Chylothorax in children is a fairly rare but at the same time serious pathology. Accumulation of a large amount of fluid in the pleural cavity leads to the development of respiratory, cardiovascular failure, and even death. In some children, this process can be initiated even before birth. The main components in the treatment of chylothorax are as follows: conservative measures aimed at reducing the amount of chyle, paracentesis, and drainage of the pleural cavity, mini-invasive surgery. To date, universal approaches to the management of patients with chylothorax have not been fully developed, there are no common diagnostic algorithms, terms, and optimal treatment tactics. There are only a few publications on this issue in literature, which are descriptive in nature and based on a small number of observations. The low prevalence of chylothorax in newborn infants, different etiology, various pathogenetic mechanisms of the disease make it difficult to conduct large-scale randomized trials in this area that would fully meet the modern requirements of evidence-based medicine. In this article, the authors demonstrate a multidisciplinary approach to treating a child with congenital chylothorax.
AIM: to establish the consensus on controversial issues of the surgery for Сrohn’s disease by Delphi method.METHODS: a cross-sectional study was conducted by the Delphi method. 62 experts voted intramural and anonymous (31.03.23). 5 statements from the current edition of clinical guidelines were selected for correction by working group and further voting [2]. Based on the practical experience of the working group and literature data, 3 new statements were created also. Statements that do not reach the required level of agreement (80% or more) will be subjected to Round 2 of the Delphi method.RESULTS: all experts took part in the anonymous voting. The panel of experts is represented by 8 different areas of practical medicine and the median of the professional experience of the respondents was 30 (12–49) years. Of the 8 statements submitted for voting, consensus (80% or more) was reached on 6 out of 8. 2 statements have been revised by working group for the distance 2nd round of the Delphi study. Consensus (more than 80%) was reached on both.CONCLUSION: a cross-sectional study by the Delphi method provided the opinions of a panel of experts on controversial issues in the surgical treatment of Crohn’s disease. Statements that reach consensus will be included by the working group in a new edition of clinical guidelines of Crohn’s disease.
Background. The approaches to the managing of nutrition for healthy children are not always applicable to patients with neurological disorders, since their body composition, muscle tone, level of physical activity, and energy requirements significantly differ from healthy children and, therefore, must be personalized with the mandatory involvement of a nutritionist/dietitian. The purpose is to assess nutrition in children with cerebral palsy (CP) depending on Gross Motor Function Classification System (GMFCS) level. Materials and methods. Eighty-eight 2 to 16 years nine months CP children rehabilitated at the National Medical Research Center for Children’s Health from 2019 to 2021 were included in this study. Participants were divided into two groups. The main group was patients with GMFCS levels IV-V (48 children) and the comparison group - GMFCS levels I-III (40 children). The medical and dietary history of participants was analyzed. Anthropometric parameters using the WHO AnthroPlus (2009) software were assessed in all participants, the ability to eat and drink was determined by questioning the EDACS scale (Eating and Drinking Ability Classification System). Results. The mean values of weight/age, height/age, BMI/age Z-scores were significantly below 0 (p = 0.01) in all patients (88): WAZ -1.54 ± 1.9, HAZ -1.03 ± 1.48, BAZ -1.5 [-3.11; -0.35]. Children of the main group had significantly lower Z-scores. As a result of the survey, patients of the main group were revealed to have indicators characterizing eating disorders significantly more often (p < 0.001) than the comparison group. EDACS survey revealed that children of the main group were significantly more likely (58% and 10%, respectively; p < 0.001) to have disorders corresponding to levels IV-V, characterized by significant safety restrictions. We have developed a nutritional assessment and management algorithm for children with cerebral palsy, admitted for rehabilitation at the neurological department. Conclusion. Children with cerebral palsy need regular nutritional assessment and management for timely and adequate nutritional support, including enteral nutrition.
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