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J M Moreno Villares

Publications and source records attributed to J M Moreno Villares.

At least 19 recordsLinked to original sources
PubMed2006

[Home enteral nutrition in Spain. Results of the register of the Spanish Society of Pediatric Gastroenterology, Hepatology and Nutrition in 2003].

INTRODUCTION: The number of children receiving prolonged home enteral nutrition (HEN) is increasing. However, precise information on the incidence and prevalence of HEN in Spain is lacking. Consequently, the Spanish Society of Pediatric Gastroenterology, Hepatology and Nutrition created a patients' register (NEPAD). The aim of the present study was to analyze the results of the first year of the NEPAD register (2003). MATERIAL AND METHODS: The NEPAD is an on-line register that gathers information on the indications for HEN, route of access, type of diet and duration of nutritional support. Quantitative data are expressed as mean and standard deviation, and qualitative data as percentages. RESULTS: In 2003, 124 children from 6 hospitals were registered. The mean age at the beginning of HEN was 3.6 years. The underlying disease was gastrointestinal in 20%, neurological or mental retardation in 20%, cystic fibrosis in 14.5%, tumor in 11%, innate error of metabolism in 10%, congenital cardiac disease in 6%, severe primary malnutrition in 6%, and other causes in 13%. A nasogastric tube was used as the first route of access in 56%, and gastrostomy was used in 42%. Sixty percent of the children received continuous nocturnal enteral nutrition and 90% used an infusion pump. The type of feeding consisted of blenderized natural food in 14%, polymeric pediatric formula in 50%, and infant formulae in 18%. On December 31st, 84 children continued to receive enteral nutrition (68%). CONCLUSIONS: Despite the efforts made to maintain the on-line national register, it has been underused in its first year of existence (2003). Patients with gastrointestinal or neurological diseases constitute the main group of patients in the register. There is a slight preference for the use of nasogastric tube over gastrostomy.

Adolescent↗
PubMed2006

[Growth in infants with cow's milk allergy].

INTRODUCTION: Approximately 2-3 % of infants develop cow's milk allergy (CMA). Treatment consists of eliminating milk from the diet. Some studies have shown growth failure in children with CMA and a milk-free diet. OBJECTIVES: To evaluate growth status at 1 and 2 years of age in infants diagnosed with CMA. MATERIAL AND METHODS: An observational, longitudinal, retrospective study of all infants diagnosed with CMA from 2000-2001 was performed. The following data were analyzed: chronology and type of feeding, the presence of allergy to other foods, atopic dermatitis or other symptoms of allergy, duration of CMA, and anthropometric data (weight and height) at diagnosis, and at 1 and 2 years of age. Anthropometric data were expressed as Z-scores. RESULTS: A total of 141 infants (71 boys and 70 girls) were studied. Atopic dermatitis was found in 67 infants (47.5%) and wheezing in 36 (25.5%). Allergy to foods other than milk was found in 27%. Only 21.3% of the infants grew out of CMA at the age of 2 years, of which 37% did so in the first year of life. Z-scores for weight were -0.5 at birth, -0.25 at the first follow-up visit, -0.25 at 1 year, and -0.19 at 2 years. Z-scores for height were 10.26 at the first follow-up visit, 10.64 at 1 year, and 10.35 at 2 years. A significant difference in Z scores for weight was found in infants with allergies to other foods, atopic dermatitis or wheezing compared with those with CMA only. CONCLUSIONS: Infants with CMA receiving a substitute formula (hydrolyzed or soy formulae) showed normal weight and height at 2 years, although the percentile for height tended to be better than that for weight. The presence of other food allergies, atopic dermatitis or wheezing seems to affect the nutritional status of infants with CMA.

Anthropometry↗
PubMed2006

[Childhood obesity. Recommendations of the Nutrition Committee of the Spanish Association of Pediatrics. Part I. Prevention. Early detection. Role of the pediatrician].

Obesity is a pathologic entity characterized by an increase in fat body mass and is a global public health problem. In Spain, between 1984 (the Paidos study) and 2000 (the enKid study), the prevalence of childhood overweight and obesity increased and significant differences were found among the autonomous communities. Consequently prophylactic measures were implemented throughout the country and in 2005 the Ministry of Health developed the NAOS strategy (strategy for nutrition, physical activity and obesity prevention). Within the medical area of this intervention, primary care pediatricians acquire a key role. Aware of this, the Spanish Association of Pediatrics, through the Nutrition Committee, aims to provide information on the current situation concerning the etiopathogenesis and early identification of at-risk populations. The epidemiology and risk periods in the pediatric age group are reviewed and recommendations on healthy lifestyle are provided, bearing in mind diet and physical activity throughout childhood, with the aim of preventing overweight and obesity.

Child↗
PubMed2004

[Therapeutic alternatives in intestinal failure].

BACKGROUND: Long-term parenteral nutrition is effective in the treatment of intestinal failure. Equally, the results of intestinal transplantation (IT) are promising. The choice of one or other form of treatment depends on the balance between the advantages and disadvantages of each. Based on these premises, we analyzed the outcome of home parenteral nutrition (HPN) for intestinal failure in our patients. METHODS: Intestinal failure was considered when parenteral nutrition was required for more than 5 months. In the 14 patients included in the HPN program since 1993, we reviewed the indication of HPN as well as their suitability for IT. RESULTS: Five of the 14 patients received HPN for causes other than intestinal failure. Of the remaining nine patients, four had severe motility disorder, three had short bowel syndrome, and two had protracted diarrhea of infancy. All these patients would be potential candidates for IT. Five patients were weaned off HPN because of intestinal adaptation between 2.5 and 13 months after starting HPN. One patient died because of lack of venous access. Three patients currently continue on HPN. CONCLUSION: Intestinal rehabilitation constitutes the best option for patients with intestinal failure. HPN offers the best interim treatment while waiting for adaptation. IT should be reserved for those patients with severe complications due to HPN. Nevertheless, it may become a real option for those with indefinite HPN. HPN and IT should be considered as complementary treatments.

Child, Preschool↗
PubMed2003

Home enteral nutrition in adults: a European multicentre survey.

AIMS: This study was undertaken to report indications and practice of home enteral nutrition (HEN) in Europe. METHODS: A questionnaire on HEN practice was sent to 23 centres from Belgium (B), Denmark (D), France (F), Germany (G), Italy (I), Poland (P), Spain (S) and the United Kingdom (UK). This involved adult patients newly registered in HEN programme from 1 January 1998 to 31 December 1998. RESULTS: A total of 1397 patients (532 women, 865 men) were registered. The median incidence of HEN was 163 patients/million inhabitants/year (range: 62-457). Age distribution was 7.5%, 16-40 years; 37.1%, 41-65 years; 34.5%, 66-80 years and 20.9% >80 years. The chief underlying diseases were a neurological disorder (49.1%), or head and neck cancer (26.5%); the main reason for HEN was dysphagia (84.6%). A percutaneous endoscopic gastrostomy (58.2%) or a naso-gastric tube (29.3%) were used to infuse commercial standard or high energy diets (65.3%), or fibre diets (24.5%); infusion was cyclical (61.5%) or bolus (34.1%). Indications and feeds were quite similar throughout the different centres but some differences exist concerning the underlying disease. There was greater variation in the choice of tubes and mode of infusion. In F, G, I, S, and UK, costs of HEN are fully funded. In B, D, and P patients have to pay part or all of the charges. CONCLUSIONS: In Europe, HEN was utilised mainly in dysphagic patients with neurological disorders or cancer, using a standard feed via a PEG. However, there were important differences among the countries in the underlying diseases treated, the routes used, the mode of administration and the funding.

Adolescent↗
PubMed2003

[A bioethics curriculum for the pediatric residency program: experience of a university hospital].

BACKGROUND: Pediatric education should be fully committed to being humanistically as well as scientifically responsive to the needs of the times. Although interest in bioethical issues in clinical practice has increased, ethical problem solving is not usually taught in residency training programs. OBJECTIVE: To describe the implementation of a bioethics training program in our department of pediatrics. METHODS: We designed a program that took into account the difficulties that such a program might face: time constraints, inadequate training in ethics among medical staff and, sometimes, residents' attitudes towards a formal program. RESULTS: Throughout the last four years, six to seven ethics sessions per year were scheduled. The contents included traditional topics in medical ethics (i.e. treatment refusal in adolescents or clinical trials involving minors) as well as issues that confront residents during their training (informed consent, confidentiality, etc.). These ethics sessions were based on clinical cases and were integrated into the existing meetings timetable (daily meetings from Monday to Thursday between October and June) and were prepared by the residents themselves. CONCLUSIONS: The implementation of a bioethics component, using a modified case-based approach, in our pediatric residency program was satisfactory.

Bioethics↗
PubMed2003

[Should the therapeutic effort in artificial nutrition be limited?].

BASIS: There exists general agreement among the experts in Bioethics in order not to maintain a treatment if it is considered that it is useless. However, there is no unanimity about if serotherapy, enteral nutrition (EN), and parenteral nutrition (PN) are really therapeutic measures or else they are measures that they are part of the concept of palliative care. OBJECTIVE: Know the opinion of users and health workers of National Health System (NHS) in these issues. DESIGN: Cross-sectional descriptive study. AREA: Primary and specialized care. METHODS: A survey was distributed to 219 individuals (84 users of the NHS, 135 health workers), that it included sociodemographic parameters, the opinion on different aspects of ethics and nutritional support, and the measures regarded as palliative care. RESULTS: The majority of the respondents think that the EN (70.8%; 95% IC: 64.2-76.8) and PN (54.8%; 95% IC: 47.9-61.6) are part of the basic care, with differences between the health personnel and the users of the NHS. 50.2% considers that there are no differences between applying or removing nutritional support. 71.3% of the health professionals answer that this decision depends on the medical, 60.5% of the users of the NHS thinks that it depends on the patient himself and/or its family members. All the evaluated measures are regarded as basic care, regardless of the characteristics of the respondent. CONCLUSIONS: Artificial nutrition is understood as a basic care, regardless of the situation and quality of life of the patient. While the health professionals think that the decision to initiate/to retire artificial nutrition depends on the physician, the users of the NHS consider that it depends on the patient/family in case of disability of this.

Adult↗
PubMed2002

Central venous catheter complications in 447 patients on home parenteral nutrition: an analysis of over 100.000 catheter days.

RATIONALE: The purpose of this study is to report the frequency of central venous catheter (CVC) complications and to analyze the potential risk factors for complications requiring CVC removal in home parenteral nutrition (HPN) patients. METHODS: A questionnaire developed by the ESPEN HAN WORKING GROUP was distributed to 12 European centers to investigate the complications occurring during the period between January 1995 and December 2000 when HPN patients used their first CVC. The questionnaire collected informations related to the Home Parenteral Nutrition technique and the underlying disease. Factors affecting the time of CVC removal were jointly investigated using Cox's multivariable regression models. RESULTS: The study was performed on 447 patients for a total of 110869 CVC-days. Complications occurred in about 1/4 of patients, approximately half were infections and about half required Central Venous Catheter removal. The Cox analysis showed that using the CVC 7 times/week and implanted ports were associated with a hazard ratio of 3 and 2.8, respectively. A reduced risk of removal (of about 40%) was associated with using CVC also for non-nutritional purposes (P = 0.0016). CONCLUSIONS: Within the limits of this retrospective investigation, the type of CVC, the type of administration of HPN and the type of training are important factors associated with occurrence of complications or with CVC removal. However, in our opinion, proper care of the CVC, of preparation and administration of the nutritive admixture seem to be paramount for a safe management of HPN.

Adult↗
PubMed2002

[Diencephalic syndrome: An uncommon cause of malnutrition].

Diencephalic syndrome (DS) is a complex of signs and symptoms related to hypothalamic dysfunction. Its main features are emaciation despite normal energy intake and an alert appearance. This syndrome has been described in association with space-occupying lesions of the hypothalamic-optic chiasm region, mainly low-grade glioma, and less often with tumors in the proximity of the IV ventricle. Two patients with DS are reported. The first patient was an 8-month old boy with classical features of DS. Extensive investigation of malabsorption revealed no abnormalities and the first neurologic sign was a rotatory nystagmus. Magnetic resonance imaging (MRI) showed evidence of a hypothalamic tumor, which was identified after surgical resection as a pilocytic astrocytoma. The second patient was an adolescent boy who presented a 20-kg weight loss over a 6-month period and psychological disturbances. Gastrointestinal disease was ruled out as a cause of malnutrition. Because of a polydipsia-polyuria syndrome, manifest while the patient was hospitalized with a suspected diagnosis of anorexia nervosa, MRI of the brain was performed. Multiple intracranial lesions were revealed, mainly in the hypothalamus, and were identified as a disseminated disgerminoma. No neurologic signs or symptoms were present. The patients died 2 years and 1 year after diagnosis, respectively. Although DS is rare, it should be considered in severe failure to thrive or emaciation despite adequate food intake and normal absorptive function of the small bowel.

Adolescent↗
PubMed2002

[Pediatric parenteral nutrition: are standard solutions better than individualized ones?].

OBJECTIVE: Pediatric parenteral nutrition (PN) in Spain has traditionally been prescribed and made up on an individual basis. This practice entails daily indication of the quantity of each of the components of the PN bag as well as precise calculations for its formulation and preparation. The main advantages of individualized prescriptions are their flexibility and precise biochemical control. The aim of this study was to determine whether pediatric PN can be standardized in a tertiary care hospital. PATIENTS AND METHODS: We reviewed the composition of all the pediatric PN bags prepared in our hospital from 1.1.1996 to 31.12.1998. Each individual prescription was compared with a standard PN fulfilling the following criteria: a) Holiday-Segar equation for volume; b) 1 kcal/ml (10 %), and c) macronutrient distribution: 8-15 % amino acids, 55-65 % dextrose; 30-35 % lipids. The results of this comparison were used to estimate the number of bags fulfilling all three criteria and those that fulfilled only the third. We also reviewed the distribution of PN bags prepared according to the protocol used in our center which allows three options: standard PN, individualized prescription, and individualized prescription except electrolytes, supplied in fixed concentrations per liter of PN. RESULTS: Five hundred fifty-four patients received 7,921 PN bags. The mean duration of PN was 14.3 days and the mean number of PN per day was 7.2. Only 4.5 % fulfilled all three criteria but 16.2 % satisfied at least the last criterion. If the three criteria for standardization were applied, only one PN bag/day could be prepared. Analysis of the application of our protocol revealed that of all the PN bags prepared only 27.9 % were partially or totally standardized. However, exclusion of neonates increased this figure to 53.2 %. CONCLUSIONS: If rigid standardization criteria are applied, only a small number of PN bags can be prepared in a tertiary hospital. Combining both standard and tailored PN could reduce pharmacy workload and costs while maintaining flexibility.

Follow-Up Studies↗
PubMed1999

[Liver complications associated with short-term parenteral nutrition in children].

OBJECTIVE: Liver dysfunction (LD) with abnormalities in biochemical liver function tests is the most common metabolic complication of parenteral nutrition (PN). The aim of this study was to estimate the prevalence of LD in children receiving short-term PN and to identify risk factors. PATIENTS AND METHODS: Data were gathered retrospectively during a 2-year period. Ninety-four children older than 28 days received PN (mean age 5.4 +/- 5.1 years). PN related LD was defined as when serum levels of one or more of the following liver function tests were increased: ALT > or = 80 IU/L, GGT > or = 120 IU/L and total bilirubin > or = 1.8 mumol/L. Children with previous liver disease were excluded (n = 17), as well as those with incomplete data (n = 16). RESULTS: LD was present in 33 children (54%). The incidence rate was 5.8 cases/100 patient days of PN. It started 9.8 +/- 6.9 days after beginning PN. The nadir appeared during the second week of PN. The following variables did not appear to significantly influence the presence of PN: age, gender, nutritional status, PN caloric load or composition and underlying disease. Length of PN (9.6 +/- 4.4 vs 19.5 +/- 10.5 days; p < 0.001) and presence of sepsis (21% vs 55%, p = 0.014) were the only variables associated with LD. It was not necessary to discontinue PN because of LD in any case. CONCLUSIONS: Early LD is present in more than 50% of our children on PN. In preventing LD we should try to avoid infection and to reduce the time on PN.

Adolescent↗