Percutaneous Endoscopic Gastrostomies in Children

PEDIATRICS ◽  
1986 ◽  
Vol 77 (2) ◽  
pp. 248-250
Author(s):  
KEITH J. BENKOV ◽  
PHILLIP G. KAZLOW ◽  
JEROME D. WAYE ◽  
NEAL S. LELEIKO
Keyword(s):  
Nutritional Status ◽  
Parenteral Nutrition ◽  
Lower Cost ◽  
Chronically Ill ◽  
Term Therapy ◽  
Short Term ◽  
Relative Ease ◽  
Enteral Feedings ◽  
Chronically Ill Children

Our ability to maintain the nutritional status of acute and chronically ill children is enhanced by advances in special enteral feedings.1-3 When compared with parenteral nutrition, enteral feedings are accompanied by fewer complications, the ability to deliver large quantities of nutrients, relative ease of administration, and lower cost.2,3 Nasogastric feedings are very manageable for short-term therapy; however, in those patients requiring long-term support, a feeding gastrostomy can offer several advantages.4 Feeding gastrostomies have traditionally been placed via laparotomy under general anesthesia.5 We would like to describe our experience, as pediatric gastroenterologists and endoscopists, in the use of this technique in children.

scholarly journals Parenteral Nutrition and Oxidant Load in Neonates

Nutrients ◽  
2021 ◽  
Vol 13 (8) ◽  
pp. 2631
Author(s):  
Kandeepan Karthigesu ◽  
Robert F. Bertolo ◽  
Robert J. Brown
Keyword(s):  
Parenteral Nutrition ◽  
Storage Temperature ◽  
Oral Feeding ◽  
Published Data ◽  
Short Term ◽  
Antioxidant Defences ◽  
Term Survival ◽  
Nutrient Sources ◽  
Short Term Survival

Neonates with preterm, gastrointestinal dysfunction and very low birth weights are often intolerant to oral feeding. In such infants, the provision of nutrients via parenteral nutrition (PN) becomes necessary for short-term survival, as well as long-term health. However, the elemental nutrients in PN can be a major source of oxidants due to interactions between nutrients, imbalances of anti- and pro-oxidants, and environmental conditions. Moreover, neonates fed PN are at greater risk of oxidative stress, not only from dietary sources, but also because of immature antioxidant defences. Various interventions can lower the oxidant load in PN, including the supplementation of PN with antioxidant vitamins, glutathione, additional arginine and additional cysteine; reduced levels of pro-oxidant nutrients such as iron; protection from light and oxygen; and proper storage temperature. This narrative review of published data provides insight to oxidant molecules generated in PN, nutrient sources of oxidants, and measures to minimize oxidant levels.

Outcome of Short-Term and Long Term Antibiotic Prophylaxis in Colostomy Closure

2016 ◽  
Vol 4 (2) ◽  
pp. 43-48
Author(s):  
Md Jamal Saleh Uddin ◽  
Sukumar Chakrabarti ◽  
Md Shahidul Islam
Keyword(s):  
Antibiotic Prophylaxis ◽  
Wound Infection ◽  
Anorectal Malformation ◽  
Hirschsprung's Disease ◽  
Hirschsprung’S Disease ◽  
Colostomy Closure ◽  
Term Therapy ◽  
Short Term ◽  
Sigmoid Colostomy

Background and Objectives: Antibiotic prophylaxis is a common practice in children undergoing colostomy closure for anorectal malformation, Hirschsprung's disease. Traditionally, antibiotics are given for unnecessarily longer period of time, which consumes scarce health resources having alternate efficient use. The present study was undertaken to compare the outcome between short-term and long-term antibiotic prophylaxis in colostomy closure. Materials & Methods: This randomized clinical trial was conducted in Dhaka Shishu Hospital, Dhaka over a period of 15 months from April 2001 to June 2002. Children admitted with anorectal malformation, Hirschsprung's disease for colostomy closures were the study population. However, immuno-compromised children or children already getting antibiotics were excluded from the study. A total of 46 such children were consecutively included and were randomly allocated to long-term group (n = 21) and short-term group (n = 25). The long-term group received antibiotic up to 5th postoperative day, while the short-term group received the same antibiotic up to 2nd postoperative day. Transverse colostomy was the main procedure employed in colostomy closure; however, a few patients required sigmoid colostomy. The outcome measures were incidence of wound infection, hospital stay and cost of treatment. Result: Majority of the children were between 1 - 5 years of age (75% in short-term and 50% in long-term group) followed by under 1 year (10% in short-term and 40% in long-term group) and > 5 years (15% in short-term and 10% in long-term group). The overall male to female ratio was 3:1. Majority (85%) of the patients in both long­term and short-term groups belonged to lower income group. Over half (52.2%) of the children had anorectal malformations (ARM) and the rest (47.8%) had Hirschsprung's disease (HD). Children were generally malnourished according to Gomez classification. Majority (91%) was operated on by transverse colostomy and few (9%) by sigmoid colostomy. Three patients in each group developed postoperative wound infection. Blood culture of none of these patients yielded growth of any organism, though wound swab culture did so in 5 cases out of 6 infected patients. In 2 cases, the organism was E.coli, in 2 cases, it was Pseudomonas and in one case Staph. aureus. Total cost of antibiotics in short-term therapy was less than 50% of that required in long-term therapy. The outcome in terms of recovery, complications and postoperative hospital stay was no different between groups. Conclusion: The study concluded that short-term antibiotic prophylaxis is as efficacious as long-term in preventing wound infection in patients with colostomy closure for anorectal malformation and Hirschsprung's disease. Short-term antibiotic prophylaxis is cost-effective Ibrahim Cardiac Med J 2014; 4(2): 43-48

scholarly journals Diagnosis and management of catheter-related bloodstream infections in patients on home parenteral nutrition

2019 ◽  
Vol 11 (1) ◽  
pp. 48-54 ◽  
Author(s):  
Ashley Bond ◽  
Paul Chadwick ◽  
Trevor R Smith ◽  
Jeremy M D Nightingale ◽  
Simon Lal
Keyword(s):  
Parenteral Nutrition ◽  
Bloodstream Infections ◽  
Venous Catheter ◽  
Nutrition Support ◽  
Central Venous ◽  
Short Term ◽  
Qualitative And Quantitative ◽  
Central Venous Catheter Removal ◽  
Support Team

Catheter-related bloodstream infections (CRBSIs) commonly arise from a parenteral nutrition catheter hub. A target for a Nutrition Support Team is to have a CRBSI rate of less than 1 per 1000. The diagnosis of CRBSI is suspected clinically by a temperature shortly after setting up a feed, general malaise or raised blood inflammatory markers. It is confirmed by qualitative and quantitative blood cultures from the catheter and peripherally. Treatment of inpatients may involve central venous catheter removal and antibiotics for patients needing short-term parenteral nutrition, but catheter salvage is generally recommended for patients needing long-term parenteral nutrition, where appropriate.

Clinical and Pharmacokinetic Evaluation of Long-Term Therapy With Didanosine in Children with HIV Infection

PEDIATRICS ◽  
1994 ◽  
Vol 94 (5) ◽  
pp. 724-731 ◽  
Author(s):  
Brigitta U. Mueller ◽  
Karina M. Butler ◽  
Vicki L. Stocker ◽  
Frank M. Balis ◽  
Philip A. Pizzo ◽  
...  
Keyword(s):  
Hiv Infection ◽  
Area Under The Curve ◽  
Chronic Administration ◽  
Cd4 Count ◽  
Term Therapy ◽  
Short Term ◽  
Apparent Relationship ◽  
Term Administration ◽  
Long Term Therapy

Background. Didanosine has demonstrated promising antiviral activity and a tolerable toxicity profile in short term studies. We describe a cohort of HIV-infected children who were treated for a prolonged period of time with didanosine. Methods. Children (6 months to 18 years of age) with symptomatic HIV infection or an absolute CD4 count < 0.5 x 109 cells/L, received oral didanosine at doses between 20 mg/m2 to 180 mg/m2 every 8 hours. Clinical, immunological, and virological parameters were assessed at least every 2 months. The pharmacokinetics of didanosine were evaluated in 85 patients. Results. Previously untreated children (n = 51) and children who had received prior antiretroviral therapy (n = 52) were enrolled in the study (median time on study 22.6 months; range 2 to 48). The long-term administration of didanosine was well tolerated and no new toxicities were observed. The absolute CD4 count increased by ≥ .05 x 109 cells/L in 28 of 87 (32%) of patients after 6 months of therapy. Responses were also sustained in 41% of these children after 3 years of therapy. Children entering the study with a CD4 count >0.1 x 109 cells/L (n = 51) had a marked survival advantage (P = .00002) with an estimated survival probability after 3 years of 80% compared to 39% for children with lower CD4 counts. Although the area under the curve of didanosine increased proportionally with the dose, there was considerable interpatient variability at each dose level. There was no apparent relationship between surrogate markers of clinical outcome and plasma drug concentration. Conclusions. Didanosine was well tolerated with chronic administration, and toxicities were uncommon and usually reversible. In 41% of patients, the CD4 count increased and was maintained at the higher level even after years of treatment.

Short-term and long-term variability of indices related to nutritional status. I: Ca, Cu, Fe, Mg, and Zn.

1989 ◽  
Vol 35 (3) ◽  
pp. 369-373 ◽  
Author(s):  
S K Gallagher ◽  
L K Johnson ◽  
D B Milne
Keyword(s):  
Superoxide Dismutase ◽  
Nutritional Status ◽  
Iron Status ◽  
Short Term ◽  
Free Living ◽  
Analytical Technique ◽  
Metabolic Unit ◽  
Biological Component ◽  
Analytical Variation

Abstract Five free-living women (ages 28-38 y) and five women (ages 23-44 y) residing in a metabolic unit and eating a constant diet were assessed for variation in indices related to mineral nutrition. Blood was sampled once a month for five months, once a week for five weeks, and once a day for five days to assess analytical and biological variability. Analytical variability was determined by using concurrently run duplicate control samples prepared from plasma or serum pools. Of the measured indices, serum ferritin varied most, with intra-individual variance of 4.72% to 18.0%. Much of this variance may have been because of changes in iron status or in the analytical technique used. Intra-individual month-to-month variance for other indices ranged from 17% for superoxide dismutase (EC 1.15.1.1) to 1.5% for calcium. Correction for long-term analytical variation indicated that most of the variance was associated with the biological component. The higher biological variabilities of some indices, including ferritin or superoxide dismutase, need to be considered when nutritional status is being evaluated or when serial observations are made over a protracted period in clinical studies or trials.

Time—A Neglected Aspect of Psychiatric Treatments

1978 ◽  
Vol 12 (4) ◽  
pp. 291-295
Author(s):  
O. T. Stanley
Keyword(s):  
Treatment Outcome ◽  
Special Reference ◽  
Latency Period ◽  
Term Therapy ◽  
Psychological Processes ◽  
Short Term ◽  
Therapeutic Implications ◽  
Short Term Therapy ◽  
Difficult Issue

This review attempts to deal with the complex issues involved in the time to heal, with special reference to psychological processes. The questions of convalescence and relapse in organic medicine are explored and extrapolated to psychiatric processes. The concept of a latency period of change in treatment outcome is discussed with reference to both less complicated reactive states as well as highly charged neurotic processes. The problems of recognizing slow but perceptible change and separating it from failure to respond is analysed. The value of long-term psychotherapy is assessed and comparison made with the newer concept of short-term therapy. Crisis therapy and disaster reactions are discussed within the concept of time to heal. Finally the difficult issue of “miraculous cure” with its therapeutic implications is evaluated.

Sign in / Sign up

Export Citation Format

Share Document