Parental Nutrition Effects Over Speech Developement

The programs of total parenteral nutrition (TPN) or continuous delivery enteral nutrition (CDEN) will have a positive effect on health and a negative effect on speech occurrence and future development. Identifying any disturbance in child’s development requires immediately taking adequate amelioration and multifactor support actions. Working as a mixed team (physicians, speech therapists, psychologists and physical therapists), we developed a program which had as its main objectives: stating the effects of the parenteral/enteral nutrition program on future child development; preventing the occurrence of disturbances in child development through family counselling and early intervention; creating a system of services addressed to families with children fed intravenously/intestinally. The beneficiaries of this program were 40 children, born prematurely and tube fed, who often needed to be hospitalized in the gastroenterology or intensive care clinics of the “St. Mary” Children Emergency Hospital from Iasi

The Gastroesophageal Reflux Disease in Children – 5 Years Cases Report

Objectives The study is investigating the gastroesophageal reflux disease in children using the gold standard method – the 24hour pH-metry. Methods 197 children underwent the 24 hours pH-metry between January 2006 and December 2010 in the Vth Clinic of Paediatrics, „St. Mary” Children Emergency Hospital, Iasi. The patients were selected based on the typical or atypical reflux symptoms: regurgitations, recurrent vomiting, asthma, recurrent wheezing, chronic cough, recurrent respiratory infections. The 24 hours pH-metry results were interpreted with the Boix Ochoa score. Results The reflux was present at 146 children (74.11%), 95 males and 51 females. For the age group 0-1 year, pH-metry was performed in 48 children, and the reflux was present in 34 cases (70.83%). Between 1-3 years old, out of 51 studied cases, 41 (80.39%) had reflux; between 3-10years old, 55 children (71.05%) out of 76 had reflux; and over 10 years old, in 16 cases out of 22 studied, the reflux was demonstrated. Over 50% of the children in the study presented only atypical reflux symptoms, especially respiratory. These children received antireflux treatment with a very good control of the symptoms. Conclusions The oesophageal pH-metry has a decisive role in the diagnosis of gastro oesophageal reflux especially for the children with atypical symptoms of reflux. A correct diagnosis through pH-metry allows a better therapeutical approach. The high percentage of positive pH-metry reflects a good selection based on clinical criteria mainly and on the poor response at the antiasthmatic therapy

RELAŢIA ALERGIE ALIMENTARĂ – BOALĂ DE REFLUX GASTRO-ESOFAGIAN LA SUGAR

Boala de refl ux gastro-esofagian (BRGE) şi alergia la proteinele laptelui de vacă (APLV) au numeroase caracteristici clinico-evolutive comune. Autorii analizează un lot de 110 sugari spitalizaţi cu suspiciunea de BRGE (45 cazuri) şi APLV (65 cazuri). Rezultatele evidenţiază riscul de evoluţie concomitentă a APLV şi RGE ca simptom în acest context. Concluzii: Investigarea prin pH-metrie esofagiană şi aplicarea testelor de diagnostic a APLV se impune atât în BRGE, cât şi în APLV (mai ales la bolnavii cu risc familial sau manifestări atopice)

GASTROESOPHAGEAL REFLUX IN NEWBORNS AND INFANTS (II)

Gastroesophageal reflux in newborns and infants is particularized by pathogeny, diagnosis and therapeutical approach, functional immaturity of the digestive tract, the anatomic immaturity of the Hiss lower esophageal sphincter and lower gastric acidity. In infants, the low compliance with the laborious procedures such as pHmetry, impedance – pH-metry and digestive endoscopy is also considered. The border between regurgitations, physiological gastroesophageal reflux and the reflux disease is sometimes hard to establish. Changing the lifestyle of infants (feeding and position changes) based on the mother’s compliance with the medical recommendations is a first step in the treatment of GER, followed in non-responsive cases by pharmacological therapy and surgery

REFLUXUL GASTROESOFAGIAN LA NOU-NĂSCUT ŞI SUGAR (I)

Refluxul gastro-esofagian (RGE) la nou-născut şi sugar se particularizează prin patogenie, încadrare diagnostică şi abordare terapeutică. La aceştia situaţia este mai complexă dacă avem în vedere imaturitatea funcţională a aparatului digestiv, imaturitatea anatomică a sfincterului esofagian inferior Hiss şi aciditatea gastrică mai mică. În cazul sugarilor se ţine cont şi de complianţa redusă la procedurile laborioase cum sunt pH-metria, impedanţpH-metria şi endoscopia digestivă. Graniţa dintre regurgitaţii, reflux gastro-esofagian fiziologic şi boală de reflux este uneori dificil de trasat. Modificarea stilului de viaţă la sugari (alimentaţia şi modificările poziţionale), prin obţinerea aderenţei mamei la recomandările medicale, reprezintă un prim pas în tratamentul RGE, fiind urmat în cazurile non-responsive de terapia farmacologică şi intervenţia chirurgicală

Food Allergy In Children

Food allergy is understood as all the adverse reactions to food products triggered by the immunological mechanism. The immunological reactions include the mediated IgE mechanisms and non-Ig-E mechanisms. It is estimated that the frequency of food allergies in general population is of 3.5-4% and usually come out in patients showing also other atopic disorders. The gastro-intestinal barrier is made up of epithelial cells, mucin cells (IgA secreting), proteolytic enzymes and billiary salts. The factors influencing the digestive tolerance are classified in antigenic factors and factors related to the host. The most important food products determining the most of allergies during childhood are: milk, eggs, nuts, flour and soya. The clinical manifestations in food allergies are the anaphylactic reaction, respiratory, cutaneous and digestive manifestations. The paraclinical diagnosis is different depending on the mediated immunologic mechanism, and the exclusion of the involved allergen is the key element in managing the food allergies

Particularities Of Chemical Gastritis In Children

Objectives: The authors intend to show correlations between the clinical, endoscopic and echographic aspects of the chemical gastritis and the infection with Helicobacter Pylori. Materials and methods: A lot of 298 patients hospitalized in the 5th Clinic of Paediatrics of the „Sf. Maria” Emergency Children Hospital Iaşi during the period January 2008 – December 2010 was studied. The patients underwent upper digestive endoscopy, abdominal echography and esogastroduodenal transit. Results: The symptomatology was present in the majority of patients with epigastric pain, nausea, biliary vomiting. Anatomical changes of the gall bladder were echographically detected: septate cholecyst, hypotone, thickened walls. Macroscopic lesions of the gastric mucosa, especially of the antral region and large quantities of bile in stomach were endoscopically observed. Gastric biopsy was used to detect the presence of H. pylori. EGD transit has shown motility changes of the superior digestive tube in most patients. The treatment consisted in administration of gastric acidity inhibitors and ursodeoxicolic acid for 21 days. A positive response to this treatment was obtained for the majority of cases. Conclusions: The reflux gastritis is a new clinical and therapeutic entity in the paediatric practice, frequently occurring in anatomically normal stomach. The reflux gastritis can be associated with the HP infection and aggravates it clinically. It is also frequently correlated with anatomical anomalies of the gall bladder and changes in the digestive tract motility

GASTROESOPHAGEAL REFLUX IN NEWBORNS AND INFANTS (I)

Gastroesophageal reflux in newborns and infants is particularized by pathogeny, diagnosis and therapeutical approach. The situation is much more complex for them due to the functional immaturity of the digestive tract, to the anatomic immaturity of the Hiss lower esophageal sphincter and to the lower gastric acidity. In infants, the low compliance with the laborious procedures such as pH-metry, impedance – pH-metry and digestive endoscopy is also considered. The border between regurgitations, physiological gastroesophageal reflux and the reflux disease is sometimes hard to establish. Changing the life style of infants (feeding and position changes) based on the mother’s compliance with the medical recommendations is a first step in the treatment of GER, followed in non-responsive cases by pharmacological therapy and surgery

A Rare Case of Infantile Grave’s Disease

The authors presents a rare case of a 12 years-old girl with Grave’s disease with typical clinical features apearing after an emotional stress. After a first-line treatment with antithyroid drugs the thyrotoxic syndrome relapsed because the lack of compliance and side effects of this medication (carbimazole). Convenient preparation to achieve the euthyroid state allowed the young patient to support a near total thyroidectomy with immediate and long-term good result. Considerations about the pathways leading to Grave’s disease, clinical and bioumoral diagnosis and especially the indications, advantages and failures of the three main methods of therapy i.e. antithyroid drugs, ablative radioiodine and surgery are discussed

REFLUXUL GASTROESOFAGIAN LA NOU-NĂSCUT ŞI SUGAR (II)

Refluxul gastroesofagian la nou-născut şi sugar se particularizează prin patogenie, încadrare diagnostică şi abordare terapeutică, imaturitatea funcţională a aparatului digestiv, imaturitatea anatomică a sfincterului esofagian inferior Hiss şi aciditatea gastrică mai mică. În cazul sugarilor se ţine cont şi de complianţa redusă la procedurile laborioase cum sunt pH-metria, impedanţ-pH-metria şi endoscopia degestivă. Graniţa dintre regurgitaţii, reflux gastroesofagian fiziologic şi boală de reflux este uneori dificil de trasat. Modificarea stilului de viaţă la sugari (alimentaţia şi modificările poziţionale), prin obţinerea aderenţei mamei la recomandările medicale reprezintă un prim pas în tratamentul RGE, fiind urmat în cazurile non-responsive de terapia farmacologică şi intervenţia chirurgicală