Analysis of the Spanish national registry for pediatric home enteral nutrition (NEPAD): implementation rates and observed trends during the past 8 years.

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.

Enterocolitis neutropénica en el niño con cáncer: nuestra casuistica y revisión de la literatura / Neutropenic enterocolitis in the child with cancer: our casuistics and review of the literature

Introducción: La enterocolitis neutropénica o tiflitis es una alteración de la región ileocecal con ausencia de infiltrado inflamatorio o tumoral y diferentes grados de afectación de la pared intestinal, típica de pacientes con tumores hematológicos afectos de neutropenia grave o prolongada secundaria a la quimioterapia. Objetivos: Revisar los casos de enterocolitis neutropénica diagnosticados en niños con cáncer del Hospital Universitario de Canarias (HUC) durante los últimos 6 años y medio y realizar una revisión actualizada de la literatura sobre el tema. Pacientes y métodos: Revisión retrospectiva de historias clínicas de los niños que padecieron tiflitis. Se analizaron las siguientes variables: edad, sexo, tipo de neoplasia, protocolo de quimioterapia, y al diagnóstico de la tiflitis; número de días desde el último ciclo de quimioterapia (quimioterápicos recibidos), días de neutropenia, síntomas, método diagnóstico (grosor máximo de la pared intestinal), tratamiento y evolución. Resultados: De los 41 casos de tumores malignos tratados con quimioterapia, el 7,3% (n = 3) presentaron uno o más episodios de enterocolitis neutropénica (todos afectos de leucemia aguda; dos mieloblásticas y una linfoblástica).Todos eran varones, con una edad media de 11 años y medio. La clínica predominante fue dolor abdominal en el contexto de una neutropenia febril postquimioterapia. La confirmación diagnóstica se realizó mediante ecografía abdominal en dos casos y tomografía computarizada (TC) en los otros dos (media del grosor intestinal máximo: 11,5 mm). El tratamiento instaurado en todos los casos fue conservador, logrando una recuperación clínico-radiológica en el 100% de los pacientes. Conclusión: En todo niño con cáncer en tratamiento quimioterápico, especialmente en afectos de leucemia aguda, con neutropenia febril que además refiera dolor abdominal persistente, vómitos y/o diarrea, se debe sospechar una enterocolitis neutropénica, solicitar una ecografía y/o una TC abdominal urgente para confirmarla, e instaurar lo antes posible el tratamiento recomendado, logrando, así, una reducción significativa de la morbimortalidad que conlleva esta grave complicación (AU)

Background: Neutropenic enterocolitis or thyphlitis is a lesion of the ileocecal arca with lack of inflammatory or tumoral infiltration and different degrees of affection on the bowel wall. It is typical in patients with hematologic malignancies with prolonged or severe neutropema alter intensive chemotherapy. Objectives: Revise all neutropenic enterocolitis diagnosed at Hospital Universitario de Canarias (HUC) in the last six and a half years in children with cancer, and carry out an up today literature review. Patients and methods: Retrospective review of the medical histories to the children who had thyplitis. We analyzed the following data: age, sex, cancer type and chemotherapy protocol, and when thyplitis was diagnosed; days from the last cytotoxic chemotherapy cycle (anticancer drugs used), days of neutropenia, symptoms, diagnosis method used (maximum thickness on the bowel wall), treatment and evolution. Results: Forty one cases of malignant neoplasms were treated with chemotherapy and 7,3% (n = 3) had one or more episodes of neutropenic enterocolitis (all of them with acute leukemia, two myelogenus and one lymphoblastic). All of them were male, with an average age of 11 years and 6 months. The symptom more frequently seen was abdominal pain in a child with a febrile neutropenia alter intensive chemotherapy. The diagnosis confirmation was with abdominal ultrasonography (US) in two cases, and computed tomography (CT) in the other two ones (average thickness on the bowel wall was 11,5 mm). All the children recovered without problems with medical treatment. Conclusion: Any child with cancer treated with chemotherapy, especially with acute leukaemia, and febrile neutropenia associated with persistent abdominal pain, vomiting and/or diarrhea, we must suspect neutropenic enterocolitis, ask for an urgent abdominal US and/or CT to confirm the diagnosis, and start as far as possible the recommended treatment, achieving as that a significative morbimortality reduction so common in this severe complication (AU)