[Percutaneous endoscopic gastrostomy (PEG) in pediatric patients: our experience and proposal of follow-up methodology]. / Gastrostomia endoscopica percutanea (PEG) nei pazienti pediatrici: nostra esperienza e proposta operativa di metodologia osservazionale.

OBJECTIVE: To evaluate effectiveness and acceptability of percutaneous endoscopic gastrostomy (PEG) in pediatric patients and to propose a data collection and follow-up methodology. MATERIALS AND METHODS: Observational retrospective and prospective study on 33 pediatric patients and 5 adults with PEG, placed using Gauderer "push" technique, between 2000 and 2007. By means of an appropriate questionnaire, the following parameters were evaluated: complications, factors of further risk, nutritional status, management and acceptability of PEG. RESULTS: No problems occurred during placement. Complications were few and easy to resolve. In 3 patients a stomal dehiscence occurred, strongly related to the tube gauge. During replacement, in 4 patients, bumper was not taken away because of difficult removal. 8 patients had pre-PEG Gastroesophageal reflux: In 2 of them, during the PEG placement, fundoplication was realized. Subsequently PEG procedure, only 1 patient needed fundoplication for worsening of GER. All of them continued gastroprotective treatment. Respiratory tract infections decreased in our 13 patients carries of tracheostomy. CONCLUSIONS: To prefer smaller gauge reduces risk of dehiscence. If the bumper's removal is hard, to leave it inside is acceptable and quite safe, on condition of a careful surveillance of gastrointestinal obstruction signs. GER is not a contraindication of PEG. A careful follow-up is important, by recording all the evaluated parameters and by questionnaire to the family, during every hospital admission. This study, even if on few patients, confi rms PEG as the technique of choice for long-term enteral feeding, also in children. Training of family and caregivers is important to care.

Does locomotion improve the cognitive profile of children with meningomyelocele?

OBJECTIVE: This study was conducted to test the hypothesis that locomotion can improve cognitive development in a paediatric population with meningomyelocele (MMC) and hydrocephalus. METHODS: Twenty-nine children with MMC and shunted hydrocephalus were studied. All had motor impairment, but after physiotherapy and training walking was possible in 23 of them (5 autonomously and 18 with an aid), while 6 had recourse to a wheelchair. In all 23 cases neuroimaging (TC scan and/or MRI) was performed to obtain data on the sequelae of perinatal lesions, alterations of the corpus callosum, and the presence or absence of cortical abnormalities and ventricular dilatation. All subjects underwent a neuropsychological assessment including the Wechsler Pre-school and Primary Scale for Infants (WIPPSI) and the Wechsler Intelligence Scale for Children Revisited (WISC-R). Statistical analysis was carried out with the ANOVA test. RESULTS: Even though global I.Q. in these MMC children was within the normal range, the characteristic splitting between verbal I.Q. (VIQ) and performance I.Q. (PIQ) was observed, but the most interesting observation was a significant performance-related difference (P=0.044 and P=0.012) between ambulatory patients (both with and without aids) and those who were dependent on wheelchairs (PIQ: 83-85 vs 63).