Unit of Pediatric Gastroenterology and Cystic Fibrosis Unit, Department of Human Pathology in Adulthood and Childhood "G. Barresi", University of Messina, Messina, Italy.
Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Ghent University Hospital, Ghent, Belgium.
J Pediatr Gastroenterol Nutr. 2021 Apr 1;72(4):e97-e101. doi: 10.1097/MPG.0000000000003020.
The main aim of this study was to determine the impact on clinical practice of the first European Society of Gastroenterology, Hepatology, and Nutrition (ESPGHAN) position paper on the diagnosis and management of nutritional and gastrointestinal problems in children with neurological impairment (NI).
In this pilot-study, a web-based questionnaire was distributed between November, 2019 and June, 2020, amongst ESPGHAN members using the ESPGHAN newsletter. Fifteen questions covered the most relevant aspects on nutritional management and gastrointestinal issues of children with NI. A descriptive analysis of responses was performed.
A total of 150 health professionals from 23 countries responded to the survey. A considerable variation in clinical practice concerning many aspects of nutritional and gastrointestinal management of children with NI was observed. The most frequently used method for diagnosing oropharyngeal dysfunction was the direct observation of meals with or without the use of standardised scores (n = 103). Anthropometric measurements were the most commonly used tools for assessing nutritional status (n = 111). The best treatment for gastroesophageal reflux disease (GERD) was considered to be proton pump inhibitor therapy by most (n = 116) participants. Regarding tube feeding, nearly all respondents (n = 114) agreed that gastrostomy is the best enteral access to be used for long-term enteral feeding. Fundoplication was indicated at the time of gastrostomy placement especially in case of uncontrolled GERD.
More studies are required to address open questions on adequate management of children with NI. Identifying knowledge gaps paves the way for developing updated recommendations and improving patient care.
本研究的主要目的是确定欧洲胃肠病学、肝病学和营养学会（ESPGHAN）关于神经损伤（NI）儿童营养和胃肠道问题诊断和管理的第一份立场文件对临床实践的影响。
在这项初步研究中，通过 ESPGHAN 通讯，于 2019 年 11 月至 2020 年 6 月期间，以在线问卷调查的形式向 ESPGHAN 成员分发问卷。15 个问题涵盖了神经损伤儿童营养管理和胃肠道问题的最相关方面。对回答进行了描述性分析。
来自 23 个国家的 150 名卫生专业人员对该调查做出了回应。观察到许多神经损伤儿童营养和胃肠道管理方面的临床实践存在相当大的差异。诊断口咽功能障碍最常用的方法是直接观察膳食，同时使用或不使用标准化评分（n=103）。评估营养状况最常用的工具是人体测量（n=111）。大多数（n=116）参与者认为质子泵抑制剂治疗是治疗胃食管反流病（GERD）的最佳方法。关于管饲，几乎所有的受访者（n=114）都认为胃造口术是用于长期肠内喂养的最佳肠内进入途径。大多数情况下（特别是在 GERD 无法控制的情况下），在进行胃造口术时，会指示进行胃底折叠术。
需要开展更多的研究来解决神经损伤儿童适当管理方面的遗留问题。确定知识差距为制定更新的建议和改善患者护理铺平了道路。
