Does sarcopenia affect outcomes in pediatric surgical patients? A scoping review

Preoperative low muscle mass and early postoperative outcomes in children undergoing living donor liver transplantation: A retrospective study

Low skeletal muscle mass may develop in children with end-stage liver disease, affecting postoperative outcomes. We retrospectively investigated whether preoperative low muscle mass was associated with early postoperative outcomes in pediatric patients undergoing living donor liver transplantation (LDLT). Electronic medical records of children (age below 12 y) who underwent LDLT between February 1, 2007, and January 31, 2018, were reviewed. The cross-sectional areas of psoas, quadratus lumborum, and erector spinae muscles at the level of fourth-fifth lumbar intervertebral disks were measured using abdominal CT images, divided by the square of the height and were added to obtain the total skeletal muscle index (TSMI). The patients were divided into two groups according to the median TSMI in the second quintile (1859.1 mm 2 /m 2 ). Complications in the early postoperative period (within 30 d after surgery) classified as Clavien-Dindo grade 3 or higher were considered major complications. Logistic regression analyses were performed to determine the association between preoperative low muscle mass and early postoperative outcomes. In the study population of 123 patients (median age, 14 mo; range, 8-38 mo) who underwent LDLT, 29% and 71% were classified in the low (mean TSMI, 1642.5 ± 187.0 mm 2 /m 2 ) and high (mean TSMI 2188.1 ± 273.5 mm 2 /m 2 ) muscle mass groups, respectively. The rates of major complications, mechanical ventilation >96 hours, intensive care unit stay >14 days, hospital stay >30 days, and in-hospital mortality were not significantly different between the 2 groups. Additionally, adverse outcomes according to pediatric end-stage liver disease scores and sex were not significantly different between the 2 groups. In conclusion, preoperative low muscle mass defined by TSMI was not associated with early postoperative outcomes in pediatric patients undergoing LDLT.

Sarcopenia in Children With Wilms Tumor: A Marker of Undernutrition Which May Impact Adversely on Clinical Outcomes

The therapeutic approach to Wilms tumor (WT) is multidisciplinary and leads to significant patient impairment, increasing the risk of nutritional compromise and malnutrition. Children with cancer are vulnerable to sarcopenia which has been recognized as a negative impact of anticancer therapy. Recent studies have highlighted the reduction in the total psoas muscle area (TPMA) to be associated with a poor prognosis in many pediatric diseases, including cancer. This study aims to evaluate changes in the TPMA compartment during the treatment of children with WT. An observational, longitudinal, and retrospective study was undertaken in a single institution evaluating children (1 to 14 y, n=38) with WT between 2014 and 2020. TPMA was assessed by the analysis of previously collected, electronically stored computed tomography images of the abdomen obtained at 3 time points: diagnosis, preoperatively, and 1 year after surgery. For all patients, TPMA/age were calculated with a specific online calculator. Our data show a high incidence of sarcopenia (55.3%) at diagnosis which increased after 4 to 6 weeks of neoadjuvant chemotherapy (73.7%) and remained high (78.9%) 1 year after the surgical procedure. Using TPMA/age Z-score curves we have found significant and rapid muscle loss in children with WT, with little or no recovery in the study period.

Establishment and validation of reference values for abdominal skeletal muscle compartments in children

BACKGROUND & AIMS

Sarcopenia, resulting from skeletal muscle loss, is a serious concern in children, for whom nutrition and physical activity are essential for growth. In sarcopenia research, the skeletal muscle mass is often obtained from computed tomography (CT) cross-sectional images in both adults and children; however, the method of evaluating skeletal muscle using CT, especially the area range to be measured, has not yet been validated in children. The aim of this study is to establish reference values for three compartments of the abdominal skeletal muscle area (aSMA) obtained from cross-sectional CT images, and to validate the differences among them by assessing correlations with physical development.

METHODS

We conducted a single-centre, retrospective, cross-sectional study and included patients aged 1-17 years who underwent abdominal CT at Chiba University Hospital from 2007 to 2020. Patients with chronic diseases such as malignant tumours and inflammatory bowel disease were excluded from the analysis. aSMA was obtained from CT cross-sections at the lumbar L3-L4 intervertebral disc level by dividing it into three compartments: the psoas muscle area (PMA), paraspinal muscle area (PSMA), and total skeletal muscle area (TSMA). Quartile regression curves by sex and muscle compartment were generated using non-crossover and nonparametric regression quantile estimation. The correlation between each compartment of aSMA with height and weight was assessed using Spearman's rank correlation coefficient.

RESULTS

We analysed the abdominal CT images of 593 children (male: n = 335, female: n = 258) and generated curves predictive for the 5th, 25th, 50th, 75th, and 95th percentiles for each compartment of aSMA by sex. In patients aged 13 years and older, boys had significantly larger aSMA areas than girls in all three compartments. Among the three compartments, PSMA had the strongest correlation coefficient with height and weight for both boys and girls.

CONCLUSIONS

We generated quantile regression curves for three aSMA compartments obtained from cross-sectional CT images and established reference values in children. PSMA values were most strongly correlated with height and weight among the three aSMA compartments.

The impact of sarcopenia and sarcopenic obesity on survival in children with Ewing sarcoma and osteosarcoma

BACKGROUND

Sarcopenia is an indicator of negative outcomes in many diseases in adults. Reports indicate this might also be true in children.

OBJECTIVE

To evaluate the effect of sarcopenia and sarcopenic obesity on event-free survival (EFS) and overall survival (OS) in children with Ewing sarcoma and osteosarcoma.

MATERIALS AND METHODS

We retrospectively measured total muscle areas of the pectoralis, paraspinal (T12 level) and psoas (L4 level) muscles and total abdominal muscle area (L3 level) on computed tomography images in 60 children diagnosed with either Ewing sarcoma (n = 34) or osteosarcoma (n = 26). Skeletal muscle indices (SMI) were calculated by normalizing muscle area to patient height. Vertebral morphologic parameters of T12 and L4 vertebrae were measured and correlated to patient height to use as a substitute in cases of missing height data (SMI_T12 and SMI_L4). We calculated sarcopenic obesity index by dividing SMI by body mass index. We subdivided children into two groups according to the median value of each parameter and assessed the differences in survival between the groups.

RESULTS

No skeletal muscle index or sarcopenic obesity index parameter significantly affected event-free or overall survival in the total group analysis. In the non-metastatic group, higher values of SMI-paraspinal and SMI_T12-psoas were correlated with longer event-free survival and no patient died in this group. Boys and children in the metastatic group with higher SMI_T12-paraspinal values had significantly longer event-free survival and both event-free and overall survival, respectively.

CONCLUSION

Although some parameters were correlated with event-free and overall survival, neither sarcopenia nor sarcopenic obesity were reliably associated with survival in children with Ewing sarcoma or osteosarcoma.

Impact of muscle loss in children with hematologic malignancies undergoing allogeneic hematopoietic cell transplantation

The widespread recognition of the concept of sarcopenia, or muscle loss, has impacted the prognosis of patients undergoing high-intensity treatments. We focused on the effect of muscle loss on the prognosis of pediatric patients with hematologic diseases. A total of 65 patients with hematologic malignancies who underwent allogeneic HCT once were investigated. The change in cross-sectional psoas muscle area (PMA) measured on computed tomography (CT) images was expressed as the muscle loss index (MLI), which was calculated by dividing the pre-HCT PMA by the baseline PMA. In this study, patients with MLI values less than 0.85 were classified into the muscle loss group. Muscle loss was observed in 27 patients (41.5%). Patients who experienced muscle loss were older than those who did not. Muscle loss was an independent predictor of higher non-relapse mortality (NRM) (p = 0.012) and inferior overall survival (OS) (p = 0.045) at 5 years. Multivariate analysis showed that muscle loss was an independent risk factor for higher NRM (p = 0.046), and inferior EFS (p = 0.048). Muscle loss observed pre-HCT may be a predictor of increased NRM, poor OS and EFS in pediatric patients with hematologic malignancies undergoing allogeneic HCT.

Scoping out the scope of scoping reviews in neonatal and pediatric pain management: A scoping review methodological framework

PURPOSE

This methodological framework was purposed to discuss the considerations for conducting scoping review for neonatal and pediatric pain management (NPPM) from the perspectives of Arksey and O' Malley and Joanna Briggs Institute (JBI) framework. Till now, there is no scoping review or standard methods are available for identifying, prioritizing, or reporting research gaps in the area of NPPM.

METHODS AND RESULTS

Scoping reviews were utilized to map the literature comprehensively across a range of study designs in a particular area. This methodological framework describes the methods used to identify, prioritize, and display research gaps in the area of NPPM. Different methods to determine research gaps have been described in this framework. This scoping review methodological framework also discussed methods for conducting scoping review in two levels with methodological considerations given by Arksey and O'Malley, and JBI Institute. Search terms and search terminologies are described to conduct scoping review effectively for NPPM. Through, this standard scoping review methodological considerations, the general understanding and current advances in NPPM can be widened.

CONCLUSION

This methodological framework describes the methods for conducting scoping review effectively in the area of NPPM.

LEVEL OF EVIDENCE

Not applicable.