The transition from controlled to partial support ventilation is a challenge in acute respiratory distress syndrome (ARDS) patients due to the risks of patient-self-inflicted lung injury. The ...magnitude of tidal volume (V
) and intrapulmonary dyssynchrony (pendelluft) are suggested mechanisms of lung injury. We conducted a prospective, observational, physiological study in a tertiary academic intensive care unit. ARDS patients transitioning from controlled to partial support ventilation were included. On these, we evaluated the association between changes in inflammatory biomarkers and esophageal pressure swing (ΔP
), transpulmonary driving pressure (ΔP
), V
, and pendelluft. Pendelluft was defined as the percentage of the tidal volume that moves from the non-dependent to the dependent lung region during inspiration, and its frequency at different thresholds (- 15, - 20 and - 25%) was also registered. Blood concentrations of inflammatory biomarkers (IL-6, IL-8, TNF-α, ANGPT2, RAGE, IL-18, Caspase-1) were measured before (T
) and after 4-h (T
) of partial support ventilation. Pendelluft, ΔP
, ΔP
and V
were recorded. Nine out of twenty-four patients (37.5%) showed a pendelluft mean ≥ 10%. The mean values of ΔP
, ΔP
, and V
were - 8.4 - 6.7; - 10.2 cmH
O, 15.2 12.3-16.5 cmH
O and 8.1 7.3-8.9 m/kg PBW, respectively. Significant associations were observed between the frequency of high-magnitude pendelluft and IL-8, IL-18, and Caspase-1 changes (T
/T
ratio). These results suggest that the frequency of high magnitude pendelluft may be a potential determinant of inflammatory response related to inspiratory efforts in ARDS patients transitioning to partial support ventilation. Future studies are needed to confirm these results.
Standardization of clinical procedures has become a desirable objective in contemporary medical practice. To this effect, the Spanish Society of Parenteral and Enteral Nutrition (SENPE) has ...endeavoured to create clinical practice guidelines and/or documents of consensus as well as quality standards in artificial nutrition. As a result, the SENPE´s Standardization Team has put together the "Document of Consensus in Enteral Access for Paediatric Nutritional Support" supported by the Spanish Society of Pediatric Gastroenterology, Hepatology and Nutrition (SEGHNP), the National Association of Pediatric and Neonatal Intensive Care Nursery (ANECIPN), and the Spanish Society of Pediatric Surgery (SECP). The present publication is a reduced version of our work; the complete document will be published as a monographic issue. It analyzes enteral access options in the pediatric patient, reviews the levels of evidence and provides the team-members' experience. Similarly, it details general and specific indications for pediatric enteral support, current techniques, care guidelines, methods of administration and complications of each enteral access. The data published by the American Society for Parenteral and Enteral Nutrition (ASPEN) and several European Societies has also been incorporated.
Recomendaciones nutricionales para el niño deportista Sánchez-Valverde Visus, F.; Moráis López, A.; Ibáñez, J. ...
Anales de pediatría (Barcelona, Spain : 2003),
August 2014, Letnik:
81, Številka:
2
Journal Article
Recenzirano
Odprti dostop
El deporte tiene numerosos beneficios para la salud y una adecuada nutrición ayuda a conseguir un óptimo rendimiento. La mayor parte de la actividad deportiva realizada por la población infantil ...tiene lugar en el ámbito escolar, no incluye actividades de resistencia y con frecuencia no tiene carácter de alta competición. Las características de la dieta del niño deportista son similares a la de la población pediátrica general, debiendo asegurar una óptima cobertura de los requerimientos. Durante la realización de la actividad, debe asegurarse una correcta hidratación y para ello el agua resulta la bebida más adecuada en la mayor parte de las situaciones, quedando el uso de otros productos reservado en pediatría a situaciones especiales muy concretas. La utilización sistemática de suplementos energéticos, así como la de micronutrientes, no está justificada con carácter general. El pediatra debe conocer y monitorizar el estado nutricional y los hábitos dietéticos del niño deportista, vigilar estrechamente aquellas situaciones donde se pretenda una disminución del peso corporal y valorar los aspectos psicológicos relacionados con la práctica deportiva competitiva.
Several health benefits have been attributed to sports practice, and an adequate nutrition status helps to maintain an optimal performance. Children most frequently practice non-competitive and non-endurance activities in a school setting. The dietary intake of children who practice sports should be similar to the general population, properly meeting their energy and nutrient requirements. During the activity performance, correct hydration should be aimed for, with water appearing to be an adequate source in most cases. General calorie and micronutrient supplementation should not be commonly recommended in children. Paediatricians must control nutritional status and dietary habits of children who practice sports, especially in those cases when weight-loss is aimed for, as well as take into account the psychological implications of competitive sports practice.
Identification of very long-chain acyl-CoA dehydrogenase deficiency is possible in the expanded newborn screening (NBS) due to the increase in tetradecenoylcarnitine (C14:1) and in the C14:1/C2, ...C14:1/C16, C14:1/C12:1 ratios detected in dried blood spots. Nevertheless, different confirmatory tests must be performed to confirm the final diagnosis. We have revised the NBS results and the results of the confirmatory tests (plasma acylcarnitine profiles, molecular findings, and lymphocytes VLCAD activity) for 36 cases detected in three Spanish NBS centers during 4 years, correlating these with the clinical outcome and treatment. Our aim was to distinguish unambiguously true cases from disease carriers in order to obtain useful diagnostic information for clinicians that can be applied in the follow-up of neonates identified by NBS.
Increases in C14:1 and of the different ratios, the presence of two pathogenic mutations, and deficient enzyme activity in lymphocytes (<12% of the intra-assay control) identified 12 true-positive cases. These cases were given nutritional therapy and all of them are asymptomatic, except one. Seventeen individuals were considered disease carriers based on the mild increase in plasma C14:1, in conjunction with the presence of only one mutation and/or intermediate residual activity (18–57%). In addition, seven cases were classified as false positives, with normal biochemical parameters and no mutations in the exonic region of ACADVL. All these carriers and the false positive cases remained asymptomatic. The combined evaluation of the acylcarnitine profiles, genetic results, and residual enzyme activities have proven useful to definitively classify individuals with suspected VLCAD deficiency into true-positive cases and carriers, and to decide which cases need treatment.
Malnutrition among hospitalized patients has clinical implications, and interest has arisen to find screening tools able to identify subjects under risk. At present, there is no consensus about the ...most suitable nutrition screening tool for pediatric patients.
To validate STAMP (Screening Tool for the Assessment of Malnutrition in Pediatrics) pediatric screening tool in Spain.
Descriptive cross-sectional study of patients admitted to a 3rd level children's hospital with both medical and surgical specialities. During the first 24 hours of admission, STAMP screening tool was applied. For its validation, results were compared with those obtained from a nutritional assessment performed by specialist staff, which included clinical, anthropometric and body composition data.
A sample of 250 children was studied. Nutritional assessment identified 64 patients (25.6%) under risk, 40 of whom were malnourished (16%). STAMP classified 48.4% of the patients as being under nutritional risk. This tool showed 75% sensitivity and 60.8% specificity when identifying patients under risk according to nutritional assessment. It showed 90% sensitivity and 59.5% specificity when identifying malnourished patients.
Malnutrition was less frequent than that reported in other European countries, although diagnosis technique was different. STAMP is a simple and useful tool for nutritional screening, avoiding the need to assess all patients on admission in order to identify those under nutritional risk.
Los lactantes y niños menores de 5 años constituyen un grupo de riesgo para el desarrollo de ferropenia, al conjugarse frecuentemente en ellos unos requerimientos elevados con una ingesta escasa de ...hierro de alta biodisponibilidad. En esta edad, la ferropenia se ha relacionado con alteraciones del desarrollo psicomotor, entre otros trastornos, y algunos de sus efectos pueden permanecer en el tiempo, a pesar de la restauración de unos adecuados niveles de hierro. Por este motivo, las estrategias encaminadas a la prevención resultan de máxima importancia.
El pilar fundamental para la prevención de la ferropenia durante la lactancia y primera infancia es una adecuada orientación dietética. Durante los primeros 4-6 meses de vida, la leche materna es capaz de cubrir adecuadamente los requerimientos, debiendo utilizarse como alternativa, en caso necesario, una fórmula fortificada. Durante la diversificación, se recomienda introducir de forma precoz los cereales fortificados y las carnes. En el niño pequeño, el consumo diario de al menos una ración de alimentos que aporten hierro de alta biodisponibilidad, combinándolos adecuadamente con otros que favorezcan su absorción, es importante para lograr la cobertura de los requerimientos. Únicamente cuando éstos no sean cubiertos por la alimentación habitual, y en determinados grupos de riesgo, se debe realizar de forma seleccionada cribado y suplementación medicamentosa.
Infants and toddlers represent a risk population for iron deficiency (ID), due to their relatively high requirements, which are frequently associated with a poor intake of iron-rich foods. A possible association between ID and impaired cognitive and psychomotor development has been described, and it has been suggested that some of these effects can be irreversible. For this reason, prevention of ID has become a subject of much concern.
To promote an adequate dietetic iron intake is the most important approach for the prevention of ID. Exclusive breast-feeding provides adequate amounts of iron during the first 4-6 months of life, and iron-fortified formula should be used when an alternative is necessary. Fortified cereals and foods containing haem iron, such as meat, should be introduced early in complementary feeding. In toddlers, iron requirements can be satisfied with a daily consumption of at least one serving of iron-containing foods, along with enhancers of iron absorption. When daily requirements are not properly met by food intake, and in some high-risk populations, screening for ID and iron supplementation should be considered.
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