Anales de pediatría : publicación oficial de la Asociación Española de Pediatría (A.E.P.)
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The number of children receiving prolonged home enteral nutrition (HEN) is increasing. However, precise information on the incidence and prevalence of HEN in Spain is lacking. Consequently, the Spanish Society of Pediatric Gastroenterology, Hepatology and Nutrition created a patients' register (NEPAD). The aim of the present study was to analyze the results of the first year of the NEPAD register (2003). ⋯ Despite the efforts made to maintain the on-line national register, it has been underused in its first year of existence (2003). Patients with gastrointestinal or neurological diseases constitute the main group of patients in the register. There is a slight preference for the use of nasogastric tube over gastrostomy.
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Randomized Controlled Trial
[Bronchodilators via metered-dose inhaler with spacer in the pediatric emergency department: what is the dosage?].
Bronchodilators administrated through a metered-dose inhaler (MDI) with spacer are as effective as nebulizers in the treatment of acute asthma exacerbations in childhood. However, consensus is lacking on the most suitable dosage. ⋯ The distinct bronchodilator doses administered via an MDI with spacer showed similar effectiveness. These findings should contribute to a reevaluation of the use of high doses of bronchodilators, at least in most acute asthma exacerbations in children.
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Several reports have described a decrease in valproic acid (VPA) serum concentrations when carbapenem therapy is administered. The exact mechanism of this pharmacokinetic interaction is unknown, although several experimental studies have been carried out in animals. ⋯ Concentrations of VPA decreased to subtherapeutic levels. We review the various mechanisms for this interaction proposed to date, as well as all reported cases.
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The Bispectral Index (BIS) is a single numeric value that indicates the depth of hypnosis by estimating the level of electrical activity in the brain through analysis of the frequency bands in the electroencephalogram. The BIS was primarily developed to monitor the level of hypnosis during surgery and has recently begun to be used in critically-ill patients. Currently, there is little experience of the BIS in critically-ill children. ⋯ The BIS was also useful in the continuous monitoring of the level of consciousness in a patient with encephalitis and in the early detection of brain death. Pacer-induced artefacts in the BIS value are also described. We conclude that BIS monitoring may be a useful, noninvasive method for assessing the level of hypnosis in critically-ill children.
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Currently, consensus is lacking on the indications for surgery in primary congenital unilateral hydronephrosis. ⋯ Severe congenital unilateral hydronephrosis resolves spontaneously in most patients. Consequently, clinicians increasingly adopt a conservative approach. The available diagnostic techniques cannot identify patients who will benefit from pyeloplasty. In general, accepted surgical indications are an increase in hydronephrosis and/or worsening of renal function. In our series, 15 % of the patients with hydronephrosis had an irreversible lesion of variable severity, which in some patients seemed to have developed during embryogenesis. Kidneys at risk of presenting a lesion were those that had grade 4 hydronephrosis.