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The purpose of intravenous fluid therapy (IFT) is to maintain or restore internal equilibrium by administering fluids and/or different electrolyte components. Its correct use and the prevention of complications arising from their misuse depend on the knowledge of the medical team on this subject. We analyzed this issue in different clinical areas of a tertiary hospital. Material and methods: We performed a descriptive cross-sectional pilot study via a questionnaire given to physicians specializing in internal medicine (IM) and digestive system surgery (SDS) who perform clinical practice in hospital units with unit dose drug dispensing system. We designed an anonymous questionnaire with 25 questions relative to knowledge of theory and practices, as well as the opinion of physicians regarding IFT. We evaluated the association between nominal qualitative variables with the Chi-square or Fisher's exact test. The behavior of the quantitative variables was assessed using the t-student test. The analysis of the data was generated using SAS/STAT, Version 9. Results: 28 questionnaires were collected from 13 surgeons and 15 digestive interns. Over 40% of specialists considered further education in IFT a necessity , especially regarding its prescription (SDS: 61.54%, IM: 71.43%). No statistically significant differences were found between the specialties in terms of perceived frequency of complications associated with IFT or in the frequency indication with the exception of hypovolemic shock, which is considered to be more prevalent in gastrointestinal surgery (p = 0.046). 90% of professionals prefer an individualized prescription. Statistically significant differences in terms of scores in the area of knowledge, with IM physicians achieving the highest scores (p = 0.014). There were also differences in attitude but they are not significant (p = 0.162). Knowledge of intravenous fluid increases with years of clinical experience (Spearman correlation coefficient = 0.386, p = 0.047). Conclusions: The professionals who prescribe IFT perceive the need to design IFT training programs, together with the production of guides and consensus protocols. [ABSTRACT FROM AUTHOR]

Bioethical decisions are present in every clinical decision. Nutrition support participates the same situation. Feeding critically ill patients, etriminal patients or in permanent vegetative status is almost always involved in bioethical dilemmas. A common problem is the confusion in concepts regarding bioethics. This lack of uniformity does not help in the deliberation process. From the Working Group in Bioethics of the Spanish Society for Parenteral and Enteral Nutrition Support (SENPE) it has been considered to gather the commonest terms used in our academic area. Each term is accompanied by a definition, a description or a commentary related to its main application. [ABSTRACT FROM AUTHOR]

Some bioethicists consider older age as a limiting factor for receiving special medical care. Older adults comprise the majority of home enteral nutrition patients (neoplams of the head, neck, and upper gastrointestinal tract neuromuscular swallowing disorders, dementia, etc) On the contrary, there are very few data on Home Parenteral Nutrition (HPN) in the elderly. We report these of a 75 years old man affected from a severe short bowel syndrome due to mesenteric thrombosis. After a hospital stay of two months he was sent home on HPN. His current caregiver was her wife, a 72 year old woman suffering from incipient Parkinson's disease. HPN lasted for 11 years and was stopped because of clinical deterioration. During this time he presented 5 catheter- related infections (1.3 episodes/1,000 days). 5 catheters were used (average length 788 days). He was hospitalized four times because of HPN complications. Functional status was maintained along almost all the length of HPN. Conclusions: The rate of complications in this patient was similar to other groups of age receiving HPN. The technique was not burdensome for the family. Older age cannot be consider, by itself a limiting factor when receiving long term nutritional support. [ABSTRACT FROM AUTHOR]

Home parenteral nutrition (HPN) has a key role in the management of permanent or transient intestinal failure in the pediatric patient. Although its use is not without complications. We review our experience since the beginning of the program in 1993. Patients and methods: Longitudinal and retrospective study of the clinical records from 25 infants and children (11 boys, 14 girls) who received HPN in this period. If a patient received HPN in periods separated more than 3 months we consider a different episode. In this way, 32 episodes were described. Quantitative data are presented as mean or median and qualitative as frequency. Complications are presented as complication rate per 1,000 days of HPN. Results: 16 patients started HPN younger than 1 year. Total length of HPN was 9,986 days, median 174 days (range 7 to 2,444 days). Main indication was short bowel syndrome (n = 6); motility disorders (n = 6); chronic diarrhea (n = 5), malnutrition (n = 3) and other causes (n = 5). 47 catheters were used; mean length 212.5 days, median 120 days (range: 7 to 930). Most of central venous catheters were tunnelled catheters (n = 42); subcutaneous ports (n=3) and in two cases periferically inserted central catheters (PICCS). Complication rate per 1,000 days of HPN was: 3.4 for catheter-related infections, 0.1 for obstruction; 0.9 for leakage, and 0.1 for accidental removal. Most common microorganisms were Staphylococcus coagulase negative (47%), Gram negative bacteria (21%), Staphylococcus aureus (15%), fungi (9%) and others in 9%. Parenteral nutrition-associated liver disease was present in 4 patients. 21 patients were weaned off HPN, 3 patients deceased because of underlying disease, 2 patients underwent intestinal transplantation, while 5 patients continue in the program. Conclusions: Every year two new patients enter in the program. 65% of patients were weaned off HPN. Infectious complications were the most frequent (rate 3.4 infections per 1,000 days of HPN). Mean length of HPN was 174 days, and 120 days for catheters. [ABSTRACT FROM AUTHOR]

Several years ago, it was recommended not to add vitamins or oligoelements to parenteral nutrition (PN) solutions and to administer them immediately after the addition of the micronutrients to avoid their decay. Nowadays, it has been observed that with multilayer bags, ternary mixtures and sunlight protection vitamins degradation is minimal. Daily intake of micronutrients is necessary in the critically ill, malnourished or long-term PN patients. Aiming at knowing the schedules of use of micronutrients in PN in Spanish hospitals and the way PN bags are prepared regarding the factors conditioning their stability, we undertook a telephone survey to the pharmacists in charge of PN at the different hospitals. We compared the data obtained with those from other surveys performed in 2001 and 2003. Pharmacists from 97 hospitals answered the questionnaire (answer rate 88%). The hospital sizes ranged 104-1728 beds. As compared to the data form preceding years, we observed a better adequacy to the current recommendations, although there are still 30% of the hospitals that administer micronutrients on an every other day basis independent of the clinical situation of the patients. In most of the hospitals, multilayer bags are used and/or sunlight protection and ternary mixtures. According to these results showing the different criteria for administering vitamins and oligoelements in PN solutions, it seems necessary to elaborate consensus documents that adapt to the reality of the diverse practices besides promoting the performance of well-designed clinical studies establishing the requirements under special clinical situations. [ABSTRACT FROM AUTHOR]

Standardization of clinical procedures has become a desirable objective in contemporary medical practice. To this effect, the Spanish Society of Parenteral and Enteral Nutrition (SENPE) has endeavoured to create clinical practice guidelines and/or documents of consensus as well as quality standards in artificial nutrition. As a result, the SENPE's Standardization Team has put together the 'Document of Consensus in Enteral Access for Paediatric Nutritional Support' supported by the Spanish Society of Pediatric Gastroenterology, Hepatology and Nutrition (SEGHNP), the National Association of Pediatric and Neonatal Intensive Care Nursery (ANECIPN), and the Spanish Society of Pediatric Surgery (SECP). The present publication is a reduced version of our work; the complete document will be published as a monographic issue. It analyzes enteral access options in the pediatric patient, reviews the levels of evidence and provides the team-members' experience. Similarly, it details general and specific indications for pediatric enteral support, current techniques, care guidelines, methods of administration and complications of each enteral access. The data published by the American Society for Parenteral and Enteral Nutrition (ASPEN) and several European Societies has also been incorporated. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To analyze the use of paediatric parenteral nutrition (PN) in a tertiary level hospital in Spain (1994-2008). MATERIALS AND METHODS: The charts from infants and children receiving NP in 2008 were reviewed. Data were compared with those in 1994 and 2002. RESULTS: 120 patients received PN, 78 and 71 corresponding to 1.6%, 1.3% and 1.0% of total admissions in 2008, 2002 and 1994 respectively. When composition of PN was compared in the first day we found significant differences in energy and lipids; but not in volume, carbohydrate, or amino acid composition. Gastrointestinal surgery was the most common indication. Mean length was 11.0 ± 9.8 days (2008) to 15.2 ± 14.8 (1994) (p < 0.05). Complications were present in 24.8 patients (2008), 10.8% (2002) and 16.9 (1994). CONCLUSIONS: PN use increased along the study period, although mean length decreased. There were more complications in 2008 than in previous years. [ABSTRACT FROM AUTHOR]

Home enteral nutrition (HEN) is a type of enteral nutrition (EN) which is becoming progressively more widespread in pediatrics due to the benefits it affords to patients, their families and to reducing hospital costs. However, the true extent of its use is unknown in Spain as the data-base set up for this purpose is still underused (Registro de Nutrición Enteral Pediátrica Ambulatoria y Domiciliaria -NEPAD-). More thorough registration of patients in the NEPAD online register will provide information about the characteristics of HEN in Spain: prevalence, diagnosis, the population sector being administered HEN, complications and developments. Likewise, forecast and planning of the necessary resources could be made while those in use could be analysed. [ABSTRACT FROM AUTHOR]

Introduction: Background: this study aimed to assess how the COVID-19 lockdown (March to June 2020) affected children's sleep quality, physical activity, screen time, and nutrition. Material and methods: the survey consisted of 479 children from the SENDO project, a pediatric cohort in Spain, aged 4-5 years. The BEAR questionnaire was used to evaluate sleep quality. Hierarchical models with two-level clustering were used to account for intra-cluster correlation between siblings, and the difference regression method was used to study the association between changes in screen consumption and physical activity and changes in sleep quality. Results: the results showed an increase in the consumption of homemade pastries and snacks. Sleep quality worsened significantly during confinement, with a mean score on the BEAR scale of 0.52 before, 1.43 during, and 1.07 after confinement. Although sleep quality improved significantly after the end of confinement, it remained worse than before. The average daily screen time increased from 1.13 hours before confinement to 2.65 hours during confinement. Physical activity decreased during confinement, with the mean number of hours per day decreasing from 1.27 to 0.79. Children who spent more time on screens during confinement had worse sleep quality, as indicated by their higher scores on the BEAR scale. We used the difference regression method to identify a statistically significant association between the increased screen time for leisure hours and the worsening of children's sleep quality during confinement. Conclusion: we observed a significant relationship between confinement and reduced sleep quality. Although the end of the lockdown led to a slight improvement, the average BEAR scale score remained higher post-confinement, suggesting that the consequences of the lockdown may persist over time.

Teduglutide is a glucagon-like-peptide-2 analogue that reduces the need for parenteral support in patients with short bowel syndrome (SBS). Nevertheless, data about long-term therapy with teduglutide in children are still scarce. Our objective was to describe the real-life experience with teduglutide in children with SBS over the last 5 years in Spain. This was a national multicentre and prospective study of paediatric patients with intestinal failure (IF) treated with teduglutide for at least 3 months. The data included demographic characteristics, medical background, anthropometric data, laboratory assessments, adverse events, and parenteral nutrition (PN) requirements. Treatment response was defined as a > 20% reduction in the PN requirement. The data were collected from the Research Electronic Data Capture (REDCap) database. Thirty-one patients from seven centres were included; the median age at the beginning of the treatment was 2.3 (interquartile range (IQR) 1.4-4.4) years; and 65% of the patients were males. The most frequent cause of IF was SBS (94%). The most common cause of SBS was necrotizing enterocolitis (35%). The median residual bowel length was 29 (IQR 12-40) cm. The median duration of teduglutide therapy was 19 (IQR 12-36) months, with 23 patients (74%) treated for > 1 year and 9 treated for > 3 years. The response to treatment was analysed in 30 patients. Twenty-four patients (80%) had a reduction in their weekly PN energy > 20% and 23 patients (77%) had a reduction in their weekly PN volume > 20%. Among the responders, 9 patients (29%) were weaned off PN, with a median treatment duration of 6 (IQR 4.5-22) months. The only statistically significant finding demonstrated an association between a > 20% reduction in the weekly PN volume and a younger age at the start of treatment (p = 0.028).   Conclusions: Teduglutide seems to be an effective and safe treatment for paediatric patients with IF. Some patients require a prolonged duration of treatment to achieve enteral autonomy. Starting treatment with teduglutide at a young age is associated with a higher response rate. What is Known: •  Glucagon-like peptide-2 (GLP-2) plays a crucial role in the regulation of intestinal adaptation in short bowel syndrome (SBS). Teduglutide is a GLP-2 analog that reduces the need for parenteral support in patients with SBS. • Data about long-term therapy with teduglutide in children in real life are still scarce. What is New: • Most pediatric patients with SBS respond in a satisfactory manner to teduglutide treatment. The occurrence of long-term adverse effects is exceptional. • Starting treatment with the drug at a young age is associated with a greater response rate., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Introduction: Objectives: the prevention of central line-associated bloodstream infections is a critical aspect of care for patients with intestinal failure who are treated with parenteral nutrition. The use of taurolidine in this context is becoming increasingly popular, however there is a lack of standardization in its pediatric application. The objective of this work is to develop a guide to support its prescription. Methodology: the guide is based on a review of the literature and expert opinions from the Intestinal Failure Group of the SEGHNP. It was developed through a survey distributed to all its members, addressing aspects of usual practice with this lock solution. Results: this manuscript presents general recommendations concerning taurolidine indications, commercial presentations, appropriate forms of administration, use in special situations, adverse reactions, and contraindications in the pediatric population Conclusions: taurolidine is emerging as the primary lock solution used to prevent central line-associated bloodstream infections, proving to be safe and effective. This guide aims to optimize and standardize its use in pediatrics.

Introduction: Background: the number of infants and children who receive artificial nutrition at home has been steadily increasing over the last decades, as better outcomes for children with chronic conditions have been achieved. In order to evaluate the need of resources to implement the technique it is necessary to know how many patients benefit from home artificial nutrition. This information can be estimated from the register of patients, when available. Methods: in this paper the characteristics of all registers were reviewed, especially those devoted to pediatric patients. Results: only two pediatric registers are active in 2023: the Canadian register and the Spanish one. NADYA register from the Spanish Society for Clinical Nutrition and Metabolism (SENPE) and the recent REPAFI, form the Spanish Society of Pediatric Gastroenterology, Hepatology and Nutrition. The most valuable register from the British Society, BANS, stopped providing information in 2018. Conclusion: despite the fact of acknowledging the importance of having gathered information on the prevalence and incidence of home artificial nutrition, to fit resources to necessities, the number of active registers is quite short.

Introduction: Background: patients with cancer are one of the main group of patients on home parenteral nutrition (HPN). Patients with malignant bowel obstruction (MBO) represent a challenging group when considering HPN. At the Ethics Working Group of SENPE ethical considerations on this subject were reviewed and a guidelines proposal was made. Methods: a literature search was done and a full set of questions arose: When, if ever, is HPN indicated for patients with MBO? How should the training program be? When withdrawal of HPN should be considered? Other questions should be also taken into consideration. May any Oncologist send home a patient with HPN? The educational program could be shortened? When considering to withdraw parenteral nutrition? Results: HPN in MBO has better outcomes when patients have a good functional status (Karnofsky ≥ 50 or ECOG ≤ 2), expected survival > 2-3 months, and low inflammatory markers. Very few data have been reported on quality of life, but HPN allows a valuable time at home albeit with a considerable burden for both patients and their families. Proposal: once a patient is considered for HPN, there is a need for a deep talk on the benefits, complications and risks. In this initial talk, when HNP should be stopped needs to be included. The palliative care team with the help of the nutrition support team should follow the patient, whose clinical status must be assessed regularly. HPN should be withdrawn when no additional benefits are achieved. Conclusion: HPN may be considered an option in patients with MBO when they have a fair or good functional status and a desire to spend their last days at home.

Objectives: To assess the awareness and training of primary care physicians on nutrition in older patients., Design: Observational, real-world data survey., Setting: Primary Care., Participants: One hundred sixty-two physicians, generalists and specialists, working in primary care., Measurements: Participants received an online questionnaire with 18 questions concerning the importance of nutrition, degree of knowledge, needs, and training in nutrition. The results were evaluated using univariate descriptive analysis, with a percentage for each chosen answer. Logistic regression models were used to evaluate if answers were related to training in nutrition and professional experience., Results: 43.2% of participants reported that nutrition is very important in individuals over 65 years old, and 90% were aware of the importance of nutrition in healthy aging. Nutritional problems affect 30 to 50% of patients, according to 44.7% of participants. 89.2% agree about the need for nutritional assessment in older patients; however, the professionals believe they should be better prepared. Two out of three respondents consider the training received in nutrition during their undergraduate course or continuing medical education as deficient. Time of professional practice was mainly associated with conceptual facts, while continuing medical education did with practical issues, mainly the use of screening and diagnostic tools [FRAIL (OR: 3.16; 95%IC: 1.55-6.46), MNA-SF (OR: 6.455; 95%IC: 2.980-13.981) and SARC-F (OR: 3.063; 95%IC: 1.284-7.309)]., Conclusion: Although primary care professionals are aware of the importance of nutrition in older patients, there are still gaps in daily practice that could be improved by developing educational strategies., Competing Interests: None.

Objective: To assess whether the Mediterranean Diet (MedDiet) is associated with lower micronutrients inadequacy in a sample of Spanish preschoolers., Design: We conducted a cross-sectional study with 4-5-year-old children participating in the SENDO project. Information was gathered through an online questionnaire completed by parents. Dietary information was collected with a previously validated semi-quantitative FFQ. The estimated average requirements or adequate intake levels as proposed by the Institute of Medicine were used as cut-off point to define inadequate intake., Statistical Analyses: Crude and multivariable adjusted estimates were calculated with generalised estimated equations to account for intra-cluster correlation between siblings., Participants: We used baseline information of 1153 participants enrolled in the SENDO project between January 2015 and June 2022., Main Outcomes Measures: OR and 95 % CI of presenting an inadequate intake of ≥ 3 micronutrients associated with the MedDiet., Results: The adjusted proportion of children with inadequate intake of ≥ 3 micronutrients was 27·2 %, 13·5 % and 8·1 % in the categories of low, medium and high adherence to the MedDiet, respectively. After adjusting for all potential confounders, children who had a low adherence to the MedDiet showed a significant lower odds of inadequate intake of ≥ 3 micronutrients compared to those with a high adherence (OR 9·85; 95 % CI 3·33, 29·09)., Conclusion: Lower adherence to the MedDiet is associated with higher odds of nutritional inadequacy.

Background: Breastfeeding has been linked to a higher consumption of fruit and vegetables at ages 4 to 5 years. More recently, it has been suggested that it may also be associated with lower ultraprocessed food (UPF) consumption in childhood., Objective: The aim of this study was to assess whether breastfeeding duration was associated with consumption of UPF in a sample of Mediterranean preschoolers., Design: This study involved a cross-sectional analysis of baseline information of children in the Child Follow-Up for Optimal Development cohort. Children were enrolled at ages 4 to 5 years and information was gathered through an online questionnaire completed by parents. Dietary information was collected with a previously validated semi-quantitative food frequency questionnaire and foods were classified based on the degree of processing according to the NOVA classification., Participants/setting: This study used baseline information for 806 participants enrolled in the Child Follow-Up for Optimal Development cohort between January 2015 and June 2021 in Spain., Main Outcomes Measures: Main study outcome measures were difference in grams per day and in the percentage of total energy intake from UPF consumption related to breastfeeding duration, and odds ratio that UPF represents a high percentage of total energy intake., Statistical Analyses: Crude and multivariable adjusted estimates were calculated with generalized estimating equations to account for intracluster correlation between siblings., Results: The prevalence of breastfeeding in the sample was 84%. After adjusting for potential confounders, children who were breastfed for some time reported significantly lower consumption of UPF than children who were not breastfed at all. The mean differences were -19.2 g (95% CI -44.2 to 10.8) for children who were breastfed for <6 months, -42.5 g (95% CI -77.2 to -7.80) for those who were breastfed for 6 to 12 months, and -43.6 g (95% CI -79.8 to -7.48) for those who were breastfed for 12 months or more (P value for trend = 0.01). After adjusting for potential confounders, compared with children who were not breastfed, those who were breastfed for ≥12 months had consistently lower odds of UPF representing more than 25%, 30%, 35%, and 40% of total energy intake., Conclusions: Breastfeeding is associated with lower consumption of UPF in Spanish preschoolers., (Copyright © 2023 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.)

Introduction: The COVID-19 lockdown has caused important changes in children's routines, especially in terms of nutrition, physical activity, screen time, social activity, and school time. Regarding these changes, recent studies show that the COVID-19 lockdown is associated with higher levels of anxiety and depression in children. The objective of this study was to assess changes in sleep quality in Spanish children during the lockdown decreed by the Spanish government between March and June 2020., Methodology: We compared the BEAR (bedtime, excessive daytime sleepiness, awakening during the night, and regularity and duration of sleep) scores of 478 participants (median age = 7.5 years; 48% girls) in the SENDO project during the periods before, during, and after lockdown. The questionnaires were filled out by one of the parents. We used hierarchical models with two levels of clustering to account for the intra-cluster correlation between siblings. The interaction of time with a set of a priori selected variables was assessed by introducing the interaction term into the model and calculating the likelihood ratio test., Results: The mean scores in the BEAR questionnaire referred to the periods before, during, and after lockdown were 0.52 (sd 1.25), 1.43 (sd 1.99), and 1.07 (sd 1.55), respectively. These findings indicate a deterioration in sleep quality during the period of confinement. Parental level of education was found to be an effect modifier ( p for interaction = 0.004). Children whose parents had higher education (university graduates or higher) showed a smaller worsening than those without., Conclusion: Our study shows that the COVID-19 lockdown was associated with a significant worsening of sleep quality. Moreover, although the end of the lockdown brought about a slight improvement, mean scores on the BEAR scale remained significantly higher than before the lockdown, suggesting that the consequences for sleep quality could persist over time. This worsening was higher in children whose parents had lower educational degrees. Helping children maintain healthy sleeping habits despite the circumstances and providing early psychological support when needed is important to prevent negative psycho-physical symptoms due to lockdown that could persist over the years.

Objective: To assess whether breastfeeding during the first months of life is associated with adherence to the Mediterranean dietary (MedDiet) pattern in preschool children., Design: The Seguimiento del Niño para un Desarrollo Óptimo (SENDO) project is an ongoing pediatric cohort with open recruitment, started in 2015 in Spain. Participants, recruited when they are 4 to 5 years old at their primary local health center or school, are followed annually through online questionnaires. For this study, 941 SENDO participants with full data on study variables were included. Breastfeeding history was collected retrospectively at baseline. Adherence to the Mediterranean diet was assessed with the KIDMED index (range -3 to 12)., Results: After accounting for multiple sociodemographic and lifestyle confounders, including parental attitudes and knowledge about dietary recommendations for children, breastfeeding was independently associated with a higher adherence to the MedDiet. Compared with children who were never breastfed, children breastfed for ≥6 months had a one-point increase on their mean KIDMED score (Mean difference +0.93, 95%confidence interval [CI]. 0.52-1.34, p for trend <0.001). The odds ratio of high adherence to the MedDiet (KIDMED index ≥8) was 2.94 (95%CI 1.50-5.36) in children who were breastfed for at least 6 months, as compared to their peers who were never breastfeed. Children who were breastfed for less than 6 months exhibited intermediate levels of adherence ( p for trend <0.01)., Conclusion: Breastfeeding for 6 months or longer is associated with a higher adherence to the Mediterranean diet during the preschool years.

Introduction: Palliative care provides a holistic approach and care for patients with a terminal illness and their families. In palliative care physical complaints as well as emotional, social and spiritual aspects are considered. Nutritional care should be also considered within palliative support. For those working in the nutritional support field, to withhold or withdraw nutritional support may be an ethical dilemma in this scenario. The controversy starts when considering nutrition and hydration as basic care or a treatment. The goals of nutrition support in palliative care patients differ from common ones, aiming to improve quality of life, survival or both. The decision should be based on a consideration of prognosis (length of survival), quality of life, and risks-benefits ratio. Regarding oral nutrition (with or without oral supplements) the idea prevails of "comfort feeding", based on providing oral feeding till discomfort or avoidance develop. There is no evidence on the benefit of specific nutrients, despite the fact that omega-3 FAs may have some positive effects in patients with cancer. Regarding nutritional support (enteral or parenteral), no scientific evidence is present, so the decision needs to be agreed according to the desires and beliefs of the patient and their family, and based on a consensus with the interdisciplinary team on the aims of this support.

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., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Introduction: Objective: to analyze the validity of self-reported somatometry data through a self-reported online questionnaire. Method: the SENDO project (Follow-up of Children for Optimal Development) is a prospective, dynamic pediatric cohort. Participants are recruited when they are between 4 and 6 years old, and followed annually through an online questionnaire. In a subsample of 82 participants, we compared the anthropometric information reported in the baseline questionnaire with the direct measurements collected by the investigating staff. To do this, we calculated the intraclass correlation index (ICC) and the Bland-Altman coefficient. Results: the ICC was 0.96 (95 % confidence interval [CI]: 0.94-0.98 for weight; 0.95 (95 % CI: 0.92-0.96) for height; 0.75 (95 % CI: 0.64-0.86) for waist circumference; and 0.84 (95 % CI: 0.76-0.89) for hip circumference. In relation to the indices calculated from these measurements, we found an ICC of 0.84 (95 % CI: 0.77-0.90) for body mass index; 0.46 (95 % CI: 0.27-0.62) for waist-hip ratio; and 0.59 (95 % CI: 0.43-0.72) for waist-height index. The Bland-Altman index ranged from 3.7 % for weight to 8.5 % for body mass index. Conclusions: we found a high correlation and concordance between the data collected in the physical exam and those reported by the parents. Our results indicate that the anthropometric measures provided by parents, especially those with which they are most familiar, are valid and can be used in epidemiological research.

Introduction: Long-chain polyunsaturated fatty acids (LC-PUFAs) are critical for infant growth and development, particularly arachidonic acid (ARA, C20:4n-6) and docosahexaenoic acid (DHA, C22:6n-3). ARA and DHA are components of cell membrane phospholipids and play an important role in cell division, differentiation, and signaling; and DHA is the n-3 fatty acid predominant in the developing brain and retina. During the third trimester of pregnancy, LC-PUFAs increase substantially in fetal circulation, and a "biomagnification" process in the fetal brain is observed. Moreover, LC-PUFAs are precursors of eicosanoids and metabolites, which modulate the intensity and duration of the immune response. LC-PUFA synthesis implies complex desaturation and elongation processes on their principal precursors, linoleic acid (LA) (18:3 n-6) (series n-6) and α-linolenic acid (LNA) (20:3 n-3) (series n-3), where fatty acid desaturases (FADS) and elongases (ELOVL) are competing. It is important to notice that during the first months of life, as a consequence of low enzymatic activity, LC-PUFA synthesis from LA and LNA is reduced, especially in those infants carrying variations in the FADS and ELOVL genes, which are involved in LC-PUFA synthesis, and so they are unable to supply their own DHA and ARA needs. Homozygote infants for FADS haplotype A (97 % of the Latinoamerican population) show low levels of ARA (only 43 %) and DHA (only 24 %) when compared to those carrying haplotype D (more prevalent in Europe, Africa and Asia). Human milk is the only source of LA, LNA, ARA, and DHA for the neonate and infant till complementary feeding (CF) is introduced. Infants fed with infant formulas must receive enough amounts of LA, LNA, ARA, and DHA to cover their nutritional requirements. The new guidelines by the European Food Safety Authority (EFSA) (2016) recommend that infant formulas and follow-on formulas must contain 20-50 mg of DHA/100 kcal (0.5-1 % of total fatty acids, which is higher than in human milk and the majority of infant formulas in the market), and it is not necessary to add ARA. This new regulation, which is already applicable since February 2020, has resulted in profound controversy because there is no scientific evidence about its appropriateness and safety for healthy children. Then, different international expert groups have revised the research already published about the effects of ARA and DHA addition to infant formulas, and discussed different emerging questions from this European directive. The expert group led from the University of Granada (Spain) recommends the addition of ARA in similar or higher concentrations than those of DHA, at least equal to those present in human milk (0.3 % of total fatty acids), although preferably 0.5 % and up to around 0.64 % of total fatty acids, since new studies confirm the optimal intake of ARA and DHA during the different developmental stages. This recommendation could be of particular importance for infants carrying the haplotype A of FADS.

Introduction: An appropriate diet in childhood is essential for suitable growth and development, but it is also essential for preventing the development of non-communicable diseases in later stages. The School stage is fundamental. A significant proportion of students in Spain make use of the school lunch. We review the current situation in Spain, as well as public policy on school lunch and a nationwide review of specific legislation on each Autonomous Community., Material and Methods: National public policy and specific considerations in every Autonomous Community were reviewed. Only considerations on the composition of the school menu were considered., Results: There are relatively recent state regulations but on school lunch menus also specific to each Autonomous Community. In general, and within a certain heterogeneity, they refer to the distribution of the diet and foods to be restricted. They usually provide guidelines, examples of daily menus, and graphic representations. Regarding school menus, there is a trend towards improvement in nutritional adequacy, but there is still room to improve. There are certain aspects related to the best solutions yet to be elucidated: management model, type of supervision, sustainability and local consumption, as well as school lunch schedules., Conclusions: The nutritional contributions made in the school canteens are qualitatively and quantitatively important. In addition, it must fulfill educational and social equity functions. Although these concerns address specific recommendation in every Autonomous Community, there is huge heterogeneity on practical implementations., (Copyright © 2021 Asociación Española de Pediatría. Published by Elsevier España, S.L.U. All rights reserved.)