Nutrición enteral en hepatopatías crónicas en niños y adolescentes

La desnutrición que se observa en enfermedades hepáticas crónicas en niños se asocia a un aumento de requerimientos por gasto calórico elevado. La historia clínica incluye un recordatorio de alimentación, evaluación clínica, antropometría. Los niños con colestasis deben recibir una dieta hipercalórica. Es fundamental garantizar el aporte calórico calculado completo y la alimentación enteral. Se debe garantizar un crecimiento adecuado en un niño en lista de espera para trasplante. Los niños con enfermedades metabólicas requieren el uso de fórmulas comerciales especiales

Colestasis neonatal

ResumenLa colestasis neonatal es causada por una bilirrubina conjugada elevada. Sus causas más frecuentes son la atresia de vías biliares, colestasis intrahepática de diferentes etiologías y la hepatitis neonatal idiopática. Una detección temprana de colestasis y un diagnóstico acertado son importantes para un tratamiento adecuado. Se presenta un análisis de causas frecuentes, de una evaluación diagnóstica y tratamiento. La valoración de recién nacidos después de dos semanas de elevación de bilirrubina conjugada tiene como objetivo un diagnóstico temprano de atresia de vías biliares y de otras enfermedades que pueden ser tratadas.[Heller S. Colestasis neonatal. MedUNAB 2005; 8 (1 Supl 1):S18-S25]Palabras clave: Colestasis, atresia de vías biliares, hepatitis neonatal, ictericia

Neonatal cholestasis

La colestasis neonatal es causada por una bilirrubina conjugada elevada. Sus causas más frecuentes son la atresia de vías biliares, colestasis intrahepática de diferentes etiologías y la hepatitis neonatal idiopática. Una detección temprana de colestasis y un diagnóstico acertado son importantes para un tratamiento adecuado. Se presenta un análisis de causas frecuentes, de una evaluación diagnóstica y tratamiento. La valoración de recién nacidos después de dos semanas de elevación de bilirrubina conjugada tiene como objetivo un diagnóstico temprano de atresia de vías biliares y de otras enfermedades que pueden ser tratadas.Neonatal cholestasis is caused by elevated conjugated bilirubin. Its most frequent causes are bile duct atresia, intrahepatic cholestasis of different etiologies, and idiopathic neonatal hepatitis. Early detection of cholestasis and accurate diagnosis are important for adequate treatment. An analysis of common causes, diagnostic evaluation and treatment is presented. The evaluation of newborns after two weeks of elevated conjugated bilirubin is aimed at early diagnosis of bile duct atresia and other diseases that can be treated

Enfermedad hepática asociada a nutrición parenteral

ResumenLa enfermedad hepática asociada a nutrición parenteral es frecuente en recién nacidos de bajo peso y lactantes con síndrome de intestino corto, que la requieren por un periodo prolongado. Los principales mecanismos que contribuyen a su desarrollo son disfunción intestinal asociada a ayuno, componentes hepatotóxicos de la solución de nutrición parenteral y 3) contribución de la enfermedad que condicionó la nutrición parenteral. Desde el punto de vista clínico, los niños cursan con elevación de bilirrubina conjugada y de aminotransferasas y si existe daño hepático grave, se agregan datos de hipertensión portal e insufi ciencia hepática. El ácido ursodeoxicóllico, antibióticos, colecistoquinina y el trasplante hepático solo o combinado con trasplante intestinal pueden usarse en el tratamiento. Cambios en la composición de la nutrición parenteral pueden requerirse en la prevención del daño hepático.[Séller A, González G. Enfermedad hepática asociada a nutrición parenteral. MedUNAB 2005; 8 (1 Supl 1):S26-S29]Palabras clave: Alimentación parenteral, enfermedad hepática, síndrome de intestino corto, colestasis

Parenteral nutrition-associated liver disease

La enfermedad hepática asociada a nutrición parenteral es frecuente en recién nacidos de bajo peso y lactantes con síndrome de intestino corto, que la requieren por un periodo prolongado. Los principales mecanismos que contribuyen a su desarrollo son disfunción intestinal asociada a ayuno, componentes hepatotóxicos de la solución de nutrición parenteral y 3) contribución de la enfermedad que condicionó la nutrición parenteral. Desde el punto de vista clínico, los niños cursan con elevación de bilirrubina conjugada y de aminotransferasas y si existe daño hepático grave, se agregan datos de hipertensión portal e insuficiencia hepática. El ácido ursodeoxicóllico, antibióticos, colecistoquinina y el trasplante hepático solo o combinado con trasplante intestinal pueden usarse en el tratamiento. Cambios en la composición de la nutrición parenteral pueden requerirse en la prevención del daño hepático.[Séller A, González G. Enfermedad hepática asociada a nutrición parenteral. MedUNAB 2005; 8 (1 Supl 1):S26-S29]Parenteral nutrition-associated liver disease is common in low birth weight newborns and infants with short bowel syndrome, who require it for a prolonged period. The main mechanisms that contribute to its development are intestinal dysfunction associated with fasting, hepatotoxic components of the parenteral nutrition solution, and 3) contribution of the disease that conditioned parenteral nutrition. From a clinical point of view, children present with elevation of conjugated bilirubin and aminotransferases and if there is severe liver damage, data of portal hypertension and liver failure are added. Ursodeoxycholic acid, antibiotics, cholecystokinin, and liver transplantation alone or combined with intestinal transplantation may be used in treatment. Changes in the composition of parenteral nutrition may be required to prevent liver damage.[Séller A, González G. Liver disease associated with parenteral nutrition. MedUNAB 2005; 8 (1 Suppl 1):S26-S29

Infant Feeding Practices That Substitute Exclusive Breastfeeding in a Semi-Rural Mexican Community: Types, Moments, and Associated Factors

International organizations recommend mothers practice exclusive breastfeeding (EBF) during the first six months of their infant’s life and introduce complementary feeding (CF) thereafter while continuing breastfeeding. However, the earlier introduction of liquids and foods is common worldwide and may have negative effects on breastfeeding practice, nutrition, and health. In this formative cross-sectional study, we interviewed 143 mothers from semi-rural communities in Tabasco, Mexico, whose infants were 4–6 months old. We explored (1) which feeding practices substituted EBF and (2) which factors were associated with each practice. During the first month of life, 42.7% of infants received formula milk (FM); this proportion increased to 74.5% by the sixth month. Adjusted Poisson regression analyses showed that giving FM was positively related to working away from home (PR 1.27; 95% CI 1.06, 1.54) and the perception that FM is an important food to accompany breast milk (PR 1.38; 95% CI 1.19, 1.70). Giving FM was negatively associated with not being sure the infant is full after breastfeeding (PR 0.75; 95% CI 0.61, 0.92). Regarding CF, less than half (47.5%) of infants had not received it by the fifth month. Factors positively associated with timely CF introduction were: the mother was told during prenatal care visits the optimal age to start CF is 6 months (PR 1.17, 95% CI 1.06, 1.29); she is convinced that giving only breast milk is best for her baby (PR 1.15, 95% CI 1.03, 1.29), and a higher infant weight-for-length (PR 1.04, 95% CI 1.00, 1.08) and length for age (PR 1.04, 95% CI 1.00, 1.09) z-scores at the study visit; conversely, it was negatively associated to the idea that if the infant is not full, she/he should receive formula milk or some other food (PR 0.87, 95% CI 0.78, 0.96). In these communities, EBF is lost to the use of FM and early CF. The factors associated with these inadequate feeding practices are related to returning to work, information received during prenatal visits, and the mother’s beliefs and thoughts. This work will guide the design of an intervention on infant feeding practices for these communities and other similar ones

Guidelines for the diagnosis and treatment of extrahepatic portal vein obstruction (EHPVO) in children

Introduction. Extrahepatic portal vein obstruction is an important cause of portal hypertension among children. The etiology is heterogeneous and there are few evidences related to the optimal treatment. Aim and methods. To establish guidelines for the diagnosis and treatment of EHPVO in children, a group of gastroenterologists and pediatric surgery experts reviewed and analyzed data reported in the literature and issued evidence-based recommendations.Results. Pediatric EHPVO is idiopathic in most of the cases. Digestive hemorrhage and/or hypersplenism are the main symptoms. Doppler ultrasound is a non-invasive technique with a high degree of accuracy for the diagnosis. Morbidity is related to variceal bleeding, recurrent thrombosis, portal biliopathy and hypersplenism. Endoscopic therapy is effective in controlling acute variceal hemorrhage and it seems that vasoactive drug therapy can be helpful. For primary prophylaxis of variceal bleeding, there are insufficient data for the use of beta blockers or endoscopic therapy. For secondary prophylaxis, sclerotherapy or variceal band ligation is effective; there is scare evidence to recommend beta-blockers. Surgery shunt is indicated in children with variceal bleeding who fail endoscopic therapy and for symptomatic hypersplenism; spleno-renal or meso-ilio-cava shunting is the alternative when Mesorex bypass is not feasible due to anatomic problems or in centers with no experience.Conclusions. Prospective control studies are required for a better knowledge of the natural history of EHPVO, etiology identification including prothrombotic states, efficacy of beta-blockers and comparison with endoscopic therapy on primary and secondary prophylaxis