Conséquences de la dénutrition chez l'enfant et l'adolescent. Mortalité, morbidité, conséquences médicoéconomiques

Association between Sleep Disturbances During Childhood and Smoking Trajectories During Adulthood: The Longitudinal TEMPO Cohort Study

OBJECTIVE

This study examined the longitudinal association between child sleep disturbances from ages 3 to 16 and smoking in adulthood among subjects from a French cohort study.

METHODS

Data from 2,134 subjects who participated in the French TEMPO cohort from 1991 to 2018 were used. Sleep disturbances observed from ages 3 to 16 years defined our exposure. Tobacco consumption trajectories constitute our outcomes and were ascertained by using Group-Based Trajectory Modeling, a semiparametric probabilistic method that hypothesizes the existence of distinct developmental trajectories over time within one population. The impact of SDs in childhood on adulthood's Tobacco consumption were studied using multinomial logistic regression.

RESULTS

Sleep disturbances at 16 years or under were observed in 26.5% of participants. Five smoking trajectories were defined: "non-smokers", "decrease in consumption at age 20 years", "low-level tobacco use", "smoking followed by cessation at age 30 years" and "high-level tobacco use". No statistically significant association between sleep disturbances and smoking trajectories was found. Compared with nonsmokers, adjusted odds-ratios and 95% Confidence Intervals for each trajectory were respectively: 0.81 [0.52-1.26], 1.28 [0.74-2.22], 1.37 [0.88-2.15] and 1.01 [0.60-1.69].

CONCLUSION

These results suggest that smoking in adulthood may not be related to sleep disturbances in childhood.

A Fatal Case of COVID-19 in an Infant with Severe Acute Malnutrition Admitted to a Paediatric Ward in Niger

While there have been very few fatal cases, SARS-CoV-2 has been reported in paediatric patients. This study aims to describe a fatal case of COVID-19 in a child with severe acute malnutrition. The eight-month-old child presented with fever, diarrhoea, and difficulty in breathing. The mother of the child had fever and shortness of breath four weeks before she died. Physical examination revealed lethargy, dehydration, and severe weight loss with a weight of 5 kg at a height of 78 cm tall. The weight-for-height index was less than three Z-scores, which corresponds to severe acute malnutrition. The pulmonary examination revealed moderate respiratory distress, and the chest X-ray presented features suggestive of pneumonia in the right lung area. In the context of the COVID-19 outbreak in Niger and the circumstances of the mother's death, a nasal swab was taken for laboratory confirmation. Treatment provided to the child included intranasal oxygen, antibiotics, and a dietary program with therapeutic milk. The child died 48 hours after his admission. The history of contact with a SARS-CoV-2 suspect or positive patient should lead to screening for infection by using RT-PCR. It is important to investigate malnutrition as a potential risk factor for severe SARS-CoV-2 infection and resultant mortality.

Malnutrition in type 2 diabetic patients does not affect healing of foot ulcers

AIM

Protein-energy malnutrition is known to be involved in wound healing. While wound healing in patients with diabetic foot ulcers (DFU) is a complex and multifactorial process, the role of malnutrition in this case has rarely been explored. The objective of this study was to determine whether the nutritional status of diabetic patients influences the healing of DFU.

METHODS

48 patients were included in this prospective, single-center study. All patients with comorbidities or factors involving malnutrition or influencing biological measurements were excluded. Patients were followed up for 24 weeks.

RESULTS

The malnutrition rate was 29.2% at baseline and 25.6% at the end of the study. The difference was not significant. Of the 35 patients with wound healing, 29% were undernourished at inclusion and 17% at the end of the study. Of the 12 patients without wound healing, 50% were undernourished at inclusion, and 42% at the end of the study. These differences were not significant. Rate and speed of wound healing were not associated with malnutrition at inclusion. 15% of patients without malnutrition at baseline had final malnutrition.

CONCLUSION

We demonstrated that wound healing was not affected by the initial presence of malnutrition. In our study, there is no evidence to support nutritional intervention to improve wound healing in diabetic patients. Nevertheless, malnutrition is responsible for an increase in morbidity and mortality and it is essential to identify malnutrition systematically for all patients with DFU, initially and during follow-up to treat it quickly and efficiently.

[Nutritional status in pediatric intermediate care: Assessment at admission, progression during the stay and after discharge]

INTRODUCTION

Malnutrition, known as a cause of morbidity, has not been studied in children admitted to pediatric intermediate care units. This study aimed to describe the association between patients' nutritional status and the relative severity of illness that characterizes this population.

PATIENTS AND METHODS

In this prospective longitudinal study, a dedicated nutrition support team assessed the nutritional status of all children, aged 5 days to 18 years, admitted to our university pediatric intermediate care unit (Hôpital Femme-Mère-Enfants, Lyon, France) over one year (2012-2013). Weight, height, body mass index, weight-for-age ratio, height-for-age ratio, and the analysis of growth curves were collected at admission. We monitored patients' weight, which allowed us to detect malnutrition occurrence during the stay, and its progression up to 3 months after discharge.

RESULTS

A total of 459 patients were enrolled. Based on the analysis integrating all nutritional indices and the progression of growth curves, malnutrition at admission was detected in 23.8% of children (20.5% and 6.8% suffered from acute and chronic malnutrition, respectively). Based only on the body mass index, malnutrition was detected in 15.5% of children. Chronic disease appeared as a risk factor for malnutrition at admission (P=0.0001) and young age for acute malnutrition (P=0.04). The incidence of acquired malnutrition during the stay (in children with a length of stay > 5 days) was up to 26%, and dyspnea was the only risk factor identified. This population recovered with a normal nutritional status late (66% after 2 months and 16% after 3 months).

CONCLUSIONS

The prevalence of malnutrition is high in our pediatric intermediate care unit. The occurrence of acquired malnutrition during the stay is frequent. All children should benefit from systematic nutritional assessment at admission as well as careful monitoring during the stay and after discharge, to adapt early and individualized nutritional support.