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La fibrose pulmonaire (FP) idiopathique (FPi) est une maladie pulmonaire chronique, évolutive et mortelle dont l’origine est inconnue. Les deux seules molécules pharmacologiques disponibles sur le marché ne font que ralentir la progression de la maladie avec des effets thérapeutiques peu satisfaisants. L’absence de traitement curatif résulte en grande partie de l’absence de modèles expérimentaux capables de mimer les mécanismes physiopathologiques spécifiques de la FPi [1]. Notre objectif est de développer et caractériser un nouveau modèle expérimental de FPi pour identifier des cibles thérapeutiques précoces.

Le mérycisme est un trouble fonctionnel gastro-intestinal défini cliniquement par les critères de Rome IV. L’observation de R-waves à la manométrie œsophagienne haute résolution permet, notamment dans les cas cliniquement incertains, d’affirmer le mérycisme. Sa physiopathologie est encore mal connue mais implique la relaxation volontaire du sphincter inférieur de l’œsophage comme trigger de la remontée alimentaire. C’est sur cette relaxation intermittente volontaire qu’agissent les principaux traitements du mérycisme, que ce soient les techniques comportementales telles la respiration diaphragmatique et le biofeedback, ou les traitements médicamenteux comme le baclofène. Parce qu’il est fréquemment responsable d’une errance diagnostique et peut parfois mettre en jeu le pronostic vital, il est indispensable de diagnostiquer et de prendre en charge le mérycisme chez l’enfant.

L’alimentation de l’enfant porteur de polyhandicap, comme dans les formes sévères de paralysie cérébrale, est un sujet de préoccupation au quotidien pour les parents et les équipes de rééducation présentes autour de lui. En effet, le plaisir et la convivialité du repas peuvent être contrariés par les difficultés de posture, de déglutition, de digestion ou encore des douleurs. L’évaluation régulière de la croissance staturo-pondérale est nécessaire selon des critères adaptés à la population des enfants en situation de polyhandicap car le risque de dénutrition est important. Nous décrivons les mécanismes à l’origine des difficultés alimentaires et nous proposons des mesures d’intervention et de prévention nutritionnelles.

En France, la stratégie de prévention de la transmission materno-fœtale du virus de l’hépatite B repose sur la sérovaccination à la naissance. La sérothérapie consiste à injecter 30UI/kg d’immunoglobulines spécifiques anti-HBs d’origine humaine dans les premières heures de vie, ce qui correspond en pratique à 1mL, soit 100UI. La vaccination doit également être réalisée dès les premières heures de vie et une nouvelle injection doit être réalisée à 1 mois et à 6 mois. Chez les nouveau-nés de moins de 32SA et/ou de moins de 2kg, une réponse vaccinale plus faible amène à prescrire une injection supplémentaire à 2 mois. Cette sérovaccination permet de réduire le risque de transmission materno-fœtale de 57 à 4 % environ. Les facteurs de risque d’échec de cette prévention sont une charge virale maternelle élevée (supérieure ou égale à 7 log) et/ou la présence d’AgHBe. La voie d’accouchement ne modifie pas le risque de transmission materno-fœtale du virus de l’hépatite B lorsque la sérovaccination à la naissance a été bien conduite. De même, l’allaitement maternel ne modifie pas le risque de transmission materno-fœtale du virus de l’hépatite B après sérovaccination. Il est recommandé par l’OMS. Pendant le travail, le pH in utero ne doit être réalisé qu’en cas de stricte nécessité, les données de la littérature ne permettant pas de conclure sur le risque de transmission.

La fibrose pulmonaire idiopathique (FPI) est une maladie pulmonaire chronique, évolutive et mortelle dont l’origine et les mécanismes de développement restent inconnus. Les rares traitements pharmacologiques disponibles ne font que ralentir la progression de la maladie. Le développement de traitements curatifs est limité par l’absence de modèles expérimentaux capables de mimer les mécanismes physiopathologiques spécifiques de la FPI. Cette mini-revue a pour but de passer en revue les modèles animaux expérimentaux les plus utilisés dans l’étude de la FPI et montrer la nécessité de rechercher de nouveaux modèles plus satisfaisants.

Les difficultés alimentaires sont fréquentes chez les patients atteints de handicap d’origine neurologique. Une dénutrition, un retard de croissance, un déficit en micronutriments et une ostéopénie peuvent compliquer l’évolution clinique de ces enfants particulièrement fragiles. Les manifestations digestives, incluant reflux gastro-œsophagien, constipation et dysphagie, sont également fréquentes et affectent leur qualité de vie et leur état nutritionnel. La prise en charge de ces problèmes digestifs et nutritionnels n’est actuellement pas systématisée. Un groupe de travail de 15 experts de la Société européenne de gastro-entérologie, hépatologie et nutrition pédiatrique (ESPGHAN) a récemment publié un guide pour leur prise en charge, dont cet article en rapporte les recommandations.

En France, la stratégie de prévention de la transmission materno-fœtale du virus de l’hépatite B repose sur la sérovaccination à la naissance. La sérothérapie consiste à injecter 30UI/kg d’immunoglobulines spécifiques anti-HBs d’origine humaine dans les premières heures de vie, ce qui correspond en pratique à 1mL, soit 100UI. La vaccination doit également être réalisée dès les premières heures de vie et une nouvelle injection doit être réalisée à 1 mois et à 6 mois. Chez les nouveau-nés de moins de 32SA et/ou de moins de 2kg, une réponse vaccinale plus faible amène à prescrire une injection supplémentaire à 2 mois. Cette sérovaccination permet de réduire le risque de transmission materno-fœtale de 57 à 4 % environ. Les facteurs de risque d’échec de cette prévention sont une charge virale maternelle élevée (supérieure ou égale à 7 log) et/ou la présence d’AgHBe. La voie d’accouchement ne modifie pas le risque de transmission materno-fœtale du virus de l’hépatite B lorsque la sérovaccination à la naissance a été bien conduite. De même, l’allaitement maternel ne modifie pas le risque de transmission materno-fœtale du virus de l’hépatite B après sérovaccination. Il est recommandé par l’OMS. Pendant le travail, le pH in utero ne doit être réalisé qu’en cas de stricte nécessité, les données de la littérature ne permettant pas de conclure sur le risque de transmission.

En France, la prévalence de l’hépatite B chronique est d’environ 1 % chez la femme enceinte (portage généralement asymptomatique de l’AgHBs). Le risque de transmission materno-fœtale de l’hépatite B est d’autant plus élevé que la charge virale mesurée par PCR est plus élevée chez la mère (supérieure à 7 log) ou que l’AgHBe est présent. En cas de transmission materno-fœtale du virus de l’hépatite B, le risque pour le nouveau-né de développer une hépatite B chronique ultérieure est très élevé (90 %), avec des complications à long terme telles que la cirrhose et le carcinome hépatocellulaire. La prévention de la transmission materno-fœtale repose sur le dépistage systématique de l’hépatite B durant la grossesse, suivie de la sérovaccination du nouveau-né à la naissance. En cas de nécessité, l’amniocentèse n’est pas contre-indiquée mais on évitera la réalisation d’un geste transplacentaire. En cas de charge virale supérieure ou égale à 7 log, un traitement antiviral à partir de 28SA peut encore diminuer ce risque de transmission. En raison du faible risque de résistance virale et de sa bonne tolérance, le ténofovir doit être préféré à la lamivudine.

One of the global targets for non-communicable diseases is to halt, by 2025, the rise in the age-standardised adult prevalence of diabetes at its 2010 levels. We aimed to estimate worldwide trends in diabetes, how likely it is for countries to achieve the global target, and how changes in prevalence, together with population growth and ageing, are affecting the number of adults with diabetes.

L’ingénierie tissulaire, dont le concept repose sur la mise en présence et l’implantation in vivo des éléments jugés nécessaires à un remodelage tissulaire vers le phénotype de l’organe voulu, pourrait représenter une alternative aux techniques classiques de remplacement œsophagien. Actuellement, l’approche hybride consistant à créer un substitut composé d’une matrice acellulaire, de cellules épithéliales et de cellules musculaires autologues est celle qui a donné les résultats les plus aboutis. Les recherches actuelles portent sur l’utilisation des cellules souches mésenchymateuses, dont le potentiel de différenciation, les propriétés pro-angiogéniques, immunomodulatrices et anti-inflammatoires, constituent des atouts prometteurs. À moyen terme, la confection de « matrices intelligentes » non cellularisées, mais contenant les molécules nécessaires à la régénération tissulaire, permettrait de s’affranchir de l’implantation cellulaire et d’obtenir des réponses biologiques standardisées in vivo. À l’heure actuelle, les applications d’ingénierie tissulaire de l’œsophage chez l’homme se sont limitées à la réalisation de plasties d’élargissement par des matrices non cellularisées. Cependant, les applications cliniques existantes de remplacement par ingénierie tissulaire d’autres organes, associées à la multiplication des protocoles de recherche translationnelle de remplacement œsophagien chez le gros animal, laissent présager à court terme l’obtention d’une autorisation des autorités sanitaires pour l’initiation d’un essai clinique.

Diabetes has been defined on the basis of different biomarkers, including fasting plasma glucose (FPG), 2-h plasma glucose in an oral glucose tolerance test (2hOGTT), and HbA1c. We assessed the effect of different diagnostic definitions on both the population prevalence of diabetes and the classification of previously undiagnosed individuals as having diabetes versus not having diabetes in a pooled analysis of data from population-based health examination surveys in different regions.

This European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) position statement provides a comprehensive guide for health care providers to manage percutaneous endoscopic gastrostomy tubes in a safe, effective, and appropriate way.

This European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) position statement provides a comprehensive guide for health care providers to manage percutaneous endoscopic gastrostomy tubes in a safe, effective, and appropriate way. Relevant literature from searches of PubMed, CINAHL, and recent guidelines was reviewed. In the absence of evidence, recommendations reflect the expert opinion of the authors. Final consensus was obtained by multiple e-mail exchange and during 3 face-to-face meetings of the gastroenterology committee of the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition. Endoscopically placed gastrostomy devices are essential in the management of children with feeding and nutritional problems. The article focuses on practical issues such as indications and contraindications. The decision to place an endoscopic gastrostomy has to be made by an appropriate multidisciplinary team, which then provides active follow-up and care for the child and the device.

L’atrésie de l’œsophage (AO) est une malformation congénitale rare (un cas pour 2500 à 3500 naissances). Le diagnostic anténatal (DAN) de cette anomalie est particulièrement intéressant car il permet de réaliser un bilan complémentaire à la recherche de formes associées de plus mauvais pronostic (échographie de référence, IRM et amniocentèse) et d’organiser la naissance dans un centre disposant de l’aval pédiatrique médicochirurgical adapté. L’hydramnios et/ou un estomac absent ou de petite taille sont les deux signes échographiques d’appel les plus fréquents mais ne sont pas spécifiques. La visualisation en échographie ou en IRM d’une image liquidienne cervicale ou thoracique correspondant à la dilatation du cul-de-sac œsophagien supérieur (pouch sign) permet d’augmenter la spécificité du diagnostic. Le DAN reste cependant difficile et moins de 50 % des AO sont repérées en anténatal. L’analyse biochimique du liquide amniotique pourrait améliorer ces résultats. En cas d’AO confirmée à la naissance, la prise en charge chirurgicale consistera en une anastomose en un temps dans les premiers jours de vie, ou en deux temps si le défect est trop important. Même si le pronostic actuel de l’AO est bon dans l’ensemble, la fréquence des complications à distance de l’intervention initiale et la nécessité d’une surveillance des lésions œsophagiennes secondaires au reflux gastro-œsophagien et à l’AO justifient qu’un suivi systématique, multidisciplinaire et prolongé soit proposé à tout patient opéré d’une AO.

Eosinophilic esophagitis (EoE) represents a chronic, immuneantigen-mediated esophageal disease characterized clinically by symptoms related to esophageal dysfunction and histologically by eosinophil-predominant inflammation. With few exceptions, 15 eosinophils per high-power field (peak value) in ≥1 biopsy specimens are considered a minimum threshold for a diagnosis of EoE. The disease is restricted to the esophagus, and other causes of esophageal eosinophilia should be excluded, specifically proton pump inhibitor–responsive esophageal eosinophilia. This position paper aims at providing practical guidelines for the management of children and adolescents with EoE.

Eosinophilic esophagitis (EoE) represents a chronic, immune/antigen-mediated esophageal disease characterized clinically by symptoms related to esophageal dysfunction and histologically by eosinophil-predominant inflammation. With few exceptions, 15 eosinophils per high-power field (peak value) in =1 biopsy specimens are considered a minimum threshold for a diagnosis of EoE. The disease is restricted to the esophagus, and other causes of esophageal eosinophilia should be excluded, specifically proton pump inhibitor–responsive esophageal eosinophilia. This position paper aims at providing practical guidelines for the management of children and adolescents with EoE. Relevant literature from searches of PubMed, CINAHL, and recent guidelines was reviewed. In the absence of an evidence base, recommendations reflect the expert opinion of the authors. Final consensus was obtained during 3 face-to-face meetings of the Gastroenterology Committee and 1 teleconference. The cornerstone of treatment is an elimination diet (targeted or empiric elimination diet, amino acid–based formula) and/or swallowed, topical corticosteroids. Systemic corticosteroids are reserved for severe symptoms requiring rapid relief or where other treatments have failed. Esophageal dilatation is an option in children with EoE who have esophageal stenosis unresponsive to drug therapy. Maintenance treatment may be required in case of frequent relapse, although an optimal regimen still needs to be determined. EoE is a chronic, relapsing inflammatory disease with largely unquantified long-term consequences. Investigations and treatment are tailored to the individual and must not create more morbidity for the patient and family than the disease itself. Better maintenance treatment as well as biomarkers for assessing treatment response and predicting long-term complications is urgently needed.

Tissues derived from the colon, stomach, and jejunum have been used to replace the esophagus in childhood to cure esophageal atresia or stricture secondary to gastroesophageal reflux or the ingestion of corrosive agents. The outcome in adulthood of colon interposition performed at an early age has yet to be satisfactorily assessed. The aim of this single-center retrospective study was to evaluate the long-term nutritional, digestive, and respiratory outcome of all patients (n = 32) who underwent colon interposition during childhood in our hospital (1970–2001). Medical records of these subjects were reviewed and their nutritional (weight, height, 24-hour food diary), digestive (questionnaire), and pulmonary function status evaluated. Of the patients, 17 had esophageal atresia (7 males, median age at surgery 11 months, range 0.5–61) and 15 had ingested corrosive substances (10 males, median age at surgery 50 months, range 22–113). Complications occurred less than 1 year postoperatively in 53% and long-term complications (occurring >1 year after surgery) in 84%. Long-term complications were common: digestive symptoms were found in 85% (most frequently observed during the first 5 years of follow-up), abnormal lung function in 7 (58%) of those tested (n = 12), feeding difficulties in 50%, scoliosis in 35%, and nutritional complications in 25%. Our study showed a high rate of sequelae following esophageal replacement. This highlights the need for multidisciplinary long-term follow-up into adulthood, and research into alternatives to colon interposition as treatment for esophageal strictures.

Tissues derived from the colon, stomach, and jejunum have been used to replace the esophagus in childhood to cure esophageal atresia or stricture secondary to gastroesophageal reflux or the ingestion of corrosive agents. The outcome in adulthood of colon interposition performed at an early age has yet to be satisfactorily assessed. The aim of this single-center retrospective study was to evaluate the long-term nutritional, digestive, and respiratory outcome of all patients (n 32) who underwent colon interposition during childhood in our hospital (1970–2001).

Abstract: The HELENA Project—Healthy Lifestyle in Europe by Nutrition in Adolescence—is a European, collaborative research project financed by the EU Sixth Framework Programme in the area of nutrition-related adolescent health. The basic objective of the HELENA project is to obtain reliable and comparable data from a random sample of European adolescents (boys and girls aged 13–16 years) on a broad battery of relevant nutrition and health-related parameters: dietary intake, food choices and preferences, anthropometry, serum indicators of lipid metabolism and glucose metabolism, vitamin and mineral status, immunological markers, physical activity, fitness and genetic markers. The HELENA project is conceived as a scientific construction with four complementary sub-studies that are elaborated through 14 well-defined work packages. Sub-studies are focused, respectively, on “a cross-sectional description of lifestyles and indicators of nutritional status (HELENA-CSS)”, “a lifestyle education intervention programme (HELENA-LSEI), “a metabolic study with cross-over design (HELENA-COMS)” and a “study on behaviour, food preferences and food development” (HELENA-BEFO). The project unites 20 research centres from 10 European countries. In addition, the consortium comprises five SMEs (small and medium-sized enterprises) that are actively involved in the research activities. The core of the HELENA project study material is an overall European cohort of 3,000 adolescents, equally recruited in ten cities from nine countries. Standardization of methods among partners is a key issue in the project and is obtained through the development of standard protocols, training sessions, validation sub-studies and pilot projects. Health-related problems have a tendency to evolve in cycles, with ever new problems emerging in ever new contexts that call for appropriate and tailored actions. The HELENA project is expected to offer essential elements for use in the overall machinery of required public health nutrition cycles. It is of the greatest importance for its results to prove useful that it can communicate with other initiatives on the level of science and society.

The HELENA Project—Healthy Lifestyle in Europe by Nutrition in Adolescence—is a European, collaborative research project financed by the EU Sixth Framework Programme in the area of nutrition-related adolescent health. The basic objective of the HELENA project is to obtain reliable and comparable data from a random sample of European adolescents (boys and girls aged 13–16 years) on a broad battery of relevant nutrition and health-related parameters: dietary intake, food choices and preferences, anthropometry, serum indicators of lipid metabolism and glucose metabolism, vitamin and mineral status, immunological markers, physical activity, fitness and genetic markers. The HELENA project is conceived as a scientific construction with four complementary sub-studies that are elaborated through 14 well-defined work packages. Sub-studies are focused, respectively, on “a cross-sectional description of lifestyles and indicators of nutritional status (HELENA-CSS)”, “a lifestyle education intervention programme (HELENA-LSEI), “a metabolic study with cross-over design (HELENA-COMS)” and a “study on behaviour, food preferences and food development” (HELENA-BEFO). The project unites 20 research centres from 10 European countries. In addition, the consortium comprises five SMEs (small and medium-sized enterprises) that are actively involved in the research activities. The core of the HELENA project study material is an overall European cohort of 3,000 adolescents, equally recruited in ten cities from nine countries. Standardization of methods among partners is a key issue in the project and is obtained through the development of standard protocols, training sessions, validation sub-studies and pilot projects. Health-related problems have a tendency to evolve in cycles, with ever new problems emerging in ever new contexts that call for appropriate and tailored actions. The HELENA project is expected to offer essential elements for use in the overall machinery of required public health nutrition cycles. It is of the greatest importance for its results to prove useful that it can communicate with other initiatives on the level of science and society.

BACKGROUND AND STUDY AIMS: Mitomycin C is an antiproliferative agent that has been used successfully as an adjunct treatment in ophthalmological procedures, in the management of laryngeal and tracheal stenosis, and more recently to prevent the recurrence of caustic esophageal strictures in children. The aim of this study was to assess the efficacy and safety of local application of mitomycin C to refractory esophageal strictures in children. PATIENTS AND METHODS: We performed a preliminary prospective study of local application of mitomycin C in four children, aged between 1 year and 6 years, who had refractory esophageal strictures. Two of the children presented with strictures caused by caustic ingestion and the other two children had anastomotic strictures following surgical repair of congenital esophageal atresia. The patients had required between four and ten esophageal dilations over a 5 - 24-month period before mitomycin C application. After an endoscopic dilation, mitomycin C was applied onto the dilation wound using a rigid endoscope. RESULTS: No complications were observed after the procedure. One child required a second application of mitomycin C 2 weeks after the first application because of recurrence of dysphagia. All the children remained asymptomatic and none of them required further dilation over a mean follow-up period of 24 months. Radiological control examinations revealed that there was no recurrence of the esophageal strictures and esophageal biopsies performed during follow-up showed no signs of dysplasia. CONCLUSIONS: Local application of mitomycin C is a potential alternative to iterative dilations, surgery, or stent placement for the treatment of refractory esophageal strictures in children. However, prospective, long-term assessment of outcomes is needed before any definitive conclusion can be drawn about the usefulness of mitomycin C in these patients.

To assess the safety of a polyethylene glycol (PEG) 4000 laxative without additional salts in pediatric patients.

To assess the safety of a polyethylene glycol (PEG) 4000 laxative without additional salts in pediatric patients. This was a 3‐month multicenter, randomized, double‐blind, double‐dummy, lactulose‐controlled, parallel study enrolling 96 ambulatory constipated children aged 6 months to 3 years, treated daily with 4‐8 g PEG or 3.33 g‐6.66 g lactulose. Total protein, albumin, iron, electrolytes, and vitamins B9 (folates), A and D (25OHD3) were measured in blood before and after treatment (day 84) in a central laboratory. The percentage of children with at least one value out of normal range at day 84 with respect to baseline status (with or without at least one value out of normal range), i.e. the primary endpoint, was 87% and 90% in the PEG and lactulose groups, respectively, without any difference between groups. The whole blood parameters showed no qualitative or quantitative treatment‐related changes. Vitamin A values were above normal range in 56% and 41% of children at baseline versus 33% and 36% at day 84 in the PEG and lactulose groups, respectively. Iron values were similarly under normal range in 47% and 51% at baseline versus 42% and 51% at day 84. Clinical tolerance was similar for both treatments except for vomiting and flatulence, which were significantly higher with lactulose. Significantly higher improvements were evidenced with PEG regarding stool consistency, appetite, fecaloma and use of additional laxatives. This 3‐month study in 96 constipated children aged 6 months to 3 years confirms the long‐term tolerance of PEG 4000 in pediatrics and indicates a PEG efficacy similar to or greater than that of lactulose.

Chronic pulmonary infection by Pseudomonas aeruginosais observed in 50% of patients with cystic fibrosis and requires the use of recurrent intravenous therapy. A decrease of resting energy expenditure (REE) and an increase of physical activity (PA) after intravenous anti-P. aeruginosatherapy (IVAT) is observed while total energy expenditure (TEE) does not change. A decrease in the energetic cost of physical activity (ECPA) could be hypothesized but has never been studied. Our aim was to assess the evolution of ECPA after home IVAT in both standardized condition at hospital and in free-living condition twice before and after IVAT.

We present the first report of an association between hydrocephalus with stenosis of the aqueduct of Sylvius (HSAS) and a specific form of congenital idiopathic intestinal pseudo‐obstruction (CIIP) in an infant. Diagnosis of HSAS was suspected during the neonatal period because of a severely dilated ventricular system associated with bilateral adducted thumbs, and was confirmed by demonstration of a mutation in the gene encoding L1 cell adhesion molecule (L1CAM). L1CAM mutations cause a variable clinical spectrum. This gene is located at Xq28 and encodes a transmembrane glycoprotein involved in neurite outgrowth and neuronal migration. Hirschprung disease has been reported to involve an L1CAM mutation that manifests as a quantitative defect in the migration of neural crest cells in distal segments of the gut. We report an association that suggests that alterations of L1CAM may cause another type of intestinal pseudo‐obstruction distension with a qualitative defect in differentiated Cajal's cells in the anterior part of the gut. This observation suggests that L1CAM has a role in the developmental regulation of multiple systems. Further clinical descriptions of gastroenterological and neuropathological data are required to extend our understanding of the mechanisms underlying L1CAM functions. © 2004 Wiley‐Liss, Inc.

To report our experience of enteral feeding via gastrostomy in children with severe chronic neonatal lung disease, failure to thrive, and oral aversive behavior after initial hospitalization.

To report our experience of enteral feeding via gastrostomy in children with severe chronic neonatal lung disease, failure to thrive, and oral aversive behavior after initial hospitalization. Thirteen patients were studied. All children had chronic lung disease of neonatal onset and were severely malnourished. They received enteral nutrition via a gastrostomy at a median age of 13 months (range: 8–35). Z-scores for weight-for-height increased significantly, from -3.4 to -1.9 after four months of enteral nutrition. Caloric intake increased significantly from 100% to 140% of the recommended daily allowance for age. Pulmonary status remained stable for all patients and oxygenation was normal. There was an aggravation of oral aversive behavior in 7 of the 13 children, especially those children who were ventilated and hospitalized for a long time (median duration: 195 days). The median follow-up of patients after gastrostomy was 30 months (range: 8–54) and only six patients could be weaned from enteral nutrition. Enteral nutrition via gastrostomy is efficient, and provides the means to improve caloric intake and nutritional status. Gastrostomy is a safe and convenient technique that should be considered early in the course of treatment for infants presenting with malnutrition related to neonatal pulmonary disease.

There are few data concerning the risk of contamination of enteral feeding systems via gastrostomy in children, and none for conditions that pertain to home-based care.

There are few data concerning the risk of contamination of enteral feeding systems via gastrostomy in children, and none for conditions that pertain to home-based care. To investigate the risk of contamination of enteral feeding systems during the home-based care of 20 children receiving gastrostomy tube feeding, five samples were taken for analysis: two samples before the enteral feeding period (gastrostomy, enteral feeding system) and three after this period (gastrostomy, distal giving set, liquid remained in container). Microorganisms were identified and counted. Different factors were studied to elucidate their role in bacterial colonization: acid suppressive therapy, gastrostomy tube or button, hanging feeding time, rate of enteral feeding, gastric pullulation and retrograde contamination, manipulation error, and use of open or closed enteral feeding systems. Overgrowth was defined as a microorganismal load exceeding 10 4colony-forming units (cfu)/mL. Overgrowth was present in 85% of gastrostomy samples before enteral nutrition started. Most microorganisms belonged to gastric flora. Some bacteria had an environmental origin or derived from cutaneous flora. Forty-five percent of the lines showed overgrowth at the end of enteral nutrition period, mainly with the same microorganism found in the gastrostomy. Closed enteral bags remained sterile, even if manipulation error occurred. Duration, rate of enteral feeding, and acid suppression treatment were not risk factors for overgrowth. Retrograde contamination of gastrostomy feeding systems occurs frequently. The preferential use of closed enteral feeding systems is recommended for home-based enteral nutrition programs.