Frequently we face with H pylori infection in children. The recommended treatment for this condition is Lansoprazole+Amoxicillin and Clarithromycin (Prevacid+Amoxil+Biaxin) for 14 days. These combinations will erradicate the H pylori infection frequently. Reinfection is up to 4% per year in pediatric population.

An Alternative for Resistent H pylori infecion is the combination of Omeprazole+Levofloxacin+Amoxicillin. This combination must be consider carefully during the pediatric age due to possible grow plates involment and it is usually reserved for mid ad

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Jaundice is the yellow discoloration of tissue due to deposition of bilirubin in the different body tissues. When Jaundice is presented the bilirubin levels should always be fractionated in direct and indirect bilirubin levels to help establishing the right diagnosis.

Cholestasis is when direct bilirubin level is 2 or more mg/dl and 20% or more of the total bilirubin levels. All Neonates jaundiced > 3 weeks have to measure direct bilirubin and all cholestatic bilirubin level results should be worked up for the underline etiology and proper treatment.

Neonatal jaundice is not always benign and it can be confused with one of these conditions and delay it proper treatment.

The differential diagnoses on Neonatal cholestasis are:
•Anatomic abnormalities: Choledochal Cyst, Spontaneous Perforation of Bile Duct, Inspissated Bile Syndrome
•Biliary atresia
•Metabolic disorders: Alpha 1 Antitrysin Deficiency, Inborn Errors of Metabolism, Bile Acid Synthesis Defects
•Genetic: Cystic Fibrosis, Alagille syndrome, Progressive Familial Intrahepatic Cholestasis
•Infections: TORCH, Acquired infections after birth (sepsis), UTI
•Endocrinopathies: Hypothyroidism, Panhypopituitarism

These infants with cholestasis have failure to thrive due to increased metabolism, and decrease fat absorption. They will need formulas with high contain in MCT oils, Fat soluble vitamin supplementation, close weight monitoring, and Ursodeoxycholic acid helps with toxic bile acid excretion and pruritus

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What it is Gastroparesis?

Gastroparesis is the condition that reduces the ability of the stomach to empty its contents, but there is no blockage (obstruction), a delayed gastric emptying time, which can be due to muscular, neural, or humoral abnormalities. In the absence of an identified cause, gastroparesis is labeled as idiopathic.
The criteria for idiopathic gastroparesis refractory to medical therapy, and had many of the symptoms of gastroparesis including early satiety, nausea, vomiting, bloating, Postprandial fullness, Epigastric pain, Epigastric burning dehydration, abdominal pain, and nutritional compromise.

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Having a child with a gastrostomy tube is at the beginning very scarry, specially when the tube poops out. Learning the simple tools to change the gastrostomy tube will give you confidence tochange the tube and gastrostomy tubetube feeding.

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