Tolerance and efficacy of preventive gastrostomy feeding in pediatric oncology

BackgroundMalnutrition in pediatric oncology remains underestimated, although having a negative impact on outcome. Enteral nutrition (EN) using percutaneous endoscopic gastrostomy (PEG) may prevent or reverse malnutrition consequences. We aimed to evaluate both efficacy and safety of early EN during tumors treatment in children. Procedures Medical records of pediatric patients having a PEG tube inserted between 1995 and 2009 were retrospectively reviewed. We compared type and incidence of complications in Group 1, including 74 patients suffering from cancer, and control Group 2, including 57 patients with neurological impairment. Efficacy of EN was evaluated through nutritional parameters [Z-scores weight for height (W/H) and height for age (H/A)], post-operative complications and relapse rates. Statistical significance was set for P < 0.05. Results PEG tolerance was similar in both groups, as shown by comparable complication rates (62% vs. 76%, NS). EN allowed improvement or stabilization of Z-score W/H in 76% of oncologic patients. The final height loss was lower (−0.5 vs. −1.2 SD of Z-scores H/A) when EN was started at the beginning of the oncologic treatment. In bone tumors, EN prevented weight loss during chemotherapy, and tended to lessen surgical complications, relapses and deaths. Conclusions Early gastrostomy feeding represents a relatively safe way to prevent malnutrition in children with cancer, and might play a role in bone tumors oncological outcome. Further prospective studies are needed to confirm these results and assess the impact of EN and PEG on quality of life

Gastrostomy for infants with severe epidermolysis bullosa simplex in neonatal intensive care

Abstract Introduction Severe epidermolysis bullosa simplex (EBS sev) is a rare genodermatosis characterized by congenital generalized blistering and mucosal involvement. Increased needs and decreased intake quickly lead to nutritional imbalance. Enteral nutrition support is proposed, but classical nasogastric tubes are not well tolerated in these patients and gastrostomy is preferred. Objective and methods To report the experience with EBS sev in neonatal units of French reference centers for gastrostomy. In this retrospective multicentric study, we included all patients with EBS sev who had gastrostomy placement before age 9 months during neonatal care hospitalization. Results Nine infants (5 males/4 females) with severe skin and mucosal involvement were included. A gastrostomy was decided, at an early age (mean 3.7 months, range 1.4 to 8 months) in infants with mean weight 4426 g (range 3500 to 6000 g). Techniques used were endoscopy with the pull technique for 5 infants and surgery under general anesthesia for 4. Main complications were local but resolved after treatment. All infants gained weight after gastrostomy. The mean withdrawal time (n = 7) for the gastrostomy was 35.8 months (range 10.5 months to 6.5 years). Seven children had persistent oral disorders. Conclusions Gastrostomy in infants with EBS sev can be necessary in neonatal intensive care units. Both surgical and endoscopic pull techniques seem efficient, with good tolerance

Management of pediatric forearm fractures: what is the best therapeutic choice? A narrative review of the literature

Purpose: This narrative review intends to summarize the most important and relevant data on diagnosis and treatment of pediatric forearm fractures and to describe the characteristics and advantage of each therapeutic option. Methods: We conducted a literature research considering peer-reviewed papers (mainly clinical trials or scientific reviews) using the string “forearm fracture AND epidemiology” or “forearm fracture AND diagnosis or “ forearm fracture AND treatment” or “forearm fracture AND casting” or “forearm fracture AND surgery”. Studies were identified by searching electronic databases (MEDLINE and PubMed) till April 2020 and reference lists of retrieved articles. Only English-language articles were included in the review. Results: Conservative management with cast immobilization is a safe and successful treatment option in pediatric forearm fractures. Surgical indication is recommended when an acceptable reduction cannot be obtained with closed reduction and casting. Surgical treatment options are intramedullary nail, plating and hybrid fixation. Conclusions: There is not a unique consensus about fracture management and treatment. Further studies are necessary to create univocal guidelines about optimal treatment, considering new techniques and available technologies

Information du patient (et de ses proches) avant la réalisation d'une gastrostomie percutanée endoscopique selon la technique "introducer" pour l'administration d'une nutrition entérale. [Information for patients (and relatives) before percutaneous endoscopic gastrostomy using "introducer" method for enteral nutrition.]

PréfaceUne dénutrition est présente chez 30 à 50 % des malades hos-pitalisés [1]. De nombreuses études ont montré que la dénutritionétait un facteur prédictif indépendant de morbidité, notam-ment infectieuse, de mortalité, d’altération de la qualité de vie,d’allongement de la durée d’hospitalisation et en conséquenced’une augmentation des coûts hospitaliers [1]. La dénutrition etle risque de dénutrition doivent être dépistés systématiquementà l’entrée en hospitalisation de fac¸on à pouvoir mettre en placeune prise en charge nutritionnelle précoce et adaptée conformé-ment aux exigences de la Haute Autorité de santé (HAS) pourla certification des établissements (critères IPAQSS). Dans lamesure du possible, la prise en charge nutritionnelle orale doitêtre privilégiée, tout particulièrement chez le sujet âgé [2]. Lescompléments nutritionnels oraux (CNO) et les conseils diété-tiques représentent les deux volets de cette prise en charge orale.L’efficacité des CNO est démontrée dans différentes situationsde dénutrition ou à risque [3] et leur prescription est recomman-dée chez le sujet âgé [2], chez le patient atteint de cancer [4],chez le patient en situation périopératoire [5] et chez le patientavec fracture du col du fémur [3