IntroductionNutritional support in the care of children with threatening or limiting diseases is based on improving their nutritional status and quality of life. Malnutrition is common in these patients due to swallowing disorders, maldigestion or malabsorption, and to chronic diseases with increased energy expenditure, losses or requirements.MethodsA descriptive, retrospective analysis of patients with life-threatening or life-limiting diseases receiving Enteral Nutrition (EN) from 2000 to 2016, admitted to a Paediatric Palliative Care/Home Hospitalisation Unit, has been performed.Results188 patients have been treated. The mean age was 2.8 years (IR: 24 days-15.8 years). The most frequent indications were: swallowing disorders (42%), malnutrition (13.8%) and failure to thrive (12.2%).According to the classification of the Association for children with life threatening situation or terminal situation and their families:• Group 1 (Diseases for which curative treatment may be feasible but may fail): 23.9% (heart disease 75.5%, cancer 17.8%)• Group 2 (Diseases for which premature death is anticipated, but intensive treatment may prolong good-quality life and participation in normal childhood activities): 26.6% (Gastrointestinal (GI) diseases and malformations 48%)• Group 3 (progressive diseases for which treatment is exclusively palliative): 21.3% (57.5% advanced or metastatic cancer, 20% neuromuscular diseases)• Group 4 (severe, non-progressive neurological impairment resulting in vulnerability and complications that may lead to premature death): 28.2% (39.6% hypoxic encephalopathy)Enteral feeding was performed through a nasogastric tube in most patients (83%), requiring gastrostomy in 23.4%.During this time period, 49 patients (26%) died in relation to their underlying disease except for one due to surgical complication of the gastrostomy.ConclusionsNeurological and oncological patients represent the most frequent pathologies requiring EN. In our study, children with congenital heart disease represent the third pathology in frequency, above GI diseases. Nutrition, along with symptom control, is one of the most important aspects of treating patients with limiting or life-threatening situations, half of which will require specialised palliative care.

IntroductionFaecal calprotectin (FC) has been proposed as an inflamatory marker both in children and adults, with high levels registered in full-term newborn and in preterm newborn (PTNB). Nevertheless, there is scarce data about kinetics in the first month and its relation with severe illness such as systemic infections or bowel injury.AimsTo determine normal levels of FC in PTNB and relate it with feeding-type, gestational age (GA), birth-weight and delivery method. Also checking if its figures increase days before the occurrence of symptoms in bowel inflamatory alterations and systemic infections.Materials and methodsObservational clinic-analytic longitudinal prospective study through randomised selection of PTNB≤35 weeks GA, from whom faecal samples were taken in days 4, 8, 15, 30, 60 and 90 of life to determine FC (µg/g of faeces, CALPREST® from Eurospital). As significant illness we considered clinical or analytical sepsis or bowel injury/stress. All the variables of interest in the patient’s clinical history were collected. Breast-feeding was considered predominant if>80% of the feeding was reached through this method.Results369 samples were taken from 114 PTNB. Mean GA was 30.2 (±2.38) weeks, with mean weight of 1376.9 (±429.16) grams. 72 children did not suffer any clinical event, giving a total of 76 patological events in 42 newborns (36.8% from the PTNB). No statistically significant differences were found in PTNB between beeing breast-fed or with formula, nor was difference found in those of different GA, except for those with birth-weight≥1500 g or<1500 g at day 8 of life (respectively 321.05±193.01 vs 169.67±134.22).Mean FC in healthy PTNB is significantly lower than in those who suffer illness, being statistically significant between days 4 and 30, days 4 and 15 and days 8 and 15.ConclutionSA high mean of calprotectin was observed in all cases ( higher in the first 4 days, statiscally significant, slight posterior decrease and stabilisation through the first months). During intercurrent diseases (systemic infections and intestinal distress), CF increases before the onset of symptoms or elevation of acute phase reactants and it remains 8–10 days elevated after the improvement. It is possible to use it as a predictor of digestive pathology in PTRB.

Introductionobesity (OB) is one of the most serious public health problems of the 21 st century, especially associated with complications, among which the predisposition to hypertension. There are conflicting data on the relationship between arginine levels and the presence of hypertension in adults, with almost no data on children.Material and methodsA prospective longitudinal observational study of cohorts. Case = high weight (overweight (BMI>p85) and obese (OB) (BMI>p95)); control = normal weight (BMI p95 respectively Children 6–11 years old, prepubertal (Tanner 1–2) were selected. Exclusion criteria: secondary obesity, other organic disease, chronic intake of drugs or diabetes. Plasma arginine levels were measured by tandem mass spectrometry (mmol/L) at initial recruitment and after 12–15 months. One year follow-up of patients repeating clinical measurements of blood pressure, anthropometry and analytical data (arginine).Results100 children, 52% male, with a mean age of 8.6±1.6 years; 71% overweight and overweight (63% obese); 79 children with waist circumference above p90. Arginine has no correlation with any of the analytical parameters or with the percentiles of BP and there is no statistically significant difference between baseline arginine levels according to the presence of insulin resistance, overweight or obesity Patients with high blood pressure at initial moment and after one year follow up have lower levels of plasma arginine (p<0.05). Among patients with a valid measure of BP after one year, 55% have a baseline arginine less than 20 mmol/L and, among them, 59% presented a rise in blood pressure above the 90th percentile (p 0.006), with an odds ratio of 7.22 (1.60–32.46), p 0.006.DiscussionOur work provides evidence that there is an already valuable arginine deficit a few months before a tensional increase above the 90th percentile. Biochemical data are provided that can serve as predictors at an age where there may be reversibility of the ”hypertensive gait” process. These findings may elucidate new pathogenic mechanisms in adult hypertension begins in childhood, especially in the case of overweight patients.