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      Síndrome de realimentación en niña con parálisis cerebral Translated title: Refeeding syndrome in a girl with cerebral palsy

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          Abstract

          Resumen El síndrome de realimentación es una complicación grave y potencialmente mortal asociada a la terapia nutricional por vía oral, enteral o parenteral. Afecta a pacientes con desnutrición severa o en riesgo de desnutrición, como aquellos con parálisis cerebral infantil. Presentamos el caso de una paciente de ocho años con parálisis cerebral que ingresó por hipoglucemia severa y que, tras iniciar la alimentación enteral por sonda nasogástrica, desarrolló un síndrome de realimentación. En niños con parálisis cerebral es fundamental valorar la presencia de factores de riesgo para desarrollar un síndrome de realimentación, iniciar la alimentación de manera progresiva y monitorizar los iones séricos.

          Translated abstract

          Abstract Refeeding syndrome is a serious and life-threatening complication associated with oral, enteral and parenteral nutritional therapy. It appears in severely malnourished patients or in those at risk of malnutrition, such as persons with cerebral palsy. We present the case of an 8-year-old girl with cerebral palsy who was admitted with severe hypoglycemia. After starting enteral nutrition by nasogastric tube, she developed refeeding syndrome. In children with cerebral palsy, it is essential to assess the presence of risk factors for refeeding syndrome before starting any nutritional support, and then start feeding progressively and monitor serum electrolytes.

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          Most cited references15

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          ASPEN Consensus Recommendations for Refeeding Syndrome

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            Nutrition in clinical practice-the refeeding syndrome: illustrative cases and guidelines for prevention and treatment.

            The refeeding syndrome is a potentially lethal complication of refeeding in patients who are severely malnourished from whatever cause. Too rapid refeeding, particularly with carbohydrate may precipitate a number of metabolic and pathophysiological complications, which may adversely affect the cardiac, respiratory, haematological, hepatic and neuromuscular systems leading to clinical complications and even death. We aimed to review the development of the refeeding syndrome in a variety of situations and, from this and the literature, devise guidelines to prevent and treat the condition. We report seven cases illustrating different aspects of the refeeding syndrome and the measures used to treat it. The specific complications encountered, their physiological mechanisms, identification of patients at risk, and prevention and treatment are discussed. Each case developed one or more of the features of the refeeding syndrome including deficiencies and low plasma levels of potassium, phosphate, magnesium and thiamine combined with salt and water retention. These responded to specific interventions. In most cases, these abnormalities could have been anticipated and prevented. The main features of the refeeding syndrome are described with a protocol to anticipate, prevent and treat the condition in adults.
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              Practical approach to paediatric enteral nutrition: a comment by the ESPGHAN committee on nutrition.

              Enteral nutrition support (ENS) involves both the delivery of nutrients via feeding tubes and the provision of specialised oral nutritional supplements. ENS is indicated in a patient with at least a partially functioning digestive tract when oral intake is inadequate or intake of normal food is inappropriate to meet the patients' needs. The aim of this comment by the Committee on Nutrition of the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition is to provide a clinical practice guide to ENS, based on the available evidence and the clinical expertise of the authors. Statements and recommendations are presented, and future research needs highlighted, with a particular emphasis placed on a practical approach to ENS.Among the wide array of enteral formulations, standard polymeric feeds based on cow's-milk protein with fibre and age adapted for energy and nutrient content are suitable for most paediatric patients. Whenever possible, intragastric is preferred to postpyloric delivery of nutrients, and intermittent feeding is preferred to continuous feeding because it is more physiological. An anticipated duration of enteral nutrition (EN) exceeding 4 to 6 weeks is an indication for gastrostomy or enterostomy. Among the various gastrostomy techniques available, percutaneous endoscopic gastrostomy is currently the first option. In general, both patients and caregivers express satisfaction with this procedure, although it is associated with a number of well-recognised complications. We strongly recommend the development and application of procedural protocols that include scrupulous attention to hygiene, as well as regular monitoring by a multidisciplinary nutrition support team to minimise the risk of EN-associated complications.
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                Author and article information

                Journal
                asisna
                Anales del Sistema Sanitario de Navarra
                Anales Sis San Navarra
                Gobierno de Navarra. Departamento de Salud (Pamplona, Navarra, Spain )
                1137-6627
                December 2021
                : 44
                : 3
                : 469-474
                Affiliations
                [1] Santander orgnameHospital Universitario Marqués de Valdecilla orgdiv1Servicio de Pediatría España
                Article
                S1137-66272021000300469 S1137-6627(21)04400300469
                10.23938/assn.0949
                34132250
                c6a27032-71e2-412f-a1c5-e7bb22354fa8

                This work is licensed under a Creative Commons Attribution-NonCommercial 3.0 International License.

                History
                : 24 March 2021
                : 13 November 2020
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 15, Pages: 6
                Product

                SciELO Spain

                Categories
                Notas Clínicas

                Niño,Parálisis cerebral,Síndrome de realimentación,Hipofosfatemia,Child,Cerebral palsy,Refeeding syndrome,Hypophosphatemia

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