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Background In clinical practise electrolyte enrichment of the parenteral nutrition admixtures is a typical request, especially on the neonatal/paediatric wards. The supplementation of parenteral nutrition with high concentrations of electrolytes is an ongoing problem since the stability of lipid emulsions in nutrition admixtures is reduced by bivalent cations. Purpose To examine the stability of 48 different paediatric admixtures designed for home parenteral nutrition. The admixtures investigated were characterised by high concentrations of electrolytes (20–61 mmol/l K+, 9–21 mmol/l Ca2+, 6–20 mmol/l Mg2+). Materials and Methods Parenteral pre-admixtures were prepared in two-chamber ethyl-vinyl-acetate bags, where a lipid emulsion was separated from the other components. Parenteral pre-admixtures (in two chambers) were stored up to 21 days at +4oC. Vitamin preparations were added only after combining the contents of two chambers of the bag. Visual observations, globule size measurement (optical microscopy, laser diffraction (LD) and photon correlation spectroscopy (PCS)), zeta potential, pH analysis and surface measurements were performed in complete admixtures at t = 0 and after 24 h at room temperature. Results In microscopic observation all admixtures were characterised by size of oily droplets not larger than 1 µm, which was confirmed using LD and PSC methods (Z-average was 260–310 nm). Oily droplet size did not change during the time of storage. Only in two admixtures were single particles up to 8–10 µm observed, so these admixtures were classified as unstable. The pH values of parenteral admixtures were in the range 5.6–6.7 and zeta potential was −36 to −47 mV and did not change during storage. Conclusions Of the 48 admixtures investigated only two were problematic and the others may be stored for at least 21 days at 4°C. The completed admixtures demonstrated stability for at least 24 h at room temperature. It was possible to obtain stable admixtures despite the high concentrations of electrolytes. No conflict of interest.

Introduction: The aim of the study was to analyze retrospectively the indications for gastrostomy in Polish children. Six medical centers which have been providing enteral nutrition participated in this study. Methods: Available medical records of children in whom the first gastrostomy was placed between 2000 and 2010 were analyzed in terms of: source and indications for gastrostomy admission, nutritional status and feeding mode preceding gastrostomy placement. Results: The analyzed group comprised of 349 children (57% males, 43% females). The mean age at first gastrostomy placement was 6.2 ± 7.4 years. 163 (46.7%) patients were fed orally and 186 (53.7%) patients received enteral nutrition via nasogastric tube before gastrostomy placement. The mean duration of nasogastric tube feeding before gastrostomy insertion amounted 37.6 ± 54.6 weeks. Body weight of most patients (278/78%) before gastrostomy placement was under the third percentile for age. Neurological impairment was present in 293 (84%) of cases. The most common indications for gastrostomy administration included dysphagia (259/74%) patients) and malnutrition (62/18%). Other indications were: necessity to increase energy intake (14/4% of cases), terminal care in hospice patients (11/3%) and gastrostomy as a transfer from parenteral to enteral nutrition in 3 cases. Based on medical records percutaneous endoscopic gastrostomy (PEG) was performed in 258/74% children, 80/23% patients underwent surgical procedure, and there was lack of data in 11 cases. Conclusion: The main indication for pediatric gastrostomy in Polish sites was neurological disorders with dysphagia. Malnutrition was reported in most of children before gastrostomy placement.

Aim The aim of this study was to evaluate the quality of life of families of children with feeding disorders after percutaneous endoscopic gastrostomy (PEG) placement. Patients and methods The study included 302 children, 132 girls (43.5%) and 170 boys (56.5%) in whom PEG was placed. Examined children were at the age from 7 months to 20 years, mean age – 9 years. For evaluation of the quality of life of patients with inserted PEG tube an original survey was used, where parents/carers answered 8 questions about the quality of life for both, the family and the patient, gastrostomy handling and rehabilitation. The results were analyzed statistically according to the age of the children. Results The placement of PEG tube facilitated lives of more than 70% of the parents/carers of sick children. However, life satisfaction of families increased only in about half of the analyzed cases. There was no correlation between the quality of life of families and the age of the children. In more than 65% of the patients the insertion of PEG tube had no effect on the number of child contacts with peers, relatives and friends. Also, over 20% of the parents/carers of the children stated that PEG tube made the physical rehabilitation of children difficult – most frequently in children under 7 years of age. Conclusions PEG is a common form of access used in enteral nutrition in children that significantly improves the quality of life of families, but often requires additional nutrition intervention.

Among possible causes of chronic hepatitis in adolescents most common are infections, autoimmune disorders and metabolic diseases. Thus, diagnostic procedures should be multidirectional. This study reports diagnosis and treatment difficulties in an 18-year-old male patient with hereditary hemochromatosis (HH), ulcerative colitis (UC), chronic hepatitis B (CHB) and Gilbert syndrome. The presented case illustrates problems in diagnostics related to the presence of numerous disease conditions in one patient. It should be taken into consideration that these diseases coexisting in one patient can mutually affect their symptoms creating specific diagnostic difficulties.