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      Nutrición parenteral domiciliaria en pacientes pediátricos con insuficiencia intestinal Translated title: Home parenteral nutrition in pediatric patients with intestinal insufficiency

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          Abstract

          Resumen: Introducción: La Nutrición Parenteral Domiciliaria (NPD) ha demostrado ofrecer importantes be neficios para los pacientes y el sistema de salud. En Chile se desconoce el número de pacientes que se encuentran recibiendo esta modalidad de tratamiento o que podrían ser candidatos a ella. Obje tivo: Determinar la prevalencia y características clínicas de pacientes con Insuficiencia Intestinal (II) que reciben actualmente NPD o que son candidatos a esta. Pacientes y Método: Estudio descriptivo transversal que incluyó pacientes de 0 a 18 años, con diagnóstico de II que se encontraban recibiendo NP por un tiempo superior a 3 meses en el domicilio, o en el hospital con situación clínica estable y con catéter venoso de larga duración (CVC). A través de una encuesta digitalizada se recolectaron y estudiaron las variables: sexo, antecedentes de nacimiento, indicación para iniciar soporte nutricional parenteral, edad de inicio de NP, tipo de CVC utilizado, frecuencia de NP, estado nutricional, alimentación al último control y complicaciones asociadas al uso de NP. Se utilizó el Programa SPSS Statistics, Versión 21, Macintosh, para el análisis de los datos. El análisis descriptivo consideró análisis de frecuencia y medidas de tendencia central. La prueba de Chi cuadrado y de Fisher se usaron para la comparación de proporciones. Resultados: Se registraron datos de 46 pacientes, cuya edad promedio fue de 55,5 meses. La principal indicación para iniciar la Nutrición Parenteral (NP) fue la disminu ción de la superficie intestinal (78,3%.). El 63% de los pacientes se encontraba hospitalizado. No se encontraron diferencias significativas entre el lugar de tratamiento y las variables estado nutricional e infecciones de catéter en el último año. Conclusiones: Se identificó la prevalencia de pacientes con NP prolongada y sus características clínicas. No se encontraron diferencias que respalden la entrega de este tratamiento en el hospital por sobre el domicilio. Es necesario desarrollar políticas públicas que garanticen la opción de recibir este tratamiento en el domicilio.

          Translated abstract

          Abstract: Introduction: Home parenteral nutrition (HPN) has been shown to offer important benefits for pa tients and the health system. In Chile, the number of patients who are receiving this type of treatment or who could be candidates for it is unknown. Objective: To determine the prevalence and clinical characteristics of patients with intestinal insufficiency (II) currently receiving HPN or who are can didates for it. Patients and Method: Cross-sectional descriptive study which included patients aged between 0 to 18 years with diagnosis of II who were receiving parenteral nutrition (PN) for over three months, either at home or in the hospital, with a stable clinical situation and a long-term venous catheter (CVC). Through a digitalized survey, the following variables were collected and studied: gender, birth history, indication to initiate parenteral nutritional support, age of initiation of PN, type of CVC, frequency of PN, nutritional status and feeding in the last control and complications as sociated with the use of PN. Data analysis was performed using the SPSS Statistics Software, Version 21, Macintosh. The descriptive analysis considered frequency analysis and central trend measures. The Chi-square and Fisher tests were used for comparison of proportions. Results: Data from 46 patients were recorded. The average age was 55.5 months. The main indication for initiating the PN was the decrease of the intestinal surface (78.3%). 63% of the patients were hospitalized. No signi ficant differences were found between the place of treatment and the nutritional status and catheter infections variables in the last year. Conclusions: The prevalence of patients with long-term PN and their clinical characteristics were identified. No differences were found to support the administration of this treatment in the hospital over the home. Public policies must be developed to guarantee the option of receiving this treatment at home.

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          Short bowel syndrome and intestinal failure: consensus definitions and overview.

          Short bowel syndrome (SBS)-associated intestinal failure is a highly disabling condition that impairs quality of life and social integration. Although the condition is not uniformly fatal, it might lead to serious, life-threatening complications. The basic goals of medical treatment are to maintain fluid, electrolyte, and nutrient balances and to make appropriate modifications in disease management to avoid side effects. Various definitions have been proposed for SBS and intestinal failure within the medical literature, but many focus on different aspects of the conditions, leading to confusion. In the past, identifying the cause of intestinal failure was of little consequence, because all patients were managed on total parenteral nutrition at home. However, with the recent development of medical therapies such as recombinant growth hormone, octreotide, and glucagon-like peptide-2 analogues and with improvements in small bowel transplantation, many patients can be made nutritionally autonomous. To evaluate the relative efficacy of these therapies, there is now a need to develop consensus definitions so that patients can be properly categorized before therapy. To this end, a group of experts on the subject was convened to develop the following new definitions: "Intestinal failure results from obstruction, dysmotility, surgical resection, congenital defect, or disease-associated loss of absorption and is characterized by the inability to maintain protein-energy, fluid, electrolyte, or micronutrient balance." "Short-bowel syndrome results from surgical resection, congenital defect, or disease-associated loss of absorption and is characterized by the inability to maintain protein-energy, fluid, electrolyte, or micronutrient balances when on a conventionally accepted, normal diet."
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            Prevalence of Home Parenteral and Enteral Nutrition in the United States

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              Ethanol locks to prevent catheter-related bloodstream infections in parenteral nutrition: a meta-analysis.

              Patients with pediatric intestinal failure (IF) depend on parenteral nutrition for growth and survival, but are at risk for complications, such as catheter-related bloodstream infections (CRBSIs). CRBSI prevention is crucial, as sepsis is an important cause of IF-associated liver disease and mortality. We aim to estimate the pooled effectiveness and safety of ethanol locks (ELs) in comparison with heparin locks (HLs) with regard to CRBSI rate and catheter replacements for pediatric IF patients with chronic parenteral nutrition dependence. A systematic review without language restriction was performed on Medline (1948-2010), Embase (1980-2010), and conference programs and trial registries up to December 2010. Search terms included "Catheter-Related Infections," "Catheter," "Catheters, Indwelling," "alcohol," "ethanol," and "lock." Two authors identified 4 retrospective studies for the pediatric IF population. Double, independent data extraction using predefined data fields and risk of bias assessment (Newcastle-Ottawa scale) was performed. In comparison with HLs, ELs reduced the CRBSI-rate per 1000 catheter days by 7.67 events and catheter replacements by 5.07. EL therapy decreased the CRBSI rate by 81% and replacements by 72%. One hundred eight to 150 catheter days of EL exposure were necessary to prevent 1 CRBSI and 122 to 689 days of exposure avoided 1 catheter replacement. Adverse events were rare and included thrombotic events. In pediatric patients with IF, EL is a more effective alternative to HL. Adverse events include thrombotic events.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Journal
                rcp
                Revista chilena de pediatría
                Rev. chil. pediatr.
                Sociedad Chilena de Pediatría (Santiago, , Chile )
                0370-4106
                January 2019
                : 0
                : 0
                Affiliations
                [1] Santiago Santiago de Chile orgnamePontificia Universidad Católica de Chile orgdiv1Escuela de Medicina orgdiv2Departamento de Nutrición, Diabetes y Metabolismo Chile
                [3] Santiago orgnameHospital Sótero del Río orgdiv1Servicio de Pediatría orgdiv2Programa de Nutrición Infantil Chile
                [4] orgnameMinisterio de Salud orgdiv1Departamento de Nutrición y Alimentos Chile
                [2] Santiago Santiago de Chile orgnamePontificia Universidad Católica de Chile orgdiv1Escuela de Medicina orgdiv2Departamento de Gastroenterología y Nutrición, División de Pediatría Chile
                [5] Santiago Santiago de Chile orgnamePontificia Universidad Católica de Chile orgdiv1Facultad de Medicina orgdiv2Departamento de Salud Pública Chile
                Article
                00211 S0370-41062019005000211
                10.32641/rchped.v90i1.800
                75a8725c-9613-4fc2-8044-05cc796fcf77

                This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

                History
                : 28 June 2018
                : 25 October 2018
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 27, Pages: 0
                Product

                SciELO Chile


                Nutrición parenteral prolongada,nutrición parenteral domiciliaria en pediatría,insuficiencia intestinal,registro,Long-term parenteral nutrition,pediatric home parenteral nutrition,intestinal insufficiency,registry

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