleos temporales. Conclusiones La falta de saneamiento ambiental, el empleo inestable de los padres y la presencia de especies zoo-nóticas fueron los factores observados más relevantes. En consecuencia, estas condiciones resultan en un aumento de las infecciones parasitarias e influyen negativamente en el crecimiento de los niños.(AU)

Validation and Adaptation of the Spanish Version of the STRONGkids Nutrition Screening Tool.

BACKGROUND: The use of malnutrition screening tools (MSTs) among hospitalized pediatric patients is a simple practice that may allow the identification of patients at nutrition risk. There are different tools developed in the English language, but there are limited data available on their validity when translated into other languages. The aim of this study was to construct a Spanish version (SV) of the STRONGkids MST and determine its validity and reliability in a pediatric population. METHODS: The translation and cross-cultural adaptation of the tool was performed, followed by the reliability, feasibility, and validity of the SV of the STRONGkids MST. Anthropometric assessment was used as the reference standard to evaluate the criterion validity of the MST. The length of hospital stay was used to determine predictive validity. RESULTS: A total 400 children were included in the study, 90 of whom took part in the reliability phase. The interrater agreement between dietitians and nursing staff was kappa (κ) = 0.67, while the intrarater agreement among dietitians was κ = 0.82. The feasibility of the MST was adequate for clinical use. The results for criterion validity between STRONGkids and anthropometric assessment was κ = 0.56, and the criterion validity between STRONGkids and length of hospital stay was κ = 0.20. The sensitivity of the MST was 86% and the specificity was 72%. CONCLUSIONS: The SV of the MST showed good reliability and feasibility. The validity is moderate, and the MST could be considered a useful resource for early detection of malnutrition risk.

Síndrome diencefálico en un niño con desnutrición crónica e hiperactividad / Diencephalic syndrome in a child with chronic malnutrition and hyperactivity

El síndrome diencefálico es una causa infrecuente de desnutrición. Se produce por la disfunción del hipotálamo y está asociado a tumores del encéfalo. Los pacientes presentan una grave y progresiva pérdida de peso, aunque el apetito y la ingesta calórica son, por lo general, adecuados. Característicamente, los síntomas neurológicos son tardíos, lo que retrasa la sospecha diagnóstica. Se presenta a un paciente de 2 años y 6 meses de edad con desnutrición crónica grado II, derivado con diagnóstico presuntivo de enfermedad celíaca con mala adherencia y fracaso del tratamiento. Durante la internación, se arribó al diagnóstico de síndrome diencefálico secundario a un astrocitoma pilocítico grado I.

Diencephalic syndrome is an infrequent cause of malnutrition. It is produced by a malfunctioning hypothalamus, and it is related to encephalic tumors. Patients present a serious and progressive weight loss although the appetite and calorie intake are, usually, adequate. Neurological symptoms typically have a late appearance, delaying diagnostic suspicion. We present a patient aged 2 years and a half with grade II chronic malnutrition, referred with presumptive diagnosis of celiac disease, with poor adherence and treatment failure. During hospitalization, diagnosis of diencephalic syndrome secondary to grade I pilocytic astrocytoma was reached.

[Diencephalic syndrome in a child with chronic malnutrition and hyperactivity]. / Síndrome diencefálico en un niño con desnutrición crónica e hiperactividad.

Diencephalic syndrome is an infrequent cause of malnutrition. It is produced by a malfunctioning hypothalamus, and it is related to encephalic tumors. Patients present a serious and progressive weight loss although the appetite and calorie intake are, usually, adequate. Neurological symptoms typically have a late appearance, delaying diagnostic suspicion. We present a patient aged 2 years and a half with grade II chronic malnutrition, referred with presumptive diagnosis of celiac disease, with poor adherence and treatment failure. During hospitalization, diagnosis of diencephalic syndrome secondary to grade I pilocytic astrocytoma was reached.

El síndrome diencefálico es una causa infrecuente de desnutrición. Se produce por la disfunción del hipotálamo y está asociado a tumores del encéfalo. Los pacientes presentan una grave y progresiva pérdida de peso, aunque el apetito y la ingesta calórica son, por lo general, adecuados. Característicamente, los síntomas neurológicos son tardíos, lo que retrasa la sospecha diagnóstica. Se presenta a un paciente de 2 años y 6 meses de edad con desnutrición crónica grado II, derivado con diagnóstico presuntivo de enfermedad celíaca con mala adherencia y fracaso del tratamiento. Durante la internación, se arribó al diagnóstico de síndrome diencefálico secundario a un astrocitoma pilocítico grado I.

Manejo anestésico de paciente pediátrico con obstrucción severa de vía aérea causada por Papilomatosis / Anesthetic management in pediatric patient with severe airway obstruction caused by papilloma virus

La papilomatosis laríngea es una enfermedad de etiología viral que puede ser transmitida en el canal de parto o por la sangre materna. Un niño de 2 años con grado III de Obstrucción Laríngea fue programado para diagnóstico por fibrolaringóscopia. Discutimos el manejo perioperatorio del caso con las diversas estrategias de ventilación. Se sugiere mantener la ventilación espontánea hasta la intubación ya que la ventilación de la máscara facial o laríngea podría ser difícil y la intubación impide el paso del fibrolaringoscopio y la valoración completa de la larínge.

Laryngeal papillomatosis is a viral etiology desease that can be transmitted at birth through vaginal way or maternal blood. A 2-year-old boy with Laryngeal Obstruction III grade was scheduled for fibrolaryngoscopy diagnosis. We discuss the perioperative management of the case with the various ventilation strategies. It is suggested to maintain spontaneous ventilation until intubation, since ventilation with facial or laryngeal mask could be difficult and intubation prevent the passage of the fibrolaryngoscope for a complete laryngeal evaluation.

STRONGkids: Predictive Validation in Brazilian Children.

OBJECTIVES: The aim of the study is to assess STRONGkids as a tool for predicting weight loss and length of hospital stay in children and to determine whether the anthropometric diagnosis of nutritional status at the time of admission was associated with weight loss and length of hospital stay. METHODS: A methodological study recruiting 245 children age between 1 and 10 years of age admitted to a tertiary hospital. The participants were weighed daily until discharge. Validation of the STRONGkids tool for the identification of patients sustaining weight loss at the end of hospitalization involved the calculation of sensitivity, specificity, and positive and negative predictive values, and anthropometric assessment. RESULTS: A total of 129 (52.7%) children lost weight at the end of hospitalization. Of these, 73 (56.6%) lost over 2% of their weight on admission. The tool had a sensitivity of 55.8%, a specificity of 38.8% and a positive predictive value of 50.3% in identifying children who lost weight. The anthropometric assessment had a sensitivity of 26.5%, a specificity of 75.9%, and a positive predictive value of 49.1%. CONCLUSIONS: The model used to develop the STRONGkids tool incorporated clinical evaluation to a greater extent than the assessment of nutritional status. The tool, however, had a low sensitivity and a high percentage of false positives. Therefore, it should be considered as a preliminary evaluation tool and its use should be complemented with clinical data.

ASSESSMENT OF NUTRITIONAL STATUS OF CHILDREN AND ADOLESCENTS WITH SPASTIC QUADRIPLEGIC CEREBRAL PALSY.

BACKGROUND:: Due to several factors, such as gastrointestinal's diseases and difficulty in feeding, children with Spastic Quadriplegic Cerebral Palsy tend to present nutritional deficits. OBJECTIVE:: To assess the nutritional status of pediatric patients with Spastic Quadriplegic Cerebral Palsy according to reference curves for this population and with the measures of folds and circumferences, obtained by the upper arm circumference and triceps skin fold. METHODS:: The data were obtained from: knee-height, estimated height, weight, upper arm circumference, and triceps skin fold. Values of folds and circumferences were compared with Frisancho, and specific curves for these patients were used as reference. The relationship between the values in the growth curve for healthy children, Z-Score, and comparison with the reference curve were verified by Fisher's exact test. We adopted the significance level of 5%. RESULTS:: We evaluated 54 patients. The mean age was 10.2 years, and 34 were male, 25 fed by gastrostomy and 29, orally. The frequency of low weight by the reference curve was 22.22%. More than half of the patients presented the parameters indicating lean mass below the 5th percentile. The height of all patients was classified as adequate for the age by the reference curve. CONCLUSION:: Low weight was found in 22% of patients, and there is a greater tendency to present reduced muscle mass and increased fat mass, showing the need for evaluation and appropriate interventions for patients with Spastic Quadriplegic Cerebral Palsy.

Métodos de avaliação do estado nutricional de crianças e adolescentes com Paralisia Cerebral Tetraespástica / Assessment of nutritional status of children and adolescents with spastic quadriplegic cerebral palsy

ABSTRACT BACKGROUND: Due to several factors, such as gastrointestinal's diseases and difficulty in feeding, children with Spastic Quadriplegic Cerebral Palsy tend to present nutritional deficits. OBJECTIVE: To assess the nutritional status of pediatric patients with Spastic Quadriplegic Cerebral Palsy according to reference curves for this population and with the measures of folds and circumferences, obtained by the upper arm circumference and triceps skin fold. METHODS: The data were obtained from: knee-height, estimated height, weight, upper arm circumference, and triceps skin fold. Values of folds and circumferences were compared with Frisancho, and specific curves for these patients were used as reference. The relationship between the values in the growth curve for healthy children, Z-Score, and comparison with the reference curve were verified by Fisher's exact test. We adopted the significance level of 5%. RESULTS: We evaluated 54 patients. The mean age was 10.2 years, and 34 were male, 25 fed by gastrostomy and 29, orally. The frequency of low weight by the reference curve was 22.22%. More than half of the patients presented the parameters indicating lean mass below the 5th percentile. The height of all patients was classified as adequate for the age by the reference curve. CONCLUSION: Low weight was found in 22% of patients, and there is a greater tendency to present reduced muscle mass and increased fat mass, showing the need for evaluation and appropriate interventions for patients with Spastic Quadriplegic Cerebral Palsy.

RESUMO CONTEXTO: Devido a diversos fatores, como doenças do trato gastrointestinal e dificuldade de alimentação, frequentemente crianças com Paralisia Cerebral Tetraespástica apresentam prejuízo no estado nutricional. OBJETIVO: Avaliar o estado nutricional de pacientes pediátricos com Paralisia Cerebral Tetraespástica de acordo com curvas de referência para essa população e comparar com as curvas de referência utilizadas para a população pediátrica em geral. MÉTODOS: Foram obtidos os dados de: altura do joelho, estatura estimada, peso, circunferência braquial e dobra cutânea triciptal. Valores de dobras e circunferências foram comparados com Frisancho e curvas específicas para esses pacientes foram utilizadas como referência. A relação entre os valores plotados na curva de crescimento para crianças saudáveis, Escore-Z e comparação com a curva referencial foram verificados através do teste exato de Fisher. O nível de significância adotado foi de 5%. RESULTADOS: Foram avaliados 54 pacientes. A média de idade foi de 10,2 anos, 34 eram do sexo masculino. Vinte cinco se alimentavam via gastrostomia e 29 via oral. A frequência de baixo peso pela curva referencial foi de 22,22%. Mais da metade dos pacientes apresentaram os parâmetros indicativos de massa magra abaixo do percentil 5. A estatura de todos os pacientes foi classificada como adequada para idade pela curva referencial. CONCLUSÃO: O baixo peso foi encontrado em 22% dos pacientes, e há maior tendência para que esses pacientes apresentem massa muscular reduzida e aumento da massa gorda, mostrando a necessidade de avaliação e intervenções apropriadas para pacientes com Paralisia Cerebral Tetraespástica.

Desnutrición en niños y niñas de la etnia Wayuu: entre lo ético, lo propio y pertinente / Malnutrition in children of the Wayuu ethnicity: among the ethical, the unique and the relevant

La desnutrición ha cobrado la vida de un importante número de niños y niñas de la etnia wayuu que habitan en el departamento de La Guajira en Colombia. Esa situación existe y persiste sin que los decisores o la sociedad civil tomen acciones que reviertan el problema, mostrando total indiferencia y falta de solidaridad. En el país en general y en La Guajira en particular, es evidente la vulneración de los derechos de los niños y las niñas, como sujetos que se construyen en el presente y cuyo futuro no puede ser preparado sin su participación, el apoyo de sus familias, sus comunidades y las organizaciones civiles e instituciones del Estado. Es importante la solidaridad de la sociedad, puesto que los indígenas requieren respuestas, teniendo en cuenta las consideraciones éticas para su atención. Quienes solicitan se hagan efectivos los derechos que tanto se proclaman por distintos medios y que se han convertido sólo en sueños, puesto que la realidad es otra (AU).

Malnutrition has claimed the lives of a great quantity of children of the Wayuu ethnicity, who live in La Guajira department, in Colombia. This situation has existed for a long time without the action of the decision makers or the social society to solve the problem, showing total indifference and lack of solidarity. In the country in general and particularly in La Guajira, it is evident the violation of the rights of the children as subjects that are in the formation process at that moment of their lives, and whose future could not be granted without their participation and the support of their families, their communities, the civilian organizations and the State institutions. It is important the society's solidarity, because native people require answers and attention, taking into account ethical consideration. There are many people asking for making effective the rights that are so widely proclaimed by different means and have become just dreams, because they are another thing in real life (AU).

Prevalence and Predictors of Malnutrition among Guatemalan Children at 2 Years of Age.

OBJECTIVE: To identify the prevalence and predictors of malnutrition among 2-year old children in the Western Highlands of Guatemala. METHODS: Prospective cohort of 852 Guatemalan children in San Lucas Toliman, Guatemala followed from birth to age 2 from May 2008 to December 2013. Socio-demographic, anthropometric, and health data of children was collected at 2 month intervals. RESULTS: Among the 402 males and 450 females in the cohort, mean weight-for-age Z-score (WAZ) declined from -0.67 ± 1.01 at 1 year to -1.07 ± 0.87 at 2 years, while mean height-for-age Z-score (HAZ) declined from -1.88 ± 1.19 at 1 year to -2.37 ± 0.99 at 2 years. Using multiple linear regression modeling, number of children <5 years old, vomiting in the past week, fever in the past week, and WAZ at 1 year were significant predictors of WAZ at 2 years. Significant predictors of HAZ at 2 years included household size, number of children <5 years old, diarrhea in the past week, WAZ at 1 year, and HAZ at 1 year. Vomiting in the past week and WAZ at 1 year were significant predictors of weight-for-height z-score (WHZ) at 2 years. CONCLUSIONS: Number of children <5 years old, symptoms such as vomiting or diarrhea in the previous week, and prior nutritional status were the most significant predictors of malnutrition in this cohort. Future research may focus on the application of models to develop predictive algorithms for mobile device technology, as well as the identification of other predictors of malnutrition that are not well characterized such as the interaction of environmental exposures with protein consumption and epigenetics.