The document, developed by the Polish Society for Pediatric Gastroenterology, Hepatology and Nutrition is based on a comprehensive analysis of the scientific literature − mainly systematic reviews of cohort studies and randomized controlled trials published during the last 7 years and on the trustworthy recommendations and position statements by European Society Paediatric Gastroenterology and Nutrition, World Health Organization, American Academy of Pediatrics, American Heart Association, Scientific Advisory Committee on Nutrition, and Polish National Food and Nutrition Institute. A draft of the document was sent to all co-authors and the final version was agreed during the discussion. The recommendations provide definitions and classification of sugars, data on the health impact of excessive use of free sugars non-sugar sweeteners at developmental age and conclusions with recommendations regarding the consumption of free sugars in children and adolescents. 

The increasing morbidity of allergic diseases, change in their clinical manifestation, including atopic dermatitis (AD), and the lack of updated Polish guidelines in this field, prompted the group of experts from the Polish Society of Allergology, Polish Dermatological Society, Food Allergy Section of the Polish Paediatric Society of Gastroenterology, Hepatology and Nutrition and the Polish Pediatric Society to organize a debate on this topic in December 2018. This paper is a comprehensive conclusion from this meeting. It provides a summary of the recommended diagnostic and therapeutic procedures in children with AD. The role of cow’s milk hydrolysates and amino acids in children with AD is discussed in detail. 

The article presents the results of the study conducted by Bellaiche et al. The aim of the study was to assess the incidence and the impact on the quality 
 of life of functional gastrointestinal disorders in formula-fed infants aged < 6. months. 

Opracowanie na podstawie: Bellaiche M, Oozeer R, Gerardi-Temporel G i wsp. Multiple functional gastrointestinal disorders are frequent in formula-fed infants and decrease their quality of life. Acta Paediatr 2018;107:1276-1282.
 

The article presents a summary of the results of Cochrane systemic review conducted in 2018 and focused on the effects of omega-3 long-chain polyunsaturated fatty acid supplementation on pregnancy outcomes and the health of mother and child. 

Opracowanie na podstawie: Middleton P, Gomersall JC, Gould JF i wsp. Omega-3 fatty acid addition during pregnancy. Cochrane Database Syst Rev 2018;11:CD003402.
 

A cyclical International Coeliac Disease Symposium (ICDS) was held in Paris on September 5-7, 2019. The report presents the main topics discussed during the symposium concerned of new diagnostic guidelines, celiac disease pathogenesis, celiac screening, novel biomarkers, and non-celiac wheat sensitivity. Presentations of Polish researchers participating at the symposium are also presented. 

Dermatological diseases in the pediatric population are a diagnostic and therapeutic challenge due to the uncommon different clinical picture of skin 
 diseases in children compared to adults. In newborns and small children, there are also entities not observed in adults, such as the streptococcal toxic shock syndrome. Early origin have also genetic disorders (genodermatoses) and chronic diseases that change their clinical picture over the years, such as atopic dermatitis. In this publication, the authors will only refer to these diseases in children that manifest with vesicular and blistering rashes. The rash, also known as exanthema, is, according to the definition, a condition associated with the presence of efflorescence, usually numerous, covering one area of   the body or its entire surface. 

Guillain-Barré syndrome (GBS) is the most common cause of an acute and sub-acute flaccid paralysis. About two-thirds of the patients have symptoms of a preceding infection of the upper respiratory tract or gastrointestinal tract. The most frequent cause of the infection is Campylobacter jejuni. In the majority of cases, the antecedent infection causes an immune response leading to damage of peripheral nerves. Main symptoms of GBS are rapidly proceeding muscle weakness, decreased deep-tendon reflexes, backache, paraesthesia, ataxia and autonomic dysfunction. The correct and fast diagnosis is crucial, because specific treatment is most effective in the early stages of the disease. Management of GBS in children includes general care, immunotherapy and physiotherapy. This article summarizes the latest knowledge on mechanisms causing the symptoms of GBS, differential diagnosis and current views on treatment and prognosis. 

The article presents the current epidemiology of intestinal parasitic diseases in children, based on an official surveillance data and the results of research studies conducted in different regions of Poland. It has been shown that enterobiasis and giardiasis are still the most commonly diagnosed parasitic diseases in children, particularly in those up to 9 years of age. Enterobius vermicularis infections were found in 7.6-37.0% of children. The highest incidence of giardiasis was recorded in Warmia and Masurian province – 9.6 case-patients per 100 000 population. Contemporary possibilities of diagnosing intestinal parasitic infections as well as principles and designs of pharmacological therapy in children were also discussed. Some attention was paid to the importance of prophylaxis in restricting of parasite transmission and re-infections. 

Feeding disorders are problematic for parents and paediatricians alike, because of difficulties in their diagnosis and because of potential serious sequalae. 
 In order to ensure a patient’s proper psychophysical development, diagnostic workup and therapy should be managed by an interdisciplinary team of professionals, preferably consisting of a doctor, a dietician, a psychologist and a speech therapist. Feeding disorders derive from many kinds of disfunctions, both behavioural and medical. In many cases, even if the underlying medical condition is treated, the child’s reluctance to food may not fade. A comprehensive diagnosis of the stage of development, nourishment, health and mental state enables to plan effective actions. Only extensive care and treatment can solve the problem. 

Human milk is the best form of feeding for premature babies due to its protective properties and beneficial preventive effect. Unfortunately human milk (after either premature or timely delivery) does not provide enough nutrients, especially for VLBW, and it should be fortified. Appropriate fortifications are now possible thanks to the use of available fortifications. The primary goal of the VLBW infant nutrition strategy is to maximize postnatal growth without adverse metabolic consequences. Therefore fortification of HM should be adapted to specific nutrient needs of each individual infant. Available human milk fortifiers, methods of fortifications and the latest research and literature reviews in this field were presented. Current recommendations in this area are presented. Human milk fortification with multi-nutrient fortifiers is recommended for newborns < 1800 g, when milk supply reaches 50-80 ml/kg/day. Optimization of HM amplification is necessary. Individualization (regulated or targeted) is the recommended method of fortification breast milk for newborns born prematurely. There is no consensus about post discharge nutrition. More research is needed to optimize both the content of fortifiers as well as methods of fortifications. 

Pharyngotonsillitis is an upper respiratory tract infection that occurs primarily in children and adolescents. Group A β-hemolytic streptococcus causes 15 to 30% of tonsillitis. To estimate the probability of streptococcal infection, a diagnostic scoring system according to Centor and McIsaac is suggested. If therapy is considered, a positive score ≥ 3 should lead to pharyngeal swab culture or rapid test in order to identify β-hemolytic streptococci. First line therapy of β-hemolytic streptococci consists of oral penicillin. Recurrent pharyngotonsillitis occurs in about 12% of children. Staphylococcus aureus and Haemophilus influenzae are most frequent pathogens in the etiology of recurrent tonsillitis and their relevance is due to their antimicrobial resistance and persistence in the internal tissues of the tonsils. Tonsillectomy is indicated in case of recurrent tonsillitis after several failures of antibiotic therapy. Several clinical studies indicate that probiotic strain Streptococcus salivarius K12 could reduce the occurrence of streptococcal infections and recurrences of pharyngotonsillitis in children. 

Introduction: The aim of this systematic review was to assess the diagnostic accuracy of laboratory parameters in identifying dehydration in children with AGE (acute gastroenteritis).

Methods: Three electronic databases (Medline [through PubMed], EMBASE, the Cochrane Library), two registers of clinical trials, and the reference lists from identified articles were screened with no language restrictions for diagnostic accuracy studies in children with AGE. The index tests were different laboratory parameters. The reference standard was the percentage loss of body weight. The main outcomes were sensitivity, specificity, positive likelihood ratio (LR), and negative LR.

Results: Eight studies involving 870 patients assessing eight laboratory parameters (BUN/urea, bicarbonate, pH, base deficit, serum uric acid, creatinine, end-tidal carbon dioxide, and urine specific gravity) were included. The diagnostic accuracy of these tests was either of no value in assessing the degree of the dehydration or, in the case of positive findings, was not confirmed by other analysed studies.

Conclusions: Limited evidence does not support the use of the laboratory parameters, either as a single test or a combination of tests, as the only tool to assess the degree of dehydration in children with AGE. 

Źródło finansowania: środki statutowe Warszawskiego Uniwersytetu Medycznego
 

Enteral nutrition is the method of choice when oral feeding is not possible or sufficient. Despite many benefits, it also involves the risk of complications. One of them is the intolerance of the formula - the problem most often observed in young children whose gastrointestinal tract is not yet fully developed. In some cases, change of the polymeric formula to one with a different composition, such as hydrolyzed milk protein, is an effective form of treatment. The article presents a clinical case of a enterally fed infant with the problem of polymeric formula intolerance and the benefits that can be obtained by changing the composition of the formula. 

Addison’s disease (AD) is a rare disorder, that can be life-threatening as a result of the adrenal crisis. The disease is characterized by long-term deficient biosynthesis of adrenocortical hormones, especially cortisol. Due to the lack of specific symptoms it is called the “great mimicker”. Patients may present with nonspecific symptoms such as fatigue, malaise, abdominal pain, myalgia, weight loss or lack of increase in children, hyperpigmentation, nausea, vomiting, orthostatic collapse and hypotension. In the diagnosis of AD, the morning measurement of plasma cortisol and ACTH, as well as the stimulation test with synthetic ACTH are applied. Hormone replacement therapy is the mainstay of treatment. The drug of choice in children is hydrocortisone. Fludrocortisone, if necessary, is also included. We report a case of a 10-year-old girl who was diagnosed with Addison’s disease. 

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Eksperci podczas debaty zorganizowanej przez redakcję „Polityki Zdrowotnej” podkreślali: alergia na mleko krowie często przechodzi w marsz alergiczny, czyli kolejne, inne postaci alergii. System ochrony zdrowia nie zawsze to widzi. 15 lipca 2019 r. odbyła się debata ekspercka zorganizowana przez redakcję portalu „Polityka Zdrowotna” dotycząca aktualnych problemów i wyzwań w postępowaniu w alergii na białko mleka krowiego. Alergia na mleko to jedna z najczęściej występujących alergii pokarmowych, jednak wciąż niewiele się o niej mówi, a pacjenci i ich rodzice często czują się niedoinformowani. W debacie poruszano zagadnienia związane ze zmieniającym się obrazem choroby alergicznej, a zwłaszcza aktualną wiedzą o jej konsekwencjach – marszu alergicznym, w kontekście jakości życia i kosztów leczenia. Eksperci przedstawiali problemy wynikające z codziennej praktyki klinicznej. Stale dowiadujemy się o tej chorobie nowych faktów, które zmieniają podejście zarówno do jej leczenia, jak i profilaktyki.