Depósito Académico
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Results
- Human bone marrow-derived mesenchymal stromal cells reduce the severity of experimental necrotizing enterocolitis in a concentration-dependent manner(MDPI, 2023) Manzoni, F. (Francesca); Amodeo, I. (Ilaria); Gulden, S. (Silvia); Lonati, C. (Caterina); Mosca, F. (Fabio); Provitera, L. (Livia); Maggioni, M. (Marco); Tomaselli, A. (Andrea); Cerasani, J. (Jacopo); Cavallaro, G. (Giacomo); Pesenti, N. (Nicola); Raffaeli, G. (Genny); Crippa, S. (Stefania); Bernardo, M.E. (Maria Ester); Arribas-Sánchez, C. (Cristina); Amelio, G.S. (Giacomo Simeone); Oldoni, S. (Samanta); Menis, C. (Camilla); Tripodi, M. (Matteo); Cortesi, V. (Valeria); Santi, L. (Ludovica); Algieri, F. (Francesca); Garrido-Martínez-de-Salazar, F. (Felipe); Cervellini, G. (Gaia): Necrotizing enterocolitis (NEC) is a devastating gut disease in preterm neonates. In NEC animal models, mesenchymal stromal cells (MSCs) administration has reduced the incidence and severity of NEC. We developed and characterized a novel mouse model of NEC to evaluate the effect of human bone marrow-derived MSCs (hBM-MSCs) in tissue regeneration and epithelial gut repair. NEC was induced in C57BL/6 mouse pups at postnatal days (PND) 3–6 by (A) gavage feeding term infant formula, (B) hypoxia/hypothermia, and (C) lipopolysaccharide. Intraperitoneal injections of PBS or two hBM-MSCs doses (0.5 × 106 or 1 × 106 ) were given on PND2. At PND 6, we harvested intestine samples from all groups. The NEC group showed an incidence of NEC of 50% compared with controls (p < 0.001). Severity of bowel damage was reduced by hBM-MSCs compared to the PBS-treated NEC group in a concentration-dependent manner, with hBM-MSCs (1 × 106 ) inducing a NEC incidence reduction of up to 0% (p < 0.001). We showed that hBM-MSCs enhanced intestinal cell survival, preserving intestinal barrier integrity and decreasing mucosal inflammation and apoptosis. In conclusion, we established a novel NEC animal model and demonstrated that hBM-MSCs administration reduced the NEC incidence and severity in a concentration-dependent manner, enhancing intestinal barrier integrity.
- Ethical issues about the paradigm shift in the treatment of children with trisomy 18(Springer, 2019) Grimaux, G. (Guadalupe); Robetto, J. (Josefina); Nucifora, L. (Laura); Moreno-Villares, J.M. (José Manuel); Silberberg, A. (Agustín)Until recently, trisomy 18 was considered a disease incompatible with life, with a high percentage of electively terminated pregnancies. The usual behavior was denial of treatment. But some medical interventions have changed the survival of children. A search for articles published in the PubMed database on the latest medical decisions in newborns with trisomy 18 was done. Two main subjects were examined: (1) the chances of survival and (2) the perception of quality of life. Trisomy 18 is no longer considered a disease incompatible with life, and the discussion has shifted towards the type of treatment that is appropriate to initiate at birth. There are two medical attitudes towards these children: either palliative care or life-prolonging interventions. With medical intervention, the survival is as high as 23% at 5 years of age. Regarding the quality of life, all decision-makers emphasize the possibility of taking the child home. The physicians’ perception is more pessimistic than that of the parents. Only a few children benefit from medical interventions. Conclusion: There is a rethinking of treatment behavior in children with trisomy 18. The possible quality of life achieved should be further investigated. It seems inappropriate to simply dismiss medical interventions.
- Experience With Teduglutide in Pediatric Short Bowel Syndrome: First Real-life Data(Wolters Kluwer, 2020) Irastorza-Terradillos, I. (Iñaki); Manrique-Moral, (Oscar); Polo-Miquel, B. (Begoña); Alcolea-Sánchez, A. (Alida); Redecillas-Ferreiro, S. (Susana); González-Sacristán, R. (Rocío); Vives-Piñera, I. (Inmaculada); García-Romero, R. (Ruth); Ramos-Boluda, E. (Esther); Germán-Díaz, M. (Marta); Bautista-Barea, M. (Marta); Núñez-Ramos, R. (Raquel); Moreno-Villares, J.M. (José Manuel)Objectives: The aim of the study was to describe the experience with teduglutide of several Spanish hospitals in pediatric patients with SBS (SBS). Methods: Seventeen pediatric patients with intestinal failure associated with SBS were treated with teduglutide. Patients received 0.05 mg kg1 day1 of subcutaneous teduglutide. Patients’ demographics and changes in parenteral nutrition (PN) needs, fecal losses, and citrulline level initially and at 3, 6, and 12 months were collected, as well as any adverse events. Results: Patients were receiving 55 ml kg1 day1 and 33 kcal kg1 day1 of parenteral supplementation on average at baseline (2 patients received only hydroelectrolytic solution). A total of 12/17 patients achieved parenteral independence: 3 patients after 3 months of treatment, 4 patients at 6 months, and 5 after 12 months. One patient discontinued treatment 1 year after the beginning as no changes in parenteral support or fecal losses were obtained. All others decreased their intravenous requirements by 50%. One patient suffered an episode of cholecystitis, and another one with a pre-existing cardiac disease, developed a cardiac decompensation. Conclusions: Teduglutide seems to be a safe and effective treatment in the pediatric SBS population with better results than in the pivotal study as well as in the adult population.
- Which is the best route to achieve nutritional goals in pediatric ECMO patients?(Elsevier, 2022) Belda-Hofheinz, S. (Sylvia); Martín-Arriscado-Arroba, C. (Cristina); Germán-Díaz, M. (Marta); Oviedo-Melgares, L. (Lidia); López-Fernández, E. (Eduardo); Núñez-Ramos, R. (Raquel); Moreno-Villares, J.M. (José Manuel)Objectives: Estimating caloric intake and choosing route of administration are fundamental in the nutritional support of patients being supported by extracorporeal membrane oxygenation (ECMO). The aim of this study was to review the nutritional intervention carried out in a pediatric cohort in a third-level hospital. Methods: This was a prospective descriptive study. Age, sex, underlying pathology, Pediatric Risk of Mortality score, ECMO indication, type of care, duration of ECMO support, and prognosis were collected. Type of nutritional support, route of administration, kcal/kg achieved, estimated energy requirements, and percentage of caloric objective (%CO) reached on days 3 and 5 after cannulation were recorded. Results: Twenty-four venoarterial ECMO runs in 23 patients over a period of 2 y were recorded. Of the 23 patients, 15 were <1 y of age. The underlying pathology in 56.5% was cardiac disease. Three groups were identified: parenteral nutrition (group 0, n = 7), enteral nutrition (group 1, n = 8), and mixed nutrition (group 2, n = 7). The median of the %CO was 33.34 (0 84) on day 3 and 87.75% (78.4 100) on day 5 of ECMO, respectively for group 0; 75.5 (42.25 98.5) and 85% (24.4 107.7) in group 1 and 68.7 (44.4 82.2) and 91.2% (35.5 92) in group 2 (P > 0.05). Children <12 mo of age and cardiac patients represented 85.71% and 71.43% of total patients in group 0. Among the eight episodes of exclusive enteral nutrition, no complications were identified. Conclusion: Enteral nutrition appears to be safe in the setting of hemodynamic stability and absence of contraindications and is equivalent to other nutritional interventions in terms of compliance with estimated energy requirements.
- Current pain management practices for preterm infants with necrotizing enterocolitis: a European survey(Nature Publishing Group, 2023) Simons, S.H.P. (Sinno H. P.); Meesters, N.J. (Naomi J.); Allegaert, K. (Karel); Vermeulen, M.J. (Marijn J.); Ten-Barge, J.A. (Judith A.); Cavallaro, G. (Giacomo); Raffaeli, G. (Genny); Bosch, G.E. (Gerbrich E.) van den; Arribas-Sánchez, C. (Cristina); Garrido-Martínez-de-Salazar, F. (Felipe)Background: Necrotizing enterocolitis (NEC) is a highly painful intestinal complication in preterm infants that requires adequate pain management to prevent short- and long-term effects of neonatal pain. There is a lack of international guidelines for pain management in NEC patients. Therefore, this study aims to describe current pain management for NEC patients in European neonatal intensive care units (NICUs). Methods: An online survey was designed and conducted to assess current practices in pain management for NEC patients in European NICUs. The survey was distributed via neonatal societies, digital platforms, and professional contacts. Results: Out of the 259 responding unique European NICUs from 36 countries, 61% had a standard protocol for analgesic therapy, 73% assessed pain during NEC, and 92% treated NEC patients with intravenous analgosedatives. There was strong heterogeneity in the used pain scales and initial analgesic therapy, which mainly included acetaminophen (70%), fentanyl (56%), and/or morphine (49%). A third of NICU representatives considered their pain assessment adequate, and half considered their analgesic therapy adequate for NEC patients. Conclusions: Various pain scales and analgesics are used to treat NEC patients in European NICUs. Our results provide the first step towards an international guideline to improve pain management for NEC patients. Impact: This study provides an overview of current pain management practices for infants with necrotizing enterocolitis (NEC) in European neonatal intensive care units. Choice of pain assessment tools, analgosedatives, and dosages vary considerably among NICUs and countries. A third of NICU representatives were satisfied with their current pain assessment practices and half of NICU representatives with their analgesic therapy practices in NEC patients in their NICU. The results of this survey may provide a first step towards developing a European pain management consensus guideline for patients with NEC.
- Dietary Intake of Individual (Intrinsic and Added) Sugars and Food Sources from Spanish Children Aged One to <10 Years—Results from the EsNuPI Study(MDPI, 2022) Martínez-de-Victoria, E. (Emilio); Rodriguez, P. (Paula); Partearroyo, T. (Teresa); Lara-Villoslada, F. (Federico); Ruiz-López, M.D. (María Dolores); Hernández-Ruiz, Á; Redruello-Requejo, M. (Marina); Gil, A. (Ángel); Varela-Moreiras, G. (Gregorio); Samaniego-Vaesken, M.L. (María de Lourdes); Leis, R. (Rosaura); Moreno-Villares, J.M. (José Manuel); Soto-Méndez, M.J. (María José); Ortega, R.M. (Rosa María)Currently, in Spain there are no studies assessing the intakes and sources of intrinsic and added sugars by both children consuming standard milks and children regularly consuming adapted milk formulas. Our goal was to evaluate current sugar intake levels (intrinsic and added) and their major dietary sources within the EsNuPI study participants by applying two 24-h dietary recalls that were completed by 1448 children (1 to <10 years) divided into two subsamples: One “Spanish Reference Sample” (SRS) of the general population (n = 707) and another sample which included children consuming adapted milks including follow-on milk, toddler’s or growing up milk and fortified and enriched milks, here called “Adapted Milk Consumers Sample” (AMS) (n = 741). Estimates of intrinsic and added sugar intakes from the Spanish EsNuPI population as well as the adherence to recommendations varied notably according to age segment, but no major differences between subsamples were found. Younger children (1 to <3 years) showed the highest added sugar contribution to total energy intake (TEI) (SRS: 12.5% for boys and 11.7% for girls; AMS: 12.2% for boys and 11.3% for girls) and the lowest adherence to recommendations set at <10% TEI (SRS: 27.4% for boys and 37.2% for girls; AMS: 31.3% for boys and 34.7% for girls). Adherence increased with age but remains inadequate, with approximately one in two children from the older age segment (6 to <10 years) exceeding the recommendations. Main food sources of intrinsic sugars for both subsamples were milk and dairy products, fruits, vegetables and cereals, while for added sugars, these were milk and dairy products (mainly yogurts), sugars and sweets (mainly sugary cocoa and nougat), bakery products (mainly cookies) and cereals (mainly bread and wheat flour). However, for the AMS, the groups milk and dairy products and cereals showed a significantly lower contribution to intrinsic sugar intake but a significantly higher contribution to that of added sugars. These results demonstrate that sugar intake and the adherence to recommendations in the studied population varied notably according to age but not to the type of milk consumed. In addition, our results highlight the need to monitor the consumption of added sugars by the infant population, as well as the need to make efforts to facilitate this task, such as harmonizing the recommendations regarding free/added sugars and the inclusion of information on their content on the nutritional labeling of products in order to incorporate them into food composition databases.
- Dietary Intake, Nutritional Adequacy, and Food Sources of Protein and Relationships with Personal and Family Factors in Spanish Children Aged One to <10 Years: Findings of the EsNuPI Study(MDPI, 2021) Martínez-de-Victoria, E. (Emilio); Lara-Villoslada, F. (Federico); Madrigal, C. (Casandra); Ruiz-López, M.D. (María Dolores); Hernández-Ruiz, Á; Gil, A. (Ángel); Valero, T. (Teresa); Varela-Moreiras, G. (Gregorio); Leis, R. (Rosaura); Moreno-Villares, J.M. (José Manuel); Soto-Méndez, M.J. (María José); Ortega, R.M. (Rosa María)Diet in the first years of life is an important factor in growth and development. Dietary protein is a critical macronutrient that provides both essential and nonessential amino acids required for sustaining all body functions and procedures, providing the structural basis to maintain life and healthy development and growth in children. In this study, our aim was to describe the total protein intake, type and food sources of protein, the adequacy to the Population Reference Intake (PRI) for protein by the European Food Safety Authority (EFSA), and the Recommended Dietary Allowance (RDA) by the Institute of Medicine (IoM). Furthermore, we analyzed whether the consumption of dairy products (including regular milk, dairy products, or adapted milk formulas) is associated with nutrient adequacy and the contribution of protein to diet and whole dietary profile in the two cohorts of the EsNuPI (in English, Nutritional Study in the Spanish Pediatric Population) study; one cohort was representative of the Spanish population from one to <10 years old (n = 707) (Spanish reference cohort, SRS) who reported consuming all kinds of milk and one was a cohort of the same age who reported consuming adapted milk over the last year (including follow-on formula, growing up milk, toddler’s milk, and enriched and fortified milks) (n = 741) (adapted milk consumers cohort, AMS). The children of both cohorts had a high contribution from protein to total energy intake (16.79% SRS and 15.63% AMS) and a high total protein intake (60.89 g/day SRS and 53.43 g/day AMS). We observed that protein intake in Spanish children aged one to <10 years old was above the European and international recommendations, as well as the recommended percentages for energy intakes. The main protein sources were milk and dairy products (28% SRS and 29% AMS) and meat and meat products (27% SRS and 26% AMS), followed by cereals (16% SRS and 15% AMS), fish and shellfish (8% in both cohorts), eggs (5% SRS and 6% AMS), and legumes (4% in both cohorts). In our study population, protein intake was mainly from an animal origin (meat and meat products, milk and dairy products, fish and shellfish, and eggs) rather than from a plant origin (cereals and legumes). Future studies should investigate the long-term effect of dietary protein in early childhood on growth and body composition, and whether high protein intake affects health later in life.
- The immediate efficacy of inhaled nitric oxide treatment in preterm infants with acute respiratory failure during neonatal transport(2019-04-25) González-Caballero, J.L. (Juan Luis); Lomax, R. (Rachel); Dady, I. (Ian); Garrido-Martínez-de-Salazar, F. (Felipe)Aim: The aim of our review was to describe the clinical response to inhaled nitric oxide (iNO) in a series of preterm babies in respiratory failure during uplift transfers to a neonatal intensive care unit. Methods: We performed a retrospective review of critical newborns with gestational age <34+0 weeks transferred from January 2013 to December 2018. Data were extracted from our Clinical Information System for transport. The primary measure of this review was to assess whether a significant improvement in the oxygenation saturation index (OSI) occurred following the use of iNO. Results: Thirty preterm babies <34+0 weeks were included in our review. OSI, as a measure of oxygenation, did not statistically improve as an immediate response to iNO from referral to receiving hospital (17.1 vs 16.4; P = .7). We found that pH (7.15 vs 7.29; P = .004) and pCO2 (8.1 vs 6.3; P = .05) significantly improved probably based on ventilation management. Conclusion: Following the recommendations of the American Academy of Paediatrics and other organizations, iNO should not routinely be used during the neonatal transfer of preterm babies <34+0 in respiratory failure. We need to conduct further studies to establish which selected preterm patients would benefit from being treated with iNO.
- Grading the level of evidence of neonatal pharmacotherapy: midazolam and phenobarbital as examples(Springer Nature, 2023-09-26) Simons, S.H.P. (Sinno H. P.); Beken, S. (Serdar); Kotidis, C. (Charalampos); Smits, A. (Anne); Mahoney, L. (Liam); Allegaert, K. (Karel); Cavallaro, G. (Giacomo); Bhatt, A. (Aomesh); Raffaeli, G. (Genny); Flint, R.B. (Robert B.); Dempsey, E.M. (Eugene M.); Ünal, S. (Sezin); Garrido-Martínez-de-Salazar, F. (Felipe)BACKGROUND: Many drugs are used off-label or unlicensed in neonates. This does not mean they are used without evidence or knowledge. We aimed to apply and evaluate the Grading and Assessment of Pharmacokinetic–Pharmacodynamic Studies (GAPPS) scoring system for the level of evidence of two commonly used anti-epileptic drugs. METHODS: Midazolam and phenobarbital as anti-epileptics were evaluated with a systematic literature search on neonatal pharmacokinetic (PK) and/or pharmacodynamic [PD, (amplitude-integrated) electroencephalography effect] studies. With the GAPPS system, two evaluators graded the current level of evidence. Inter-rater agreement was assessed for dosing evidence score (DES), quality of evidence (QoE), and strength of recommendation (REC). RESULTS: Seventy-two studies were included. DES scores 4 and 9 were most frequently used for PK, and scores 0 and 1 for PD. Inter-rater agreements on DES, QoE, and REC ranged from moderate to very good. A final REC was provided for all PK studies, but only for 25% (midazolam) and 33% (phenobarbital) of PD studies. CONCLUSIONS: There is a reasonable level of evidence concerning midazolam and phenobarbital PK in neonates, although using a predefined target without integrated PK/PD evaluation. Further research is needed on midazolam use in term neonates with therapeutic hypothermia, and phenobarbital treatment in preterms.
- 101 Alimentos saludables para tener en tu casa(Universidad de Valladolid, 2020) Moreno-Villares, J.M. (José Manuel)El prof. De Luis, además de ser un referente nacional e internacional en el campo del Metabolismo y la Nutrición, se embarcó desde hace unos años en divulgar el conocimiento nutricional. “Nutrición para todos los públicos” podía ser el lema de su aventura. Bajo el auspicio de la Universidad de Valladolid, que publica esta obra, da continuidad a la tarea que comenzó con su obra anterior (21 consejos nutricionales para vivir sanos), de la que ya dimos rendida cuenta en su momento en la revista Nutrición Hospitalaria