1
|
Tuna Kirsaçlioğlu C. Management of gastrointestinal and nutritional problems in children on home invasive mechanical ventilation. Pediatr Pulmonol 2024; 59:2170-2179. [PMID: 38088191 DOI: 10.1002/ppul.26801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 10/09/2023] [Accepted: 11/10/2023] [Indexed: 07/27/2024]
Abstract
In recent decades, the patient survival is increased due to advances in intensive care units and development of modern mechanic ventilators. Unfortunately, it is not always possible to wean these children from mechanical ventilation. Recently, after placement a tracheostomy tube, these children can be supported at home with noninvasive or invasive mechanical ventilation. Most of the children who need ventilation support at home have neurological impairment. The nutritional issues and gastrointestinal (GI) complications are well defined in critically ill patients, but there are very limited studies on children with tracheostomy. Considering that majority of the patients have neuromuscular disorders, the nutritional and GI problems of the children with tracheostomy are discussed in light of the knowledge of critically ill patients.
Collapse
Affiliation(s)
- Ceyda Tuna Kirsaçlioğlu
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Ankara University School of Medicine, Ankara, Türkiye
| |
Collapse
|
2
|
Shrivastava S, Shaw K, Lee M, Reitich P, Hunter S, Klosterman M, Sathe M. Association of in-line digestive enzyme cartridge with enteral feeds on improvement in anthropometrics among pediatric patients with cystic fibrosis. Nutr Clin Pract 2024; 39:903-910. [PMID: 38493301 DOI: 10.1002/ncp.11142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 02/13/2024] [Accepted: 02/16/2024] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND Approximately 85% of patients with cystic fibrosis (CF) have exocrine pancreatic insufficiency (EPI) with 10% requiring supplemental nighttime enteral tube feedings. Administration of pancreatic enzyme replacement therapy (PERT) with nighttime feedings is fraught with challenges. RELiZORB (Alcresta Therapeutics, Inc), an in-line lipase cartridge, delivers PERT continuously with enteral feedings. Outcomes related to the use of this in-line lipase cartridge are lesser known. This project evaluated anthropometrics related to in-line lipase cartridge use among pediatric patients with CF already receiving oral PERT therapy prior to nighttime enteral feedings. METHODS Retrospective chart review was performed on 29 patients with CF and EPI receiving supplemental tube feedings and utilizing in-line lipase cartridge for a continuous 12 month period between 2015 and 2019. Anthropometrics were evaluated 12 months before and after initiation of in-line lipase cartridge. RESULTS Compared with mean height z score at 6-months pre-in-line lipase cartridge, mean height z score at 6-months post-in-line-lipase cartridge (adjusted mean difference [AMD] = 0.2540; 95% CI = [0.0487, 0.4592]; P = 0.0153) and mean height z score at 12-months post-in-line lipase cartridge (AMD = 0.2684; 95% CI = [0.0203, 0.5166]; P = 0.0340) were significantly higher. Mean weight z score at 12-months post-in-line-lipase-cartridge neared statistical significance compared with 6-months pre-in-line lipase cartridge (AMD = 0.2816; 95% CI = [-0.0003, 0.5634]; P = 0.0502) when excluding seven patients with advanced lung disease (forced expiratory volume in the first second of expiration of 40%). Weight-for-length or body mass index did not significantly differ compared with pre-in-line lipase cartridge. CONCLUSION Use of in-line lipase cartridge with enteral feeds improved anthropometrics, especially height, in pediatric patients with CF.
Collapse
Affiliation(s)
- Samarth Shrivastava
- Department of Pediatrics, Division of Combined Internal Medicine and Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Karyn Shaw
- Pediatric Clinical Nutrition, Children's Health, Dallas, Texas, USA
| | - MinJae Lee
- Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Patricia Reitich
- Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology and Nutrition, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Stacie Hunter
- Pediatric Clinical Nutrition, Children's Health, Dallas, Texas, USA
| | - Mary Klosterman
- Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology and Nutrition, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Meghana Sathe
- Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology and Nutrition, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| |
Collapse
|
3
|
Tolín Hernani MDM, Miranda Cid MDC, Guerrero Cuevas M, Álvarez Calatayud G, Sánchez C. Perception of Paediatricians and Families about Nutritional Supplements: Acceptance, Tolerability and Satisfaction in Malnourished Children (PerceptiONS Jr Study). Nutrients 2024; 16:2475. [PMID: 39125355 PMCID: PMC11313921 DOI: 10.3390/nu16152475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2024] [Revised: 07/22/2024] [Accepted: 07/26/2024] [Indexed: 08/12/2024] Open
Abstract
BACKGROUND Malnutrition is a common situation in the Spanish paediatric population. Malnourished children may benefit from different strategies, including dietary modifications or nutritional supplements (NS). It is important to know the different factors that can influence treatment tolerance and adherence, and their impact on nutrition monitoring. OBJECTIVES To explore the perception of doctors who prescribe nutritional supplements (NS) in children and to investigate different factors involved in tolerance and adherence. MATERIAL AND METHODS A cross-sectional, descriptive observational study based on an ad hoc electronic survey designed to study doctors' perceptions of at least five of their children with NS and their families, subjected to outpatient follow up. Variables included were the socio-demographic variables of the doctors and children, nutritional status of the patients, amount and characteristics of NS (hyper-caloric oral with fibre (HOFF), oral peptide (OPF) and hyper-caloric infant (HIF)), route of administration, perceived benefits, satisfaction, palatability, adherence, and acceptance. RESULTS 815 patients aged 0-16 years (mean 10.6 years; SD 7.8) were included. A proportion of 64% received HOFF, 16% FOP, and 20% HIF. A proportion of 84% received exclusive oral NS. Total daily calorie intake prescribed with NS ranged from 30-75% in 48.2% of cases, though it was significantly higher in children under 6 months of age. Improvement in overall condition, nutritional status and quality of life was observed in 82%, 79.5%, and 80% of subjects. Improvement in tolerance and digestive symptoms was reported in 83.5% and 72% of subjects. The degree of satisfaction and acceptance of NS was very good in 80% of cases, with taste being the most influential factor (82.3%). Adherence was adequate in more than 60%, and smell was the most significant feature in lack of adherence (55%). The flavour of the best-accepted supplement was chocolate (44%). A total of 97% of prescribing doctors would recommend the same formula again. CONCLUSIONS In our study, prescribing doctors and families perceived an excellent benefit from the use of the prescribed formulas, improved quality of life, high satisfaction, acceptance, and adherence. The positive factors for adequate adherence were sufficient information about the formulations and their benefits, and continuity of care during follow-up. Prescribing doctors would recommend supplement use again given the perceived benefits and satisfaction.
Collapse
Affiliation(s)
- María del Mar Tolín Hernani
- Digestive, Hepatology and Paediatric Nutrition Unit, Infant Maternal Hospital, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain; (M.d.M.T.H.); (M.d.C.M.C.); (G.Á.C.)
| | - María del Carmen Miranda Cid
- Digestive, Hepatology and Paediatric Nutrition Unit, Infant Maternal Hospital, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain; (M.d.M.T.H.); (M.d.C.M.C.); (G.Á.C.)
| | | | - Guillermo Álvarez Calatayud
- Digestive, Hepatology and Paediatric Nutrition Unit, Infant Maternal Hospital, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain; (M.d.M.T.H.); (M.d.C.M.C.); (G.Á.C.)
| | | | - César Sánchez
- Digestive, Hepatology and Paediatric Nutrition Unit, Infant Maternal Hospital, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain; (M.d.M.T.H.); (M.d.C.M.C.); (G.Á.C.)
| |
Collapse
|
4
|
Rudie C, Persaud S, Hron BM, Raymond M, Huh SY. Survey of nutrition screening practices in pediatric hospitals across the United States. Nutr Clin Pract 2024. [PMID: 39049548 DOI: 10.1002/ncp.11193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 06/26/2024] [Accepted: 06/28/2024] [Indexed: 07/27/2024] Open
Abstract
BACKGROUND Nutrition screening on admission is critically important to systematically identify patients with undernutrition given the known relationship with deleterious clinical outcomes. Limited data exist regarding optimal processes and criteria for pediatric nutrition screening. Therefore, we sought to characterize nutrition screening practices in pediatric hospitals. METHODS A total of 365 inpatient pediatric hospitals in the United States were identified, eligible, and contacted. Eligible hospitals included general pediatric hospitals, adult hospitals with pediatric units, and specialty pediatric hospitals. One respondent at each eligible hospital was asked to complete a 33-question survey of admission nutrition screening practices. RESULTS Of 268 survey respondents, 37% represented pediatric units in adult hospitals, 35% general pediatric hospitals, and 28% pediatric specialty or psychiatric hospitals. A total of 98.5% endorsed the existence of a screening process on admission. Anthropometrics (eg, body mass index z score, 84%) and nutrition status (eg, change in intake, 67%) were the most common screening criteria applied. A nutrition screening instrument was used in 37% of institutions, and only 31% of institutions reported using pediatric-specific screening instruments. Pediatric units within adult hospitals were 1.38 times more likely to use a screening instrument validated in any population. Barriers to nutrition screening included the lack of a standard screening procedure and insufficient staff to conduct screening. Fifty-four percent of respondents reported a desire to change their hospital's nutrition screening process. CONCLUSION Most pediatric hospitals screen for nutrition risk on admission. However, methods and criteria varied widely across pediatric hospitals, highlighting the importance of standardized best practices.
Collapse
Affiliation(s)
- Coral Rudie
- Center for Nutrition, Division of Gastroenterology, Hepatology, and Nutrition, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Sabrina Persaud
- Center for Nutrition, Division of Gastroenterology, Hepatology, and Nutrition, Boston Children's Hospital, Boston, Massachusetts, USA
- Clinical Education, Informatics, Quality, and Professional Practice Department, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Bridget M Hron
- Center for Nutrition, Division of Gastroenterology, Hepatology, and Nutrition, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Michelle Raymond
- Center for Nutrition, Division of Gastroenterology, Hepatology, and Nutrition, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Susanna Y Huh
- Center for Nutrition, Division of Gastroenterology, Hepatology, and Nutrition, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
5
|
Létourneau J, Bélanger V, Marchand V, Boctor DL, Rashid M, Avinashi V, Groleau V, Spahis S, Levy E, Marcil V. Post-discharge complications and hospital readmissions are associated with nutritional risk and malnutrition status in a cohort of Canadian pediatric patients. BMC Pediatr 2024; 24:469. [PMID: 39044205 PMCID: PMC11265476 DOI: 10.1186/s12887-024-04941-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 07/11/2024] [Indexed: 07/25/2024] Open
Abstract
BACKGROUND This study constitutes a secondary analysis of a prospective cohort aiming to evaluate the potential correlation between nutritional risk and status at admission with the occurrence of post-discharge complications and hospital readmissions in children receiving care at high resource Centres. METHODS Data was collected from 5 Canadian tertiary pediatric Centers between 2012 and 2016. Nutritional risk and status were evaluated at hospital admission with validated tools (STRONGkids and Subjective Global Nutrition Assessment [SGNA]) and anthropometric measurements. Thirty days after discharge, occurrence of post-discharge complications and hospital readmission were documented. RESULTS A total of 360 participants were included in the study (median age, 6.1 years; median length of stay, 5 days). Following discharge, 24.1% experienced complications and 19.5% were readmitted to the hospital. The odds of experiencing complications were nearly tripled for participants with a high nutritional risk compared to a low risk (OR = 2.85; 95% CI [1.08-7.54]; P = 0.035) and those whose caregivers reported having a poor compared to a good appetite (OR = 2.96; 95% CI [1.59-5.50]; P < 0.001). According to SGNA, patients identified as malnourished had significantly higher odds of complications (OR, 1.92; 95% CI, 1.15-3.20; P = 0.013) and hospital readmission (OR, 1.95; 95% CI, 1.12-3.39; P = 0.017) than to those well-nourished. CONCLUSIONS This study showed that complications and readmission post-discharge are common, and these are more likely to occur in malnourished children compared to their well-nourished counterparts. Enhancing nutritional care during admission, at discharge and in the community may be an area for future outcome optimization.
Collapse
Affiliation(s)
- Joëlle Létourneau
- Department of Nutrition, Université de Montréal, Research Center CHU Sainte-Justine, 3175 Ch de la Côte-Sainte-Catherine, Room 4.17.006, Montreal, QC, H3T 1C5, Canada
| | - Véronique Bélanger
- Department of Nutrition, Université de Montréal, Research Center CHU Sainte-Justine, 3175 Ch de la Côte-Sainte-Catherine, Room 4.17.006, Montreal, QC, H3T 1C5, Canada
| | - Valérie Marchand
- Department of Pediatrics, Université de Montréal, CHU Sainte-Justine, Montreal, QC, Canada
| | - Dana L Boctor
- Alberta Children's Hospital, University of Calgary, Calgary, AB, Canada
| | - Mohsin Rashid
- IWK Health Center, Dalhousie University, Halifax, NS, Canada
| | - Vishal Avinashi
- Division of Gastroenterology, Hepatology and Nutrition, British Columbia Children's Hospital, Vancouver, BC, Canada
| | - Véronique Groleau
- Department of Pediatrics, Université de Montréal, CHU Sainte-Justine, Montreal, QC, Canada
| | - Schohraya Spahis
- Department of Nutrition, Université de Montréal, Research Center CHU Sainte-Justine, 3175 Ch de la Côte-Sainte-Catherine, Room 4.17.006, Montreal, QC, H3T 1C5, Canada
| | - Emile Levy
- Department of Nutrition, Université de Montréal, Research Center CHU Sainte-Justine, 3175 Ch de la Côte-Sainte-Catherine, Room 4.17.006, Montreal, QC, H3T 1C5, Canada
| | - Valérie Marcil
- Department of Nutrition, Université de Montréal, Research Center CHU Sainte-Justine, 3175 Ch de la Côte-Sainte-Catherine, Room 4.17.006, Montreal, QC, H3T 1C5, Canada.
| |
Collapse
|
6
|
Cai X, Qin Y, Liu C, Xie L, Zhu J. High-calorie, whole protein/peptide nutritional formulations for children with cerebral palsy: a retrospective clinical study. Am J Transl Res 2024; 16:3171-3181. [PMID: 39114733 PMCID: PMC11301499 DOI: 10.62347/bqpn6962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 04/28/2024] [Indexed: 08/10/2024]
Abstract
BACKGROUND Children with cerebral palsy often experience inadequate nutritional intake due to factors like anorexia, intellectual impairments, underdeveloped motor skills of the oral sensory system, and eating and swallowing disorders. These challenges not only hinder their rehabilitation but also impose various degrees of burden on society and their families. Addressing malnutrition in children with cerebral palsy has become a pressing international clinical issue. This study assessed the nutritional status of children with cerebral palsy and examined the impact of a high-calorie enteral nutrition formula as a nutritional intervention. METHODS This retrospective study involved 132 malnourished children with cerebral palsy undergoing rehabilitation at the First People's Hospital of Yulin City from July 2020 to July 2023. Sixty-six children received conventional nutritional interventions after their parents were educated and trained in dietary practices and feeding techniques, forming the general group. The other sixty-six children were given a high-calorie intact protein or short peptide enteral nutrition formula milk powder (Nuiren JUNIOR or Peptamen Junior), and were referred to as the nutrient group. Data on anthropometric measurements, blood indicators, gross motor function, and adverse events were collected at baseline, three months, and six months. RESULTS After 6 months of intervention, both groups showed improvements in height, weight, weight-for-height Z-score, weight-for-age Z-score and gross motor function. There were statistical differences in height change, body mass index-for-age Z-score, and gross motor function between the two groups (P<0.05). The efficiency of nutritional intervention was significantly higher in the nutrient group than in the general group (P<0.05). In addition, total albumin, albumin, prealbumin, and 25-hydroxyvitamin D levels were higher in the nutrient group than in the general group (P<0.05). An incidence of side effects was observed in 15.15% of the children in the general group and 9.09% in the nutrient group, without significant difference (χ2=1.138, P=0.286). CONCLUSION High-calorie whole protein or peptide nutritional formulas can significantly improve malnutrition and enhance gross motor function development in children with cerebral palsy and has a low incidence of adverse events. These interventions hold promise for broader clinical application.
Collapse
Affiliation(s)
- Xia Cai
- Child Rehabilitation Department, Yulin First People's Hospital Yulin 537000, Guangxi, China
| | - Yingying Qin
- Child Rehabilitation Department, Yulin First People's Hospital Yulin 537000, Guangxi, China
| | - Chaoyun Liu
- Child Rehabilitation Department, Yulin First People's Hospital Yulin 537000, Guangxi, China
| | - Ling Xie
- Child Rehabilitation Department, Yulin First People's Hospital Yulin 537000, Guangxi, China
| | - Juelong Zhu
- Child Rehabilitation Department, Yulin First People's Hospital Yulin 537000, Guangxi, China
| |
Collapse
|
7
|
Dziechciarz P, Stróżyk A, Horvath A, Cudowska B, Jedynak-Wąsowicz U, Mól N, Jarocka-Cyrta E, Zawadzka-Krajewska A, Krauze A. Nutritional status and feeding difficulties in children up to 2 years of age with cow's milk allergy. J Pediatr Gastroenterol Nutr 2024; 79:131-139. [PMID: 38291802 DOI: 10.1002/jpn3.12139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 01/10/2024] [Accepted: 01/10/2024] [Indexed: 02/01/2024]
Abstract
BACKGROUND/OBJECTIVES To assess the nutritional status and incidence of feeding difficulties in Polish children up to 2 years of age with cow's milk allergy (CMA) on cow's milk proteins-free diet. METHODS A cross-sectional, multi-center study included children aged 6 months to 2 years with confirmed or suspected (without oral food challenge) diagnosis of CMA on the elimination diet for at least 1 month. The primary outcomes were an assessment of proportion of children with impaired nutritional status (with the weight for length and body mass index (BMI) z-score > 1 and <-1), and feeding difficulties according to the Montreal Children's Hospital Feeding Scale. Children with confirmed and suspected CMA were assessed separately. RESULTS A 144 children with confirmed CMA and 88 with suspected CMA were included (57 and 78% with multiple food allergies, respectively). Among children with confirmed CMA, one-third (35.5%) of participants had any nutritional status impairment regardless of definition. Among those, most of children had mild malnutrition (10.4 vs. 9%) and possible risk of overweight (11.1 vs. 9.7%; following respectively BMI for age and weight for length z-scores). Only 16.0% of children had feeding difficulties. Feeding difficulties was identified to be a risk factor for moderate malnutrition compared to children without feeding difficulties (odds ratio 10, 95% confidence interval: 4-27). CONCLUSIONS Mild malnutrition and possible risk of overweight are concern in children up to 2 years of age on cow's milk proteins-free diet. Feeding difficulties are less common, however, may affect the nutritional status.
Collapse
Affiliation(s)
- Piotr Dziechciarz
- Department of Pediatrics, Medical University of Warsaw, Warsaw, Poland
| | - Agata Stróżyk
- Department of Pediatrics, Medical University of Warsaw, Warsaw, Poland
| | - Andrea Horvath
- Department of Pediatrics, Medical University of Warsaw, Warsaw, Poland
| | - Beata Cudowska
- Department of Paediatrics, Gastroenterology, Hepatology, Nutrition and Allergology, Medical University of Bialystok, Bialystok, Poland
| | | | - Nina Mól
- Department of Pediatrics, Jagiellonian University Medical College, Krakow, Poland
| | - Elżbieta Jarocka-Cyrta
- Department of Pediatrics, Gastroenterology, and Nutrition, Collegium Medicum, University of Warmia & Mazury, Olsztyn, Poland
| | - Anna Zawadzka-Krajewska
- Department of Pneumonology and Allergology for Children, Medical University of Warsaw, Warsaw, Poland
| | | |
Collapse
|
8
|
Joel MA, Cooper M, Peebles R, Albenberg L, Timko CA. Clinical characterization of Co-morbid autoimmune disease and eating disorders: a retrospective chart review. Eat Disord 2024; 32:353-368. [PMID: 38270383 DOI: 10.1080/10640266.2024.2306437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Abstract
Research suggests a link between autoimmune illnesses (AI) and eating disorders (ED). We retrospectively reviewed charts of adolescent patients presenting for eating disorder treatment. We compared the presentation and treatment course for those with an ED and comorbid AI [with (GI-AI, N = 59) or without (non-GI, N = 21) gastrointestinal inflammation] with matched ED-only cases. The sample was overwhelmingly female, with an average age of 15.40. Weight gain trajectories differed across groups, with similar rates of weight gain between controls and non GI-AI cases and with a lower rate of weight gain for individuals with comorbid GI-AI. Over half (56%) of patients reported an AI diagnosis prior to ED; 38% reported an AI diagnosis following ED, and 6% reported ED and AI simultaneous diagnosis. On presentation, ED-only controls had higher rates of comorbid anxiety than cases in either AI group, while those with non-GI AI were more likely to report depression. Mean total GI symptoms, % goal weight at presentation, vital sign instability, and markers of refeeding syndrome did not differ across groups. Health care professionals treating patients with either condition should have a low threshold for asking additional questions to identify the presence of the other condition.
Collapse
Affiliation(s)
- Marisa A Joel
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Marita Cooper
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Rebecka Peebles
- CHOP's medical school uses divisions, Craig Dalsimer Division of Adolescent Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Pediatrics, Perelman School of Medicine at University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Lindsey Albenberg
- CHOP's medical school uses divisions, Division of Gastroenterology, Hepatology, and Nutrition, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - C Alix Timko
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Psychiatry, Perelman School of Medicine at University of Pennsylvania, Philadelphia, Pennsylvania, USA
| |
Collapse
|
9
|
Ross JD, Diaz-Thomas A. Perioperative Evaluation and Management of Children with Osteoporosis and Low Bone Mineral Density. Orthop Clin North Am 2024; 55:345-353. [PMID: 38782506 DOI: 10.1016/j.ocl.2023.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
As medical and surgical treatment options for children with osteoporosis expand, multidisciplinary strategies for bone health optimization become more important. Each patient's bone mineral density and fracture history should be interpreted in context. Off-label bisphosphonate use is a standard pharmacologic intervention for children with osteoporosis for optimal bone accrual. It is possible to continue this therapy perioperatively under certain circumstances. The rare side effects (osteonecrosis of the jaw and atypical femur fractures) seem less common in children. Physical therapy, vitamin D supplementation, and other interventions are also important tools for optimal bone health perioperatively and for satisfactory surgical outcomes.
Collapse
Affiliation(s)
- Jordan D Ross
- University of Tennessee Health Science Center, Faculty Office Building, Room 119, 49 North Dunlap, Memphis, TN 38103, USA.
| | - Alicia Diaz-Thomas
- Division of Pediatric Endocrinology, University of Tennessee Heath Science Center, Suite 1006, 910 Madison Avenue, Memphis, TN 38163, USA; Division of Pediatric Endocrinology, Le Bonheur Children's Hospital, Memphis, TN, USA
| |
Collapse
|
10
|
Saxena R, Agrawal T, Saxen R, Pathak M, Nayak S, Jadhav AS, Rathod KJ, Sinha A. Relationship between preoperative nutritional status assessed using anthropometric measures and postoperative complications in pediatric surgical patients. Pediatr Surg Int 2024; 40:156. [PMID: 38871828 DOI: 10.1007/s00383-024-05736-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/02/2024] [Indexed: 06/15/2024]
Abstract
AIM To determine the relationship between preoperative nutritional status assessed using anthropometric measures and postoperative complications in pediatric surgical patients. METHODOLOGY This prospective observational cohort study included 650 patients from 6 months to 18 years undergoing elective surgery at our institution. Elective surgery included procedures such as herniotomy, orchidopexy, urethroplasty, cystoscopy, PUV fulguration, pyeloplasty, ureteric reimplantation, stoma formation/closure, anorectoplasty, pull-through, choledochal cyst excision and repair, VP shunt insertion, lipomyelomeningocele repair, diastematomyelia excision and repair, and cyst excision. Nutritional status was standardized using Z scores for weight, length, and BMI. Patients were monitored for a month following surgery to detect any complications, and they were classified into five grades using the Clavien-Dindo classification. The duration of hospital stays and readmission within 30 days following discharge were secondary outcomes. RESULTS There were 627 patients of both sexes involved in the study: 350 patients aged 6 months to 5 years (Group A), while 277 were aged between 5 and 18 years (Group B). Wasting status was 47.71% in Group A and 41.52% in Group B. In Group A, 40% of patients were stunted, while 83.75% were in Group B. Group A had 57.14% underweight patients. The complication rate was 39.14% in Group A and 38.99% in Group B. The incidence of postoperative complications was not significantly different in malnourished patients. The patients with prolonged duration of surgery (> 2 h) developed more complications in both groups (Group A-67.2%, Group B-82.6%; p < 0.0001). In addition, the patients who experienced complications had lengthier hospital stays (p < 0.001 in both groups) and increased readmission rates (p = 0.016 in Group A and p = 0.008 in Group B). CONCLUSION In our study, half of the patients in Group A and nearly two-third in Group B were malnourished. The preoperative poor nutritional status based on anthropometric parameters is not associated with increased postoperative complications. Randomized control trials linking preoperative malnutrition based on anthropometric measures and clinical outcomes in pediatric surgery patients are necessary to provide more robust information on this subject.
Collapse
Affiliation(s)
- Rahul Saxena
- Paediatric Surgery, All India Institute of Medical Sciences, Jodhpur, 342001, Rajasthan, India.
| | - Tripti Agrawal
- Paediatric Surgery, All India Institute of Medical Sciences, Jodhpur, 342001, Rajasthan, India
| | - Rahul Saxen
- Paediatric Surgery, All India Institute of Medical Sciences, Jodhpur, 342001, Rajasthan, India
| | - Manish Pathak
- Paediatric Surgery, All India Institute of Medical Sciences, Jodhpur, 342001, Rajasthan, India
| | - Shubhalaxmi Nayak
- Paediatric Surgery, All India Institute of Medical Sciences, Jodhpur, 342001, Rajasthan, India
| | - Avinash Sukdev Jadhav
- Paediatric Surgery, All India Institute of Medical Sciences, Jodhpur, 342001, Rajasthan, India
| | - Kirtikumar J Rathod
- Paediatric Surgery, All India Institute of Medical Sciences, Jodhpur, 342001, Rajasthan, India
| | - Arvind Sinha
- Paediatric Surgery, All India Institute of Medical Sciences, Jodhpur, 342001, Rajasthan, India
| |
Collapse
|
11
|
Sill J, Lukich S, Alejos A, Lim H, Chau P, Lowery R, McCormick A, Peng DM, Yu S, Schumacher KR. Changes in nutritional status and the development of obesity and metabolic syndrome following pediatric heart transplantation. Pediatr Transplant 2024; 28:e14782. [PMID: 38767001 DOI: 10.1111/petr.14782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 04/10/2024] [Accepted: 04/29/2024] [Indexed: 05/22/2024]
Abstract
BACKGROUND Nutritional status in pediatric patients undergoing heart transplantation (HT) is frequently a focus of clinical management and requires high resource utilization. Pre-operative nutrition status has been shown to affect post-operative mortality but no studies have been performed to assess how nutritional status may change and the risk of developing nutritional comorbidities long-term in the post-transplant period. METHODS A single-center retrospective chart review of patients ≥2 years of age who underwent heart transplantation between 1/1/2005 and 4/30/2020 was performed. Patient data were collected at listing, time of transplant, 1-year, and 3-year follow-up post-transplant. Nutrition status was classified based on body mass index (BMI) percentile in the primary analysis. Alternative nutritional indices, namely the nutrition risk index (NRI), prognostic nutrition index (PNI), and BMI z-score, were utilized in secondary analyses. RESULTS Of the 63 patients included, the proportion of patients with overweight/obese status increased from 21% at listing to 41% at 3-year follow-up. No underweight patients at listing became overweight/obese at follow-up. Of patients who were overweight/obese at listing, 88% maintained that status at 3-year follow-up. Overweight/obese status at listing, 1-year, and 3-year post-transplantation were significantly associated with developing metabolic syndrome. In comparison to the alternative nutritional indices, BMI percentile best predicted post-transplant metabolic syndrome. CONCLUSIONS The results suggest that pediatric patients who undergo heart transplantation are at risk of developing overweight/obesity and related nutritional sequelae (ie, metabolic syndrome). Improved surveillance and interventions targeted toward overweight/obese HT patients should be investigated to reduce the burden of associated comorbidities.
Collapse
Affiliation(s)
- J Sill
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - S Lukich
- Department of Pediatrics, Lurie Children's Hospital - Northwestern University, Chicago, Illinois, USA
| | - A Alejos
- Department of Community Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - H Lim
- Division of Pediatric Cardiology, C.S. Mott Children's Hospital - University of Michigan, Ann Arbor, Michigan, USA
| | - P Chau
- Division of Pediatric Cardiology, Rady Children's Hospital, San Diego, California, USA
| | - R Lowery
- Division of Pediatric Cardiology, C.S. Mott Children's Hospital - University of Michigan, Ann Arbor, Michigan, USA
| | - A McCormick
- Division of Pediatric Cardiology, C.S. Mott Children's Hospital - University of Michigan, Ann Arbor, Michigan, USA
| | - D M Peng
- Division of Pediatric Cardiology, C.S. Mott Children's Hospital - University of Michigan, Ann Arbor, Michigan, USA
| | - S Yu
- Division of Pediatric Cardiology, C.S. Mott Children's Hospital - University of Michigan, Ann Arbor, Michigan, USA
| | - K R Schumacher
- Division of Pediatric Cardiology, C.S. Mott Children's Hospital - University of Michigan, Ann Arbor, Michigan, USA
| |
Collapse
|
12
|
Rompca A, McCallister A, Cruse W, Webber EC, Vanderpool C. Education and documentation strategies to improve malnutrition diagnosis in hospitalized children: A quality improvement project. Nutr Clin Pract 2024; 39:696-701. [PMID: 37817534 DOI: 10.1002/ncp.11080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 08/21/2023] [Accepted: 09/17/2023] [Indexed: 10/12/2023] Open
Abstract
BACKGROUND The Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition (AND/ASPEN) published malnutrition guidelines in 2014. In 2015, our institution implemented a quality improvement project focused on malnutrition identification with the goal to improve the diagnosis of malnutrition in hospitalized children. METHODS Our project included three approaches: education, nutrition assessment, and documentation initiatives. Education initiatives focused on physicians at all levels of training. Nutrition screening was completed on all patients admitted to our institution. Registered dietitians (RDs) conducted nutrition assessments and identified and documented malnutrition based on AND/ASPEN guidelines. Documentation initiatives included development of automatic text and template changes to allow import of RD-assigned malnutrition diagnosis into physician documentation. We met with members of our clinical documentation integrity team regularly to review the results of these initiatives starting in 2016. RESULTS The total diagnosed cases of malnutrition increased from 208 cases in 2016 at the start of our monitoring to >800 cases per year in 2020-2022. Unspecified (no severity assigned) protein calorie malnutrition as a percentage of total malnutrition diagnoses decreased from 36.9% in 2016 to <10% since 2018. Children with severe malnutrition have remained the largest portion of children with a malnutrition diagnosis, with >40% of children with malnutrition diagnosed with severe malnutrition. CONCLUSION Our education and documentation initiatives have led to both improved diagnosis of malnutrition and accurate identification and documentation of malnutrition severity. These initiatives could be utilized to improve malnutrition diagnosis and documentation at other institutions caring for hospitalized children.
Collapse
Affiliation(s)
- Annemarie Rompca
- Division of Pediatric Gastroenterology, School of Medicine, Indiana University, Indianapolis, Indiana, USA
| | - Anne McCallister
- Riley Hospital for Children at Indiana University Health, Indianapolis, Indiana, USA
| | - Wendy Cruse
- Riley Hospital for Children at Indiana University Health, Indianapolis, Indiana, USA
| | - Emily C Webber
- Riley Hospital for Children at Indiana University Health, Indianapolis, Indiana, USA
- Division of Pediatric Hospital Medicine, School of Medicine, Indiana University, Indianapolis, Indiana, USA
| | - Charles Vanderpool
- Division of Pediatric Gastroenterology, School of Medicine, Indiana University, Indianapolis, Indiana, USA
- Riley Hospital for Children at Indiana University Health, Indianapolis, Indiana, USA
| |
Collapse
|
13
|
Persaud S, Hron BM, Rudie C, Mantell P, Kahlon PS, Ariagno K, Ozonoff A, Trivedi S, Yugar C, Mehta NM, Raymond M, Duggan CP, Huh SY. Improving anthropometric measurements in hospitalized children: A quality-improvement project. Nutr Clin Pract 2024; 39:685-695. [PMID: 38153693 PMCID: PMC11068491 DOI: 10.1002/ncp.11112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 10/16/2023] [Accepted: 11/24/2023] [Indexed: 12/29/2023] Open
Abstract
BACKGROUND The objective of this quality-improvement project was to increase documentation rates of anthropometrics (measured weight, length/height, and body mass index [BMI], which are critical to identify patients at malnutrition (undernutrition) risk) from <50% to 80% within 24 hours of hospital admission for pediatric patients. METHODS Multidisciplinary champion teams on surgical, cardiac, and intensive care (ICU) pilot units were established to identify and iteratively test interventions addressing barriers to documentation from May 2016 to June 2018. Percentage of patients with documented anthropometrics <24 h of admission was assessed monthly by statistical process control methodology. Percentage of patients at malnutrition (undernutrition) risk by anthropometrics was compared by χ2 for 4 months before and after intervention. RESULTS Anthropometric documentation rates significantly increased (P < 0.001 for all): BMI, from 11% to 89% (surgical), 33% to 57% (cardiac), and 16% to 51% (ICU); measured weight, from 24% to 88% (surgical), 69% to 83% (cardiac), and 51% to 67% (ICU); and length/height, from 12% to 89% (surgical), 38% to 57% (cardiac), and 26% to 63% (ICU). Improvement hospital-wide was observed (BMI, 42% to 70%, P < 0.001) with formal dissemination tactics. For pilot units, moderate/severe malnutrition (undernutrition) rates tripled (1.2% [24 of 2081] to 3.4% [81 of 2374], P < 0.001). CONCLUSION Documentation of anthropometrics on admission substantially improved after establishing multidisciplinary champion teams. Goal rate (80%) was achieved within 26 months for all anthropometrics in the surgical unit and for weight in the cardiac unit. Improved documentation rates led to significant increase in identification of patients at malnutrition (undernutrition) risk.
Collapse
Affiliation(s)
- Sabrina Persaud
- Clinical Education, Informatics, Quality and Professional Practice Department, Boston Children’s Hospital, Boston, Massachusetts, USA
- Center for Nutrition and Division of Gastroenterology, Hepatology and Nutrition, Boston Children’s Hospital, Boston, Massachusetts, USA
| | - Bridget M. Hron
- Center for Nutrition and Division of Gastroenterology, Hepatology and Nutrition, Boston Children’s Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Coral Rudie
- Center for Nutrition and Division of Gastroenterology, Hepatology and Nutrition, Boston Children’s Hospital, Boston, Massachusetts, USA
| | - Patricia Mantell
- Clinical Education, Informatics, Quality and Professional Practice Department, Boston Children’s Hospital, Boston, Massachusetts, USA
| | - Prerna S. Kahlon
- Program for Patient Safety and Quality, Boston Children’s Hospital, Boston, Massachusetts, USA
| | - Katelyn Ariagno
- Center for Nutrition and Division of Gastroenterology, Hepatology and Nutrition, Boston Children’s Hospital, Boston, Massachusetts, USA
| | - Al Ozonoff
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
- Division of Infectious Diseases, Boston Children’s Hospital, Boston, Massachusetts, USA
| | - Shrunjal Trivedi
- Center for Applied Pediatric Quality Analytics, Boston Children’s Hospital, Boston, Massachusetts, USA
| | - Carlos Yugar
- Center for Applied Pediatric Quality Analytics, Boston Children’s Hospital, Boston, Massachusetts, USA
| | - Nilesh M. Mehta
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Boston, Massachusetts, USA
| | - Michelle Raymond
- Center for Nutrition and Division of Gastroenterology, Hepatology and Nutrition, Boston Children’s Hospital, Boston, Massachusetts, USA
| | - Christopher P. Duggan
- Center for Nutrition and Division of Gastroenterology, Hepatology and Nutrition, Boston Children’s Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Susanna Y. Huh
- Center for Nutrition and Division of Gastroenterology, Hepatology and Nutrition, Boston Children’s Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
- Ironwood Pharmaceuticals, Boston, Massachusetts, USA
| |
Collapse
|
14
|
Fenton TR, Merlino Barr S, Elmrayed S, Alshaikh B. Expected and Desirable Preterm and Small Infant Growth Patterns. Adv Nutr 2024; 15:100220. [PMID: 38670164 PMCID: PMC11251411 DOI: 10.1016/j.advnut.2024.100220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Revised: 03/29/2024] [Accepted: 04/02/2024] [Indexed: 04/28/2024] Open
Abstract
Adequate nutrition is necessary for achieving optimal growth and neurodevelopment. Growth is a natural and expected process that happens concomitantly with rapid advancements in neurodevelopment. Serial weight, length, and head circumference growth measures are essential for monitoring development, although identifying pathological deviations from normal growth can pose challenges. Appropriate growth assessments require considerations that a range of sizes for length, head circumference, and weight are expected and appropriate. Because of genetic differences and morbidities, there is a considerable overlap between the growth of healthy infants and those with growth alterations. Parents tend to be over-concerned about children who plot low on growth charts and often need reassurance. Thus, the use of terms such as "poor" growth or growth "failure" are discouraged when growth is approximately parallel to growth chart curves even if their size is smaller than specific percentiles. No specific percentile should be set as a growth goal; individual variability should be expected. An infant's size at birth is important information that goes beyond the common use of prognostic predictions of appropriate compared with small or large for gestational age. The lower the birthweight, the lower the nutrient stores and the more important the need for nutrition support. Compared to term infants, preterm infants at term-equivalent age have a higher percentage of body fat, but this diminishes over the next months. Current research findings support expert recommendations that preterm infants should grow, after early postnatal weight loss, similar to the fetus and then term-born infants, which translates to growth approximately parallel to growth chart curves. There is no need for a trade-off between optimum cognition and optimum future health. Each high-risk infant needs individualized nutrition and growth assessments. This review aims to examine infant growth expectations and messaging for parents of preterm and term-born infants within the broader causal framework.
Collapse
Affiliation(s)
- Tanis R Fenton
- Community Health Sciences, O'Brien Institute of Public Health, Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Canada.
| | | | - Seham Elmrayed
- Community Health Sciences, O'Brien Institute of Public Health, Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Canada; Institute of Global Health and Human Ecology, American University in Cairo, Egypt
| | - Belal Alshaikh
- Community Health Sciences, O'Brien Institute of Public Health, Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Canada; Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Canada
| |
Collapse
|
15
|
Umentum B, Kim HJ, Adkins A, Feuling MB, Hilbrands J, Martin N, Goday PS, Smith A. Are dietitian recommendations followed? A descriptive study of paediatric hospitalised and ambulatory patients. J Hum Nutr Diet 2024; 37:655-662. [PMID: 38420835 DOI: 10.1111/jhn.13291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 01/30/2024] [Accepted: 02/01/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND The primary objective of this cross-sectional retrospective study was to describe the implementation of dietitian prescribed nutrition recommendations in malnourished paediatric patients in the hospital and ambulatory settings. We also aimed to investigate other characteristics that could be associated with differences in implementation. METHODS Data were collected from 186 hospitalised and 565 ambulatory patients between February 2020 and January 2021. Data included age, hospital or ambulatory specialty departments, primary diagnosis, malnutrition status, hospital length of stay (LOS), and medical nutrition therapy recommendations. Implementation by the medical team in the hospital setting and adherence by the family in the outpatient setting were categorised as "Full", "Partial" or "None". "Partial" and "None" were combined for analysis. RESULTS Dietitian prescribed recommendations were implemented in 79.6% of hospitalised patients. In the ambulatory population, 46.4% of patients were adherent with nutrition recommendations. Within the hospital, there was a significant difference in implementation of nutrition recommendations based on age (p = 0.047), hospital department (p = 0.002) and LOS (p = 0.04), whereas, in the ambulatory population, there were no significant differences in the rate of adherence among any of the studied characteristics. CONCLUSIONS Dietitian recommendations are frequently implemented in the hospital, whereas adherence to such recommendations is poor in the outpatient population. Interventions to improve adherence to nutrition recommendations in the ambulatory setting are needed.
Collapse
Affiliation(s)
| | | | - Ashley Adkins
- Milwaukee Hospital-Children's Wisconsin, Milwaukee, WI, USA
| | | | | | - Nicole Martin
- Milwaukee Hospital-Children's Wisconsin, Milwaukee, WI, USA
| | | | - Amber Smith
- University of California San Francisco Health, San Francisco, CA, USA
| |
Collapse
|
16
|
Hopkins J, Merritt R. Strategies to Promote Success in Oral Feedings in Infants and Children with Intestinal Failure due to Short Bowel Syndrome. Gastroenterol Clin North Am 2024; 53:329-341. [PMID: 38719382 DOI: 10.1016/j.gtc.2024.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
Infants and children with intestinal failure are at risk for pediatric feeding disorders, which challenge their oral feeding development. This article explores these challenges and offers several practical strategies that can be used by multidisciplinary care teams and at-home caregivers to help support the development of oral feeding in these children and eventually lead to their attaining enteral autonomy.
Collapse
Affiliation(s)
- Judy Hopkins
- Division of Occupational Therapy, Children's Hospital Los Angeles, Los Angeles, CA, USA.
| | - Russell Merritt
- Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital Los Angeles; Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| |
Collapse
|
17
|
Luz GD, Pereira DS, Minho JB, Dias PDC, Moraes ES, da Silva VM, Dutra APBS, Silva FM, Dalle Molle R. Association of handgrip strength with nutritional status and clinical outcomes in hospitalized pediatric patients. Clin Nutr ESPEN 2024; 61:413-419. [PMID: 38777463 DOI: 10.1016/j.clnesp.2024.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 03/17/2024] [Accepted: 04/11/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND & AIMS Malnutrition in children and adolescents is prevalent at hospital admission and the incidence increases with length of stay. Malnourished patients have loss of muscle mass and strength, compromising their functionality. Handgrip strength (HGS) is a nutritional marker understudied in pediatrics although it is capable of detecting nutritional deprivation before changes in body composition are observed. Therefore, this study aimed to evaluate the association between reduced HGS at hospital admission, compromised nutritional status and worse clinical outcomes of pediatric patients. METHODS Cohort study conducted with patients aged 6-18 years admitted to a pediatric ward. Nutritional status was assessed in the first 48 h of hospital admission using the z-score of height for age (H/A) and body mass index for age (BMI/A), percentile of mid-arm muscle circumference for age (MAMC/A) and the pediatric global subjective nutritional assessment (SGNA). HGS was measured using a digital dynamometer and considered reduced when the maximum value of three measurements was below the 5th percentile for sex and age. The clinical outcomes analyzed were length of hospital stay and frequency of readmission within 3 months after hospital discharge. RESULTS A total of 135 patients were evaluated (median age 10.9 years, 55.6% male) and 17.8% had reduced HGS. Patients with reduced HGS had lower H/A z-score (-0.50 vs 0.22, p = 0.012) and a higher frequency of reduced MAMC when compared to those with normal HGS (8% vs 13%, p = 0.007). Reduced HGS was not associated with malnutrition (OR = 0.63; 95%CI 0.23-1.77), prolonged hospital stay (OR = 1.89; 95%CI 0.72-4.92) or readmission to hospital 3 months after hospital discharge (OR = 1.82; 95%CI 0.67-4.93), in a model adjusted for the clinical condition. CONCLUSION Reduced HGS was not a predictor of malnutrition and clinical outcomes. However, it was associated with lower H/A Z-score and MAMC/A percentile values and can be used as a complementary measure in the nutritional status assessment of hospitalized pediatric patients.
Collapse
Affiliation(s)
- Gabriela Duarte Luz
- Programa de Pós-Graduação em Ciências da Nutrição, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
| | - Danielly Steffen Pereira
- Programa de Pós-Graduação em Ciências da Nutrição, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
| | - Jéssica Batista Minho
- Programa de Pós-Graduação em Ciências da Nutrição, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
| | - Patrícia Daniele Chrisóstomo Dias
- Programa de Pós-Graduação em Ciências da Nutrição, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
| | - Emilly Santos Moraes
- Curso de Graduação em Nutrição, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
| | | | | | - Flávia Moraes Silva
- Programa de Pós-Graduação em Ciências da Nutrição, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil; Curso de Graduação em Nutrição, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
| | - Roberta Dalle Molle
- Programa de Pós-Graduação em Ciências da Nutrição, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil.
| |
Collapse
|
18
|
Murphy JD, Symons HJ, Cooke KR. Nutritional Support Best Practices in Pediatric Blood and Marrow Transplant Patients: An Integrative Review. CHILDREN (BASEL, SWITZERLAND) 2024; 11:637. [PMID: 38929217 PMCID: PMC11202119 DOI: 10.3390/children11060637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Revised: 05/17/2024] [Accepted: 05/23/2024] [Indexed: 06/28/2024]
Abstract
Nutrition is vital to the long-term survival of children undergoing blood and marrow transplantation (BMT), but there is no standardization on how to optimize the nutritional status of these patients. A literature search was performed to evaluate nutritional support approaches currently in practice for pediatric patients who are undergoing BMT. CINAHL, Embase, and Cochrane databases were searched for peer-reviewed articles evaluating nutritional interventions for BMT recipients aged 20 or younger. Nine articles published between 2019 and 2023 were found and reviewed. The nutritional support varied between enteral nutrition, parenteral nutrition, a combination of both, and prophylactic feeding tube placement. The post-transplant outcomes identified as associated with alterations in nutritional regimens included length of stay, date of platelet engraftment, incidence of acute graft-versus-host disease, infection rate, and overall survival. The use of any amount of enteral nutrition compared to parenteral alone was beneficial. Complications during BMT can potentially be decreased via prioritizing enteral nutrition over parenteral. The paucity of literature on this topic highlights an unmet need in the field. Future research should focus on ways to optimize the nutritional support of transplant recipients, including increasing the likelihood of enteral feeding tube placement and utilization.
Collapse
Affiliation(s)
- Jessica D. Murphy
- School of Nursing, Johns Hopkins University, Baltimore, MD 21287, USA;
| | - Heather J. Symons
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA;
| | - Kenneth R. Cooke
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA;
| |
Collapse
|
19
|
Bern EM, Milliren CE, Tsang KK, Mancini LA, Carmody JK, Gearhart MG, Eldredge O, Samsel C, Crowley M, Richmond TK. Variation in care for inpatients with avoidant restrictive food intake disorder leads to development of a novel inpatient clinical pathway to standardize care. J Eat Disord 2024; 12:66. [PMID: 38783304 PMCID: PMC11112782 DOI: 10.1186/s40337-024-01018-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 05/09/2024] [Indexed: 05/25/2024] Open
Abstract
INTRODUCTION There is limited evidence to guide management of patients with avoidant restrictive food intake disorder (ARFID) admitted for medical stabilization. We describe variations in inpatient care which led to the development of a multidisciplinary inpatient clinical pathway (ICP) to provide standardized management and examine differences after the ICP was implemented. METHODS A retrospective review of patients with ARFID admitted to Adolescent Medicine, Gastroenterology, and General Pediatrics at a single academic center was conducted. We compare hospital utilization and use of consulting services during the pre-ICP (2015-2017) and post-ICP (2018-2020) periods. RESULTS 110 patients were admitted with ARFID (n = 57 pre- vs. n = 53 post-ICP). Most presented with moderate/severe malnutrition (63% pre vs. 81% post; p = 0.11) and co-morbid anxiety and/or depression (74% pre vs. 92% post; p = 0.01). There was some variation in use of enteral tube feeding by service in both periods (p = 0.76 and p = 0.38, respectively), although overall use was consistent between periods (46% pre vs. 58% post; p = 0.18). Pre-ICP, use of the restrictive eating disorder protocol differed across services (p < 0.001), with only AM using it. Overall, utilization of the restrictive eating disorder protocol decreased from 16% pre-ICP to 2% post-ICP (p = 0.02). There was variation by service in psychiatry/psychology (range 82-100% by service; p = 0.09) and social work consultations (range 17-71% by service; p = 0.001) during the pre-ICP period, though variation was reduced in the post-ICP period (p = 0.99 and p = 0.05, respectively). Implementation of the ICP led to improvements in these consultative services, with all patients in the post-ICP period receiving psychiatry/psychology consultation (p = 0.05) and an increase in social work consults from 44 to 64% (p = 0.03). Nutrition consults were consistently utilized in both periods (98% pre vs. 100% post; p = 0.33). CONCLUSION The ICP was developed to standardize inpatient medical stabilization for patients with ARFID. In this single center study, implementation of the ICP increased standardized care for inpatients with ARFID with variation in care reduced: there were improvements in the use of consulting services and a reduction in the use of the restrictive eating disorder protocol. The ICP demonstrates the potential to further standardize and improve care over time.
Collapse
Affiliation(s)
- Elana M Bern
- Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, 333 Longwood Avenue, 5th Floor, Boston, MA, 02115, USA.
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA.
| | - Carly E Milliren
- Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, Boston, MA, USA
| | - Kevin K Tsang
- Department of Psychiatry and Behavioral Sciences, Boston Children's Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Lisa A Mancini
- Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, 333 Longwood Avenue, 5th Floor, Boston, MA, 02115, USA
| | - Julia K Carmody
- Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, 333 Longwood Avenue, 5th Floor, Boston, MA, 02115, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Marina G Gearhart
- Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, 333 Longwood Avenue, 5th Floor, Boston, MA, 02115, USA
| | - Olivia Eldredge
- Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, 333 Longwood Avenue, 5th Floor, Boston, MA, 02115, USA
| | - Chase Samsel
- Department of Psychiatry and Behavioral Sciences, Boston Children's Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - McGreggor Crowley
- Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, 333 Longwood Avenue, 5th Floor, Boston, MA, 02115, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Tracy K Richmond
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA
| |
Collapse
|
20
|
Brunet-Wood K, Tul-Noor Z, Bandsma RHJ, Carter L, Fleming-Carroll B, Gramlich L, Hutchison K, Huysentruyt K, Kalnins D, Marchand V, Martinez A, Pai N, Vachon M, Hulst JM. Development of the Pediatric Integrated Nutrition Pathway for Acute Care (P-INPAC) using a modified Delphi technique. Appl Physiol Nutr Metab 2024; 49:700-711. [PMID: 38320255 DOI: 10.1139/apnm-2023-0180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
One in three hospitalized children have disease-related malnutrition (DRM) upon admission to hospital, and all children are at risk for further nutritional deterioration during hospital stay; however, systematic approaches to detect DRM in Canada are lacking. To standardise and improve hospital care, the multidisciplinary pediatric working group of the Canadian Malnutrition Taskforce aimed to develop a pediatric, inpatient nutritional care pathway based on available evidence, feasibility of resources, and expert consensus. The working group (n = 13) undertook a total of four meetings: an in-person meeting to draft the pathway based on existing literature and modelled after the Integrated Nutrition Pathway for Acute Care (INPAC) in adults, followed by three online surveys and three rounds of online Delphi consensus meetings to achieve agreement on the draft pathway. In the first Delphi survey, 32 questions were asked, whereas in the second and third rounds 27 and 8 questions were asked, respectively. Consensus was defined as any question/issue in which at least 80% agreed. The modified Delphi process allowed the development of an evidence-informed, consensus-based pathway for inpatients, the Pediatric Integrated Nutrition Pathway for Acute Care (P-INPAC). It includes screening <24 h of admission, assessment with use of Subjective Global Nutritional Assessment (SGNA) <48 h of admission, as well as prevention, and treatment of DRM divided into standard, advanced, and specialized nutrition care plans. Research is necessary to explore feasibility of implementation and evaluate the effectiveness by integrating P-INPAC into clinical practice.
Collapse
Affiliation(s)
- Kim Brunet-Wood
- Canadian Malnutrition Task Force, Canadian Nutrition Society, Ottawa, ON K1C 6A8, Canada
| | - Zujaja Tul-Noor
- Division of Paediatric Gastroenterology, Hepatology and Nutrition, Department of Paediatrics, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
| | - Robert H J Bandsma
- Division of Paediatric Gastroenterology, Hepatology and Nutrition, Department of Paediatrics, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
- Department of Nutritional Sciences, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Laura Carter
- Nutrition Services, Alberta Health Services, Edmonton, AB, Canada
| | - Bonnie Fleming-Carroll
- SickKids Learning Institute, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
| | - Leah Gramlich
- Division of Gastroenterology, University of Alberta, Edmonton, AB T6G 2G3, Canada
| | - Kim Hutchison
- Health Sciences Centre, Winnipeg, MB R3A 1R9, Canada
| | - Koen Huysentruyt
- Department of Pediatric Gastroenterology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel (VUB), 1090 Brussels, Belgium
| | - Daina Kalnins
- Department of Clinical Dietetics, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
| | - Valerie Marchand
- Division of Paediatric Gastroenterology, Hepatology and Nutrition, Department of Paediatrics, Ste-Justine UHC, University of Montreal, Montreal, QC H3T 1C5, Canada
| | - Andrea Martinez
- Division of Paediatric Gastroenterology, Hepatology and Nutrition, Department of Paediatrics, IWK Health Centre, University of Dalhousie, Halifax, NS B3K 6R8, Canada
| | - Nikhil Pai
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, McMaster Children's Hospital, Hamilton, ON, Canada
| | - Mélanie Vachon
- Department of Clinical Nutrition, Centre Hospitalier Universitaire de Québec-Université Laval, Quebec, QC, G1R 2J6, Canada
| | - Jessie M Hulst
- Division of Paediatric Gastroenterology, Hepatology and Nutrition, Department of Paediatrics, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
- Department of Nutritional Sciences, University of Toronto, Toronto, ON M5S 1A8, Canada
| |
Collapse
|
21
|
Lucendo A, Groetch M, Gonsalves N. Dietary Management of Eosinophilic Esophagitis. Immunol Allergy Clin North Am 2024; 44:223-244. [PMID: 38575220 DOI: 10.1016/j.iac.2023.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
Eosinophilic esophagitis (EoE) is a chronic immune-mediated food allergy-driven disease characterized by eosinophilic inflammation of the esophagus leading to symptoms of esophageal dysfunction. Prior studies have supported the key role of food allergen exposure as the main driver behind the etiopathogenesis showing that removal of food antigens can result in disease remission in both children and adults. These landmark studies serve as the basis for the rising interest and evolution of dietary therapy in EoE. This article will focus on the rationale for dietary therapy in EoE and provide helpful tools for the implementation of dietary therapy in practice.
Collapse
Affiliation(s)
- Alfredo Lucendo
- Department of Gastroenterology, Hospital General de Tomelloso, Tomelloso, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd); Instituto de Investigación Sanitaria de Castilla-La Mancha (IDISCAM), Tomelloso, Ciudad Real 13700, Spain
| | - Marion Groetch
- Department of Pediatric Allergy & Immunology, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY 10029, USA
| | - Nirmala Gonsalves
- Division of Gastroenterology and Hepatology, Northwestern University-Feinberg School of Medicine, 676 North St. Claire, Suite 1400, Chicago, IL 60611, USA.
| |
Collapse
|
22
|
Hulst JM, van de Vorst K, Olieman JF, Hendriks DM, Oudshoorn JH, Plötz FB, Roskam M, van der Schoor SRD, Tramper-Stranders GA, Verhoeven JJ, van Wering HM, Winder E, Joosten KFM. Prospective evaluation and follow-up of nutritional status of children hospitalized in secondary-care level hospitals: a multicentre study. Appl Physiol Nutr Metab 2024; 49:680-686. [PMID: 38359413 DOI: 10.1139/apnm-2023-0188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
Although disease-associated undernutrition is still an important problem in hospitalized children that is often underrecognized, follow-up studies evaluating post-discharge nutritional status of children with undernutrition are lacking. The aim of this multicentre prospective observational cohort study was to assess the rate of acute undernutrition (AU) and/or having a high nutritional risk (HR) in children on admission to seven secondary-care level Dutch hospitals and to evaluate the nutritional course of AU/HR group during admission and post-discharge. STRONGkids was used to indicate HR, and AU was based on anthropometric data (z-score < -2 for weight-for-age (WFA; <1 year) or weight-for-height (WFH; ≥1 year)). In total, 1985 patients were screened for AU/HR over a 12-month period. On admission, AU was present in 9.9% of screened children and 6.2% were classified as HR; 266 (13.4%) children comprised the AU/HR group (median age 2.4 years, median length of stay 3 days). In this group, further nutritional assessment by a dietitian during hospitalization occurred in 44% of children, whereas 38% received nutritional support. At follow-up 4-8 weeks post-discharge, 101 out of orginal 266 children in the AU/HR group (38%) had available paired anthropometric measurements to re-assess nutrition status. Significant improvement of WFA/WFH compared to admission (-2.48 vs. -1.51 SD; p < 0.001) and significant decline in AU rate from admission to outpatient follow-up (69.3% vs. 35.6%; p < 0.001) were shown. In conclusion, post-discharge nutritional status of children with undernutrition and/or high nutritional risk on admission to secondary-care level pediatric wards showed significant improvement, but about one-third remained undernourished. Findings warrant the need for a tailored post-discharge nutritional follow-up.
Collapse
Affiliation(s)
- Jessie M Hulst
- Department of Paediatric Gastroenterology, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands
- Department of Paediatrics, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Kelly van de Vorst
- Department of Paediatric Gastroenterology, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Joanne F Olieman
- Department of Dietetics, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Daniëlle M Hendriks
- Department of Paediatrics, HAGA Hospital-Juliana Children's Hospital, The Hague, the Netherlands
| | | | - Frans B Plötz
- Department of Paediatrics, Tergooi Hospital, Blaricum, the Netherlands
| | - Mariëlle Roskam
- Department of Paediatrics, Sint Lucas Andreas Hospital, Amsterdam, the Netherlands
| | | | | | | | | | - Eefje Winder
- Department of Dietetics, MC Alkmaar, Alkmaar, the Netherlands
| | - Koen F M Joosten
- Department of Paediatrics, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands
| |
Collapse
|
23
|
South CA, Keown-Stoneman CDG, Birken CS, Malik V, Zlotkin SH, Maguire JL. Underweight in the first 2 years of life and nutrition risk in later childhood: a prospective cohort study. J Hum Nutr Diet 2024; 37:474-483. [PMID: 38149751 DOI: 10.1111/jhn.13269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 11/21/2023] [Indexed: 12/28/2023]
Abstract
BACKGROUND Children with underweight in the first 2 years have lower body mass index z-score (zBMI) and height-for-age z-score (HAZ) in later childhood. It is not known if underweight in the first 2 years is associated with nutrition risk in later childhood. OBJECTIVE (1) Determine the relationship between underweight (zBMI < -2) in the first 2 years and nutrition risk measured by the Nutrition Screening for Toddlers and Preschoolers (NutriSTEP) score from 18 months to 5 years. (2) Explore the relationship between underweight in the first 2 years and the NutriSTEP subscores for eating behaviours and dietary intake from 18 months to 5 years. METHODS This was a prospective study, including healthy full-term children in Canada aged 0-5 years. zBMI was calculated using measured heights and weights and the WHO growth standards. NutriSTEP score was measured using a parent-completed survey and ranged from 0 to 68. Nutrition risk was defined as a score ≥21. Linear mixed effects models were used. RESULTS Four thousand nine hundred twenty-nine children were included in this study. At enrolment, 51.9% of participants were male. The prevalence of underweight children was 8.8%. Underweight in the first 2 years was associated with higher NutriSTEP (0.79, 95% CI: 0.29,1.29), higher eating behaviour subscore (0.24, 95% CI: 0.03, 0.46) at 3 years and higher odds of nutrition risk (OR: 1.39, 95% CI: 1.07,1.82) at 5 years. CONCLUSIONS Children with underweight in the first 2 years had higher nutrition risk in later childhood. Further research is needed to understand the factors which influence these relationships.
Collapse
Affiliation(s)
- Courtney A South
- Department of Pediatrics, St. Michael's Hospital, Toronto, Ontario, Canada
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Charles D G Keown-Stoneman
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Catherine S Birken
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, Hospital for Sick Children, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Vasanti Malik
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Stanley H Zlotkin
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jonathon L Maguire
- Department of Pediatrics, St. Michael's Hospital, Toronto, Ontario, Canada
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
24
|
Taha M, Nael Maslamani A, Atef Abdelsattar Ibrahim H. The Predictive and Prognostic Value of Percentage Change in Calf Circumference in Infants and Children During the First Week of Admission in the Pediatric Intensive Care Unit: A Prospective Cohort Study. Clin Pediatr (Phila) 2024:99228241238631. [PMID: 38511639 DOI: 10.1177/00099228241238631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Abstract
Calf circumference (CC) is an easy measure of muscle loss; yet, there are limited studies in children. We aimed to assess the viability of the first-week percent change in CC as a prognostic nutritional marker. Two MUAC (mid-upper arm circumference), CC, and weight measurements were carried out: one on the first day of admission and another on the seventh day. The differences and correlations between their percent changes were examined. The possible association between CC percent change and prolonged length of hospital stay (PLOS) and in-hospital mortality was assessed. Seventy participants were enrolled with a median age of 19.5 months. The median (interquartile range [IQR]) of CC percent change was 0.54 (5.5) with significant correlations between it and each of MUAC and weight percent change (ρ = 0.928, P = .001), (ρ = 0.902, P = .001), respectively. Calf circumference percent changes were significantly more negative in children with PLOS; (P = .004). These changes seem to be viable measures of nutritional status.
Collapse
Affiliation(s)
- Marwa Taha
- Department of Pediatrics, Mataria Teaching Hospital, General Organization for Teaching Hospitals and Institutes (GOTHI), Cairo, Egypt
| | | | - Hoda Atef Abdelsattar Ibrahim
- Pediatric Clinical Nutrition Division, Department of Pediatrics, Faculty of Medicine, Cairo University, Cairo, Egypt
- Department of Pediatrics, Faculty of Medicine, Cairo University, Cairo, Egypt
| |
Collapse
|
25
|
李 东, 申 月, 王 美, 杨 文, 夏 露, 张 雨, 赵 顺, 闫 洁. [Correlation of nutritional status with clinical characteristics and lung function in children with cystic fibrosis]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2024; 26:275-281. [PMID: 38557380 PMCID: PMC10986383 DOI: 10.7499/j.issn.1008-8830.2308075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 02/02/2024] [Indexed: 04/04/2024]
Abstract
OBJECTIVES To investigate the nutritional status of children with cystic fibrosis (CF) and understand the correlation between malnutrition and clinical characteristics as well as lung function. METHODS A retrospective analysis was performed on clinical data of CF children admitted from January 2016 to June 2023. Clinical characteristics of CF children with different nutritional statuses were compared, and the correlation between malnutrition and lung function was analyzed. RESULTS A total of 52 CF children were included, comprising 25 boys (48%) and 27 girls (52%), aged between 7 months and 17 years. Respiratory symptoms were the predominant clinical manifestations (96%, 50/52). The prevalence of malnutrition was 65% (34/52), with moderate/severe malnutrition being the most common (65%, 22/34). The malnutrition group had a longer duration of illness, higher proportion of digestive system symptoms, and lower levels of serum albumin (P<0.05). Pulmonary function parameters, including forced expiratory volume in one second as a percentage of the predicted value, ratio of forced expiratory volume in one second to forced vital capacity, forced expiratory flow at 25% of forced vital capacity exhaled, forced expiratory flow at 50% of forced vital capacity exhaled, forced expiratory flow at 75% of forced vital capacity exhaled, and maximum mid-expiratory flow as a percentage of the predicted value, were lower in the malnutrition group compared to the normal nutrition group (P<0.05). Correlation analysis showed body mass index Z-score was positively correlated with the above six pulmonary function parameters (P<0.05). CONCLUSIONS The prevalence of malnutrition is high in CF children and is associated with decreased lung function. CF children with higher body mass index have better lung function. Therefore, screening and evaluation of nutritional status as well as appropriate nutritional intervention should be emphasized in CF children.
Collapse
Affiliation(s)
| | - 月琳 申
- 国家儿童医学中心/首都医科大学附属北京儿童医院,呼吸二科北京100045
| | | | | | | | - 雨晴 张
- 国家儿童医学中心/首都医科大学附属北京儿童医院,呼吸二科北京100045
| | - 顺英 赵
- 国家儿童医学中心/首都医科大学附属北京儿童医院,呼吸二科北京100045
| | | |
Collapse
|
26
|
Maunder K, Markey O, Batchelor R, McNicholas F. A systematic review of COVID-19 and the presentation of avoidant/restrictive food intake disorder and avoidant/restrictive food intake disorder-like symptoms. BJPsych Open 2024; 10:e56. [PMID: 38433590 PMCID: PMC10951850 DOI: 10.1192/bjo.2023.655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 11/20/2023] [Accepted: 12/28/2023] [Indexed: 03/05/2024] Open
Abstract
BACKGROUND The adverse effects of COVID-19 and the associated restrictions on eating disorder populations have been discussed in recent literature. However, little is known about the presentation of cases with avoidant/restrictive food intake disorder (ARFID) during this period. AIMS To explore the extent of the literature on the presentation of ARFID, and ARFID-like cases, during the COVID-19 pandemic. METHOD Cochrane Library, CINAHL (EBSCO), PsycINFO (EBSCO), EMBASE (Ovid) and Medline (Ovid) were searched for publications between March 2020 and May 2023. Google Scholar and reference lists were hand searched. At least two reviewers independently screened each paper. Narrative synthesis was used. RESULTS Seven papers were included: four case reports and three cohort studies (total ARFID sample of 46). Included papers were assessed as having high (n = 3) or moderate (n = 4) quality. Findings did not suggest an increase in ARFID cases during the COVID-19 pandemic, although it is unclear if this is because of a lack of impact or underrecognition of ARFID. A need for a multidisciplinary approach to differentiate between ARFID and organic causes of ARFID-like presentations (e.g. gastrointestinal effects of COVID-19) was highlighted. CONCLUSIONS Publications specifically pertaining to ARFID presentations during the COVID-19 pandemic have been few. Papers found have been of small sample sizes and lack subanalyses for ARFID within broader eating disorder samples. Continued surveillance is needed to evaluate any COVID-19-specific effects on the development, identification, treatment and outcomes of ARFID.
Collapse
Affiliation(s)
- Kristen Maunder
- Department of Child and Adolescent Psychiatry, University College Dublin, Ireland; Department of Liaison Child and Adolescent Psychiatry, Tallaght University Hospital, Ireland; and Department of Child and Adolescent Psychiatry, Linn Dara Child and Adolescent Mental Health Services, Dublin, Ireland
| | - Oscar Markey
- Department of Psychology, Universiteit Leiden, The Netherlands; Department of Psychology, Trinity College Dublin, Ireland; and Department of Child and Adolescent Psychiatry, Lucena St John of God's Child and Adolescent Mental Health Services, Dublin, Ireland
| | - Rachel Batchelor
- Department of Psychology, Oxford Institute of Clinical Psychology Training and Research, UK; and Department of Psychology, Oxford Health NHS Foundation Trust, UK
| | - Fiona McNicholas
- Department of Child and Adolescent Psychiatry, University College Dublin, Ireland; Department of Child and Adolescent Psychiatry, Lucena St John of God's Child and Adolescent Mental Health Services, Dublin, Ireland; and Department of Liaison Child and Adolescent Psychiatry, Children's Health Ireland at Crumlin, Ireland
| |
Collapse
|
27
|
Hegazi R, Miller A, Sauer A. Evolution of the diagnosis of malnutrition in adults: a primer for clinicians. Front Nutr 2024; 11:1169538. [PMID: 38379550 PMCID: PMC10876842 DOI: 10.3389/fnut.2024.1169538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 01/19/2024] [Indexed: 02/22/2024] Open
Abstract
During the last two decades, the definition, diagnosis, and management of malnutrition have significantly evolved. Malnutrition is generally defined as deficiencies, excesses, or imbalances in a person's intake of energy and/or nutrients. While malnutrition is associated with a significantly increased risk of morbidity, mortality, and healthcare cost, it is often underdiagnosed both in healthcare and community settings. One contributing factor is the lack of a consensus on its definition and appropriate diagnostic indicators. In the current article, we review the evolution of frameworks for the diagnosis of malnutrition. Recently published consensuses by prominent clinical nutrition societies have established a trajectory for the uniform global diagnosis of malnutrition. Limiting the use of body mass index (BMI) as a diagnostic criterion while emphasizing the use of muscle mass enables a more consistent and accurate diagnosis of malnutrition in the clinical setting. Guidance for the unified methodology and terminology for diagnosing malnutrition, such as the one proposed in the current article will enable policy makers to systematically address the two faces of malnutrition, starvation- and disease-related malnutrition applicable to both pediatric and adult populations. Policies and programs that could address issues of food insecurity and scarcity as well as early diagnosis and management of disease-related malnutrition will empower better care of community nutrition.
Collapse
Affiliation(s)
- Refaat Hegazi
- Department of Scientific and Medical Affairs, Abbott Nutrition, Columbus, OH, United States
| | - Anthony Miller
- Department of Food Science and Human Nutrition, University of Illinois at Urbana-Champaign, Champaign, IL, United States
| | - Abby Sauer
- Department of Scientific and Medical Affairs, Abbott Nutrition, Columbus, OH, United States
| |
Collapse
|
28
|
Wong J, Densmore J, Hilbrands J, Elkadri A, Cabrera J, Noe J, Eickhoff J, Goday PS. Perioperative nutrition in the setting of pediatric inflammatory bowel disease. Nutr Clin Pract 2024; 39:184-192. [PMID: 37302062 DOI: 10.1002/ncp.11021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 04/10/2023] [Accepted: 04/30/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND Optimization of nutrition prior to inflammatory bowel disease (IBD)-related surgery could improve outcomes. The aim of this study was to assess the perioperative nutrition status and management of children undergoing intestinal resection for treatment of their IBD. METHODS We identified all patients with IBD who underwent primary intestinal resection. We identified malnutrition using established criteria and methods of nutrition provision at various time points (preoperative outpatient evaluation, admission, and postoperative outpatient follow-up) for elective cases (who underwent their procedure at a scheduled admission) and urgent cases (who underwent an unplanned surgical intervention). We also recorded data on postsurgical complications. RESULTS A total of 84 patients were identified in this single-center study (male sex: 40%, mean age: 14.5 years, Crohn's disease: 65%). Thirty-four patients (40%) had some degree of malnutrition. Prevalence of malnutrition in the urgent and elective cohorts was similar (48% vs 36%; P = 0.37). Of these patients, 29 (34%) were noted to be on some type of nutrition supplementation prior to surgery. Postoperatively, BMI z scores increased (-0.61 vs -0.42; P = 0.0008), but the percentage of patients who were malnourished did not change from preoperative status (40% vs 40%; P = 0.10). Despite this, use of nutrition supplementation was only noted in 15 (17%) patients at postoperative follow-up. Complications were not associated with nutrition status. CONCLUSION Utilization of supplemental nutrition decreased postprocedure despite no change in malnutrition prevalence. These findings support the development of a pediatric-specific perioperative nutrition protocol in the setting of IBD-related surgery.
Collapse
Affiliation(s)
- Jonathan Wong
- Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology and Nutrition, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, USA
| | - John Densmore
- Department of Surgery, Division of Pediatric Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Julia Hilbrands
- Department of Clinical Nutrition, Children's Wisconsin, Milwaukee, Wisconsin
| | - Abdul Elkadri
- Department of Clinical Nutrition, Children's Wisconsin, Milwaukee, Wisconsin
| | - Jose Cabrera
- Department of Clinical Nutrition, Children's Wisconsin, Milwaukee, Wisconsin
| | - Josh Noe
- Department of Clinical Nutrition, Children's Wisconsin, Milwaukee, Wisconsin
| | - Jens Eickhoff
- Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin
| | - Praveen S Goday
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Nationwide Children's Hospital, Columbus, Ohio, USA
| |
Collapse
|
29
|
Beer SS, Wong Vega M. Malnutrition, sarcopenia, and frailty assessment in pediatric transplantation. Nutr Clin Pract 2024; 39:27-44. [PMID: 38088812 DOI: 10.1002/ncp.11105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 11/08/2023] [Accepted: 11/13/2023] [Indexed: 01/13/2024] Open
Abstract
Nutrition assessment can be challenging in children with end-stage organ disease and in those requiring an organ transplant. The effect of poor nutrition status can exert long-lasting effects on children with end-stage organ disease requiring transplantation. Malnutrition, sarcopenia, and frailty are conditions that require provision of optimal nutrition to prevent or support the treatment of these conditions. Unfortunately, the literature on the assessment of malnutrition, sarcopenia, and frailty in pediatric end-stage organ disease is scarce, thus leading to confusion on how to effectively identify them. Recently, the addition of a variety of validated nutrition and functional assessment techniques has assisted with appropriate assessment of these conditions. The objective of this narrative review is to provide an overview of the current literature for pediatric assessment of malnutrition, sarcopenia, and frailty in the setting of solid organ transplantation and provide practicing nutrition clinicians a solid foundation for learning how to effectively assess these conditions with the current literature available.
Collapse
Affiliation(s)
- Stacey Silver Beer
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Molly Wong Vega
- Renal Section, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
- Department of Health and Human Performance, University of Houston, Houston, Texas, USA
| |
Collapse
|
30
|
Nucci AM, Crim K, King E, Ganoza AJ, Remaley L, Rudolph J. Nutrition support considerations in pediatric small bowel transplantation. Nutr Clin Pract 2024; 39:75-85. [PMID: 37925666 DOI: 10.1002/ncp.11091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 10/06/2023] [Accepted: 10/12/2023] [Indexed: 11/07/2023] Open
Abstract
Enteral autonomy is the primary goal of intestinal failure therapy. Intestinal transplantation (ITx) is an option when enteral autonomy cannot be achieved and management complications become life-threatening. The purpose of this review is to summarize existing medical literature related to nutrition requirements, nutrition status, and nutrition support after pediatric ITx. Achieving or maintaining adequate growth after intestinal transplant in children can be challenging because of episodes of rejection that require the use of corticosteroids, occurrences of infection that require a reduction or discontinuation of enteral or parenteral support, and fat malabsorption caused by impaired lymphatic circulation. Nutrient requirements should be assessed and modified regularly based on nutrition status, growth, ventilatory status, wound healing, and the presence of complications. Parenteral nutrition (PN) should be initiated as a continuous infusion early postoperatively. Enteral support should be initiated after evidence of graft bowel function and in the absence of clinical complications. Foods high in simple carbohydrates should be limited, as consumption may result in osmotic diarrhea. Short-term use of a fat-free diet followed by a low-fat diet may reduce the risk of the development of chylous ascites. Micronutrient deficiencies and food allergies are common occurrences after pediatric ITx. Enteral/oral vitamin and mineral supplementation may be required after PN is weaned. Nutrition management of children after ITx can be challenging for all members of the healthcare team. Anthropometric parameters and micronutrient status should be monitored regularly so that interventions to promote growth and prevent or reverse nutrient deficiencies can be implemented promptly.
Collapse
Affiliation(s)
- Anita M Nucci
- Department of Nutrition, Georgia State University, Atlanta, Georgia, USA
| | | | - Elizabeth King
- Department of Nutrition, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Armando J Ganoza
- Thomas E. Starzl Transplant Institute, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Lisa Remaley
- Thomas E. Starzl Transplant Institute, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jeffrey Rudolph
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| |
Collapse
|
31
|
Morrow R, de Zoeten EF, Ma N, Chun C, Scott FI. Bone health screening practices with dual-energy X-ray absorptiometry and prediction of abnormal results in pediatric inflammatory bowel disease. J Pediatr Gastroenterol Nutr 2024; 78:252-260. [PMID: 38374562 DOI: 10.1002/jpn3.12107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 09/18/2023] [Accepted: 10/04/2023] [Indexed: 02/21/2024]
Abstract
OBJECTIVES Pediatric patients diagnosed with inflammatory bowel disease (IBD) are at risk of suboptimal peak bone mass attainment. This study aimed to understand rates of bone health screening adherence, describe factors associated with dual-energy X-ray absorptiometry (DXA) acquisition, and identify factors associated with abnormal DXA. METHODS We performed a retrospective cohort study of pediatric IBD patients over a 10-year time frame. We included IBD patients (2-20 years of age) enrolled in ImproveCareNow and excluded patients with primary metabolic bone disease. Time-to-event methods and multivariable logistic regression were employed to identify factors associated with DXA acquisition and abnormal DXA. RESULTS In 676 patients, 464 (68.63%) pediatric patients with IBD had a risk factor for low bone mineral density (BMD); 137 (29.53%) underwent an initial DXA scan. Quiescent disease was significantly associated with a reduced likelihood of DXA (hazard ratio [HR]: 0.48; 95% confidence interval [CI]: 0.24-0.97), while weight z-score <-2 was significantly associated with DXA performance (HR: 2.07; 95% CI: 1.08-3.98). Abnormal DXA results (BMD z-score ≤-1) occurred in 59 (35.54%) individuals. After adjusting for visit diagnosis, delayed puberty, severe disease course, 6 months or greater of steroid exposure, and history of fracture, BMI z-score <-1 (odds ratio: 5.45; 95% CI: 2.41-12.33) was associated with abnormal DXA. CONCLUSIONS DXA screening occurred in less than one-third of eligible pediatric IBD patients. Compliance was more common in patients with a weight z-score <-2 and less common in those with quiescent disease. BMI strongly predicted abnormal DXA results when adjusting for risk factors for abnormal BMD.
Collapse
Affiliation(s)
- Ryan Morrow
- Children's Hospital Colorado, Digestive Health Institute, Aurora, Colorado, USA
- Department of Pediatrics, School of Medicine, University of Colorado Anschutz, Aurora, Colorado, USA
| | - Edwin F de Zoeten
- Children's Hospital Colorado, Digestive Health Institute, Aurora, Colorado, USA
- Department of Pediatrics, School of Medicine, University of Colorado Anschutz, Aurora, Colorado, USA
| | - Nina Ma
- Department of Pediatrics, School of Medicine, University of Colorado Anschutz, Aurora, Colorado, USA
- Section of Pediatric Endocrinology, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Camille Chun
- Department of Pediatrics, School of Medicine, University of Colorado Anschutz, Aurora, Colorado, USA
| | - Frank I Scott
- Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| |
Collapse
|
32
|
Downs EM, Brun A, Bellin MD. Nutrition support in the pediatric total pancreatectomy with islet autotransplantation recipient. Nutr Clin Pract 2024; 39:100-108. [PMID: 38073153 DOI: 10.1002/ncp.11101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 11/06/2023] [Accepted: 11/09/2023] [Indexed: 01/13/2024] Open
Abstract
For children with diminished quality of life and chronic pain caused by acute recurrent or chronic pancreatitis who are undergoing total pancreatectomy with islet autotransplantation, postoperative nutrition support has several unique characteristics. Surgical complications may lead to delays in nutrition support initiation or require modifications to the regimen. Early postoperative dysmotility requires the use of temporary enteral nutrition until this improves. The resultant complete exocrine pancreatic insufficiency necessitates lifelong pancreatic enzyme replacement therapy and fat-soluble vitamin supplementation. A low-oxalate diet is recommended to prevent kidney stones. Carbohydrate counting is needed for the provision of short-term insulin dosing and possibly long-term as well, depending on the transplanted islet yield. Children should have careful nutrition assessment and monitoring at several follow-up visits during the first year, then annually, and at any time with concerns.
Collapse
Affiliation(s)
- Elissa M Downs
- Pediatric Gastroenterology, Hepatology, and Nutrition, M Health Fairview, University of Minnesota Masonic Children's Hospital, Minneapolis, Minnesota, USA
| | - Amanda Brun
- Nutrition Services, M Health Fairview, Minneapolis, Minnesota, USA
| | - Melena D Bellin
- Pediatric Endocrinology and Transplant Surgery, M Health Fairview, University of Minnesota Masonic Children's Hospital, Minneapolis, Minnesota, USA
| |
Collapse
|
33
|
Valdes C, Nataraj P, Kisilewicz K, Simenson A, Leon G, Kang D, Nguyen D, Sura L, Bliznyuk N, Weiss M. Impact of Nutritional Status on Total Brain Tissue Volumes in Preterm Infants. CHILDREN (BASEL, SWITZERLAND) 2024; 11:121. [PMID: 38255433 PMCID: PMC10813841 DOI: 10.3390/children11010121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 01/04/2024] [Accepted: 01/11/2024] [Indexed: 01/24/2024]
Abstract
Preterm infants bypass the crucial in utero period of brain development and are at increased risk of malnutrition. We aimed to determine if their nutritional status is associated with brain tissue volumes at term equivalent age (TEA), applying recently published malnutrition guidelines for preterm infants. We performed a single center retrospective chart review of 198 infants < 30 weeks' gestation between 2018 and 2021. We primarily analyzed the relationship between the manually obtained neonatal MR-based brain tissue volumes with the maximum weight and length z-score. Significant positive linear associations between brain tissue volumes at TEA and weight and length z-scores were found (p < 0.05). Recommended nutrient intake for preterm infants is not routinely achieved despite efforts to optimize nutrition. Neonatal MR-based brain tissue volumes of preterm infants could serve as objective, quantitative and reproducible surrogate parameters of early brain development. Nutrition is a modifiable factor affecting neurodevelopment and these results could perhaps be used as reference data for future timely nutritional interventions to promote optimal brain volume.
Collapse
Affiliation(s)
- Cyndi Valdes
- Division of Neonatology, Department of Pediatrics, University of Florida, Gainesville, FL 32608, USA; (C.V.); (P.N.); (K.K.); (L.S.)
| | - Parvathi Nataraj
- Division of Neonatology, Department of Pediatrics, University of Florida, Gainesville, FL 32608, USA; (C.V.); (P.N.); (K.K.); (L.S.)
| | - Katherine Kisilewicz
- Division of Neonatology, Department of Pediatrics, University of Florida, Gainesville, FL 32608, USA; (C.V.); (P.N.); (K.K.); (L.S.)
| | - Ashley Simenson
- College of Medicine, Gainesville Campus, University of Florida, Gainesville, FL 32608, USA; (A.S.); (G.L.); (D.K.)
| | - Gabriela Leon
- College of Medicine, Gainesville Campus, University of Florida, Gainesville, FL 32608, USA; (A.S.); (G.L.); (D.K.)
| | - Dahyun Kang
- College of Medicine, Gainesville Campus, University of Florida, Gainesville, FL 32608, USA; (A.S.); (G.L.); (D.K.)
| | - Dai Nguyen
- Department of Pediatrics, University of Florida, Gainesville, FL 32608, USA;
| | - Livia Sura
- Division of Neonatology, Department of Pediatrics, University of Florida, Gainesville, FL 32608, USA; (C.V.); (P.N.); (K.K.); (L.S.)
| | - Nikolay Bliznyuk
- Department of Agricultural & Biological Engineering, University of Florida, Gainesville, FL 32608, USA;
| | - Michael Weiss
- Division of Neonatology, Department of Pediatrics, University of Florida, Gainesville, FL 32608, USA; (C.V.); (P.N.); (K.K.); (L.S.)
| |
Collapse
|
34
|
Oftedal S, McCormack S, Stevenson R, Benfer K, Boyd RN, Bell K. The evolution of nutrition management in children with severe neurological impairment with a focus on cerebral palsy. J Hum Nutr Diet 2024. [PMID: 38196166 DOI: 10.1111/jhn.13277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 12/15/2023] [Indexed: 01/11/2024]
Abstract
Nutritional management of children with severe neurological impairment (SNI) is highly complex, and the profile of this population is changing. The aim of this narrative review was to give the reader a broad description of evolution of the nutritional management of children with SNI in a high resource setting. In the last decade, there has been an emphasis on using multiple anthropometric measures to monitor nutritional status in children with SNI, and several attempts at standardising the approach have been made. Tools such as the Feeding and Nutrition Screening Tool, the Subjective Global Nutrition Assessment, the Eating and Drinking Ability Classification System and the Focus on Early Eating and Drinking Swallowing (FEEDS) toolkit have become available. There has been an increased understanding of how the gut microbiome influences gastrointestinal symptoms common in children with SNI, and the use of fibre in the management of these has received attention. A new diagnosis, 'gastrointestinal dystonia', has been defined. The increased use and acceptance of blended food tube feeds has been a major development in the nutritional management of children with SNI, with reported benefits in managing gastrointestinal symptoms. New interventions to support eating and drinking skill development in children with SNI show promise. In conclusion, as the life expectancy of people with SNI increases due to advances in medical and nutrition care, our approach necessitates a view to long-term health and quality of life. This involves balancing adequate nutrition to support growth, development and well-being while avoiding overnutrition and its associated detrimental long-term effects.
Collapse
Affiliation(s)
- Stina Oftedal
- Queensland Cerebral Palsy Rehabilitation Research Centre, Faculty of Medicine, The University of Queensland Child Health Research Centre, Brisbane, Queensland, Australia
| | - Siobhan McCormack
- Department of Child Development and Neurodisability, Children's Health Ireland at Tallaght, Dublin, Ireland
- Department of Paediatrics, School of Medicine, University of Galway, Galway, Ireland
| | - Richard Stevenson
- Division of Neurodevelopmental and Behavioral Pediatrics, Department of Pediatrics, School of Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Katherine Benfer
- Queensland Cerebral Palsy Rehabilitation Research Centre, Faculty of Medicine, The University of Queensland Child Health Research Centre, Brisbane, Queensland, Australia
| | - Roslyn N Boyd
- Queensland Cerebral Palsy Rehabilitation Research Centre, Faculty of Medicine, The University of Queensland Child Health Research Centre, Brisbane, Queensland, Australia
| | - Kristie Bell
- Queensland Cerebral Palsy Rehabilitation Research Centre, Faculty of Medicine, The University of Queensland Child Health Research Centre, Brisbane, Queensland, Australia
- Dietetics and Food Services, Children's Health Queensland, South Brisbane, Queensland, Australia
| |
Collapse
|
35
|
Kesumarini D, Widyastuti Y, Boom CE, Dinarti LK. Risk Factors Associated With Prolonged Mechanical Ventilation and Length of Stay After Repair of Tetralogy of Fallot. World J Pediatr Congenit Heart Surg 2024; 15:81-88. [PMID: 37769605 DOI: 10.1177/21501351231191456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
BACKGROUND This study examined preoperative, intraoperative, and postoperative data to identify factors that are associated with prolonged mechanical ventilation (PMV) and prolonged intensive care unit length of stay (ICU LOS) in tetralogy of Fallot (TOF) patients undergoing repair surgery. METHODS A retrospective study was carried out after approval from the institutional review board. All patients (age 0-52 years) who underwent TOF repair from January 2016 to September 2022 were included. Prolonged mechanical ventilation was defined as >24 h of ventilation, while prolonged ICU LOS was defined as ICU stay >3 days. RESULTS A total of 922 patients were included, among whom 288 (31.2%) were intubated for >24 h and 222 (24.1%) stayed in ICU for >3 days. Younger age (odds ratio [OR] = 2, 95% confidence interval [CI] 1.2-3.3, P = .007), lower weight (OR = 2.1, 95% CI 1.2-3.5, P = .003), and residual lesion (OR = 3.27, 95% CI 1.2-8.7, P = .017) were associated with PMV. Moreover, independent risk factors for prolonged ICU LOS are similar to PMV risk factors, including younger age (OR = 2.3, 95% CI 1.28-4.12, P = .005), lower weight (OR = 2.83, 95% CI 1.58-5, P < .001), underweight status (OR = 1.7, 95% CI 1.12-2.57, P = .012), and residual lesion (OR = 3.79, 95% CI 1.43-10.05, P = .007). Both aortic cross-clamp and cardiopulmonary bypass times did not exhibit clinically significant risk factors toward PMV and prolonged ICU LOS. CONCLUSIONS The risk factors for PMV and prolonged ICU LOS were residual lesion, younger age, and lower weight. Nutritional status contributed to the risk of prolonged ICU LOS, but not PMV. Consideration of these factors may provide optimal care to improve the outcome following TOF corrective surgery.
Collapse
Affiliation(s)
- Dian Kesumarini
- Department of Anesthesia and Intensive Therapy, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
- Doctoral Programme, Faculty of Medicine and Public Health University of Gadjah Mada, Yogyakarta, Indonesia
| | - Yunita Widyastuti
- Department of Anesthesia and Intensive Therapy, Universitas Gadjah Mada/Dr Sardjito Hospital, Yogyakarta, Indonesia
| | - Cindy Elfira Boom
- Department of Anesthesia and Intensive Therapy, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - Lucia Kris Dinarti
- Department of Cardiology and Vascular Medicine, Universitas Gadjah Mada/Dr Sardjito Hospital, Yogyakarta, Indonesia
| |
Collapse
|
36
|
Li Y, Lu Z, Ma A, Yao W, Dong R, Li K, Wu M, Dong K, Qian T. Nutritional status associated with clinical outcomes in children with solid tumors: A retrospective cohort study from China. Cancer Med 2024; 13:e6798. [PMID: 38111308 PMCID: PMC10807599 DOI: 10.1002/cam4.6798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 10/12/2023] [Accepted: 11/27/2023] [Indexed: 12/20/2023] Open
Abstract
OBJECTIVE To investigate the long-term changes in nutritional status in children with solid tumors during treatment and the relationship between nutritional status and clinical outcomes. METHODS This study was a retrospective medical records review of data from children who were diagnosed with solid tumors and followed up for more than 3 months from January 2016 to December 2021 in China. Patient demographics and clinical information, including nutritional status, parenteral nutrition use, intensive care unit (ICU) transfers, infection during hospitalization, hospitalization frequency, length of stay, hospitalization costs and antibiotic costs, were collected to analyze the nutritional status of children with different types of solid tumors, the dynamic changes in nutritional status during treatment, and the relationship between nutritional status and clinical outcomes. RESULTS Among the 764 patients (383 males (50.1%); 381 females (49.9%); mean age: 2.58 years), 41.6% of the solid tumors were neuroblastomas, 17.1% were hepatoblastomas, and Wilms tumors as the third most common solid tumors (8.9%). The median follow-up duration was 6 months (range: 3-40 months). At diagnosis, the proportion of children who were undernourished (underweight and wasting) versus overweight or obese were 26.71% versus 5.21% (25.86% vs. 2.89% in the third month; 29.77% vs. 2.28% in the sixth month; 24.77% vs. 3.27% in the 12th month). The body mass index Z scores decreased from the initial values after the first month (-0.56 (-1.47, 0.23) vs. -0.44 (-1.29, 0.41)) but improved later and decreased again at 6 months. The children in the undernutrition group had longer hospital stays (p < 0.001), higher hospitalization costs (p < 0.001), higher antibiotic costs (p < 0.001), a higher risk of neutropenia (OR = 4.781 (95% CI: 1.571-14.553), p = 0.006), and a higher risk of ICU transfers (OR = 1.498 (95% CI: 1.010-2.224), p = 0.044). No significant differences in those associations by malnutrition and infection, ICU duration, or length of parenteral nutrition were observed. CONCLUSION There is a considerable prevalence of malnutrition in children with solid tumors. Malnutrition is related to adverse clinical outcomes and increases in total hospital expenses and antibiotic costs.
Collapse
Affiliation(s)
- Yongzhen Li
- Clinical nutrition DepartmentChildren's Hospital of Fudan UniversityShanghaiChina
- Child Health Management CentreStarkids Children's HospitalShanghaiChina
| | - Zhongying Lu
- Clinical nutrition DepartmentChildren's Hospital of Fudan UniversityShanghaiChina
| | - Ao Ma
- Pediatric Clinical Research Unit, Department of Research ManagementChildren's Hospital of Fudan UniversityShanghaiChina
| | - Wei Yao
- Department of OncologyChildren's Hospital of Fudan UniversityShanghaiChina
| | - Rui Dong
- Department of OncologyChildren's Hospital of Fudan UniversityShanghaiChina
| | - Kai Li
- Department of OncologyChildren's Hospital of Fudan UniversityShanghaiChina
| | - Min Wu
- Department of OncologyChildren's Hospital of Fudan UniversityShanghaiChina
| | - Kuiran Dong
- Department of OncologyChildren's Hospital of Fudan UniversityShanghaiChina
| | - Tian Qian
- Clinical nutrition DepartmentChildren's Hospital of Fudan UniversityShanghaiChina
| |
Collapse
|
37
|
Murphy JD, Cooke KR, Symons HJ, VanGraafeiland B. Enteral nutrition optimization program for children undergoing blood & marrow transplantation: A quality improvement project. J Pediatr Nurs 2024; 74:61-68. [PMID: 38000117 DOI: 10.1016/j.pedn.2023.11.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 11/08/2023] [Accepted: 11/09/2023] [Indexed: 11/26/2023]
Abstract
BACKGROUND Malnutrition in children and young adults undergoing blood and marrow transplantation (BMT) increases morbidity and mortality. Addressing this via optimization of enteral nutrition can potentially improve outcomes. METHODS This Quality Improvement project utilized pre-post-intervention design and post-intervention survey to evaluate a novel program optimizing enteral nutrition support in children undergoing BMT. All patients aged 0-18 who were admitted during the 16-week implementation period followed the Enteral Nutrition Optimization Program from pre-BMT through discharge. Data on biometric indicators, complications, and post-transplant milestone time markers were evaluated via Mann-Whitney U, Fisher's exact, and Chi-square tests as indicated using SPSS™ Version 27. A separate sample of clinical providers completed a post-intervention survey to evaluate the feasibility and acceptance of the intervention. FINDINGS Six patients received the intervention, with 12 patients evaluated. There were no statistical differences between groups on measured evaluations of weight loss (0.15 kg vs +0.4 kg, p = 0.39), malnutrition (2 vs 3, p = 0.545), graft-versus-host-disease (2 vs 2, p = 1), time to engraftment (platelets day 22 vs 20.5, p = 0.589), infections (p = 0.368), and length of stay (32.5 days vs 31 days, p = 1). The provider sample of 45 participants showed overall feasibility and acceptance of the intervention (88.9% agreed or strongly agreed). DISCUSSION Feasibility and acceptance were high, resulting in increased use of nasogastric and gastrostomy tubes. Though no clinical significance, interpretation is limited due to the small sample size. PRACTICE IMPLICATIONS Implementing a novel nutritional support program resulted in a culture shift towards enteral nutrition optimization. Further studies are needed to determine clinical impacts.
Collapse
Affiliation(s)
- Jessica D Murphy
- Johns Hopkins University School of Nursing, 525 North Wolfe Street, Baltimore, MD, USA.
| | - Kenneth R Cooke
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Heather J Symons
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Brigit VanGraafeiland
- Johns Hopkins University School of Nursing, 525 North Wolfe Street, Baltimore, MD, USA.
| |
Collapse
|
38
|
Shen CL, Liebstein D, Fernandez H. Malnutrition and protein energy wasting are associated with severity and progression of pediatric chronic kidney disease. Pediatr Nephrol 2024; 39:243-250. [PMID: 37464056 DOI: 10.1007/s00467-023-06078-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 06/26/2023] [Accepted: 06/26/2023] [Indexed: 07/20/2023]
Abstract
BACKGROUND Protein energy wasting (PEW), a state of deficient protein storage, is not well understood in children and adolescents with chronic kidney disease (CKD). We aimed to re-define PEW using pediatric malnutrition guidelines from the Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition (AND/ASPEN), and to describe the relationship between PEW, malnutrition, and kidney function. METHODS This was a retrospective review of outpatients ≤ 20 years old with a diagnosis of CKD from January 1, 2013, to August 31, 2018. Malnutrition was diagnosed by a licensed dietitian, and PEW was diagnosed using an updated definition incorporating AND/ASPEN malnutrition guidelines. Logistic regression and linear mixed effects modeling were performed on the relationship of malnutrition and PEW to estimated glomerular filtration rate (eGFR). RESULTS The 142 patients included in this analysis had a median age of 11.1 years and median eGFR of 57 ml/min/1.73 m2 at initial visit. Malnutrition was diagnosed in 50% of patients in at least one visit, and 17.6% met ≥ 2 PEW criteria. Patients with eGFR < 30 ml/min/1.73 m2 had significantly increased risk of malnutrition [OR 2.5, 95% CI 2.0-3.3] (p < 0.001) and PEW [OR 4.9, 95% CI 3.0-8.0] (p < 0.001). A diagnosis of malnutrition or PEW was associated with worse eGFR by logistic regression (p = 0.01 and p = 0.001, respectively) and more rapid eGFR decline by linear mixed effects model (p = 0.002 and p < 0.001, respectively) compared to those without these diagnoses. CONCLUSIONS Malnutrition and PEW are prevalent in pediatric CKD and are associated with significantly lower eGFR and more rapid decline in eGFR, emphasizing the need to address nutritional status. A higher resolution version of the Graphical abstract is available as Supplementary information.
Collapse
Affiliation(s)
- Carol L Shen
- Division of Pediatric Nephrology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.
| | - Dana Liebstein
- Department of Pediatrics, New York Presbyterian Morgan Stanley Children's Hospital of New York, New York, USA
| | - Hilda Fernandez
- Division of Nephrology, Columbia University Irving Medical Center, New York, NY, USA
| |
Collapse
|
39
|
Bashir A, Antos N, Miller T, Challa SA, Pan AY, Gosa M, Silverman A, Goday PS. A Cross-Sectional Study of Pediatric Feeding Disorder in Children with Cystic Fibrosis. J Pediatr Gastroenterol Nutr 2023; 77:819-823. [PMID: 37771032 DOI: 10.1097/mpg.0000000000003951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/30/2023]
Abstract
BACKGROUND The exact prevalence of feeding problems in children with cystic fibrosis (CF) is unknown. Pediatric feeding disorder (PFD) encompasses poor oral intake with associated medical, nutrition, psychosocial, or feeding skill dysfunction. We hypothesized that PFD is common in CF and aimed to categorize feeding dysfunction across various domains in children with CF. METHODS An observational cross-sectional study was conducted in children with CF. Data collected included anthropometrics, nutrition data (including need for tube feeding/enteral nutrition [EN] or high-energy beverages, dietary diversity), feeding skills (Pediatric version of the Eating Assessment tool [pEAT]), and psychosocial function (About Your Child's Eating questionnaire [AYCE] in children 2-17 years of age/Behavioral Pediatric Feeding Assessment Scale [BPFAS] in children 12-23 months of age). PFD was defined as poor oral intake with: (a) pEAT score > 5; and/or (b) AYCE or BPFAS score > 2 standard deviation of normative controls; and/or (c) nutrition dysfunction (body mass index/weight-for-length z score < -1 and/or preference of oral high energy beverages or dependence on EN and/or decreased dietary diversity). RESULTS Of 103 children in the study, 62 (60.1%) had PFD, 7 children (6.8%) were malnourished, 10 needed EN (9.7%), and 30 (29.1%) needed oral high-energy beverages. Dietary diversity was decreased in 42 children (41.5%), 1 child had feeding skill dysfunction, and 11 (10.8%) met criteria for psychosocial dysfunction. CONCLUSION Almost 2/3rd of children with CF have PFD and many have poor dietary diversity. A significant percentage of children rely on EN and oral supplements, but psychosocial dysfunction is less prevalent.
Collapse
Affiliation(s)
- Anam Bashir
- From the Division of Pediatric Gastroenterology, Hepatology and Nutrition, Medical College of Wisconsin, Milwaukee, WI
| | - Nicholas Antos
- the Division of Pediatric Pulmonology, Medical College of Wisconsin, Milwaukee, WI
| | - Tami Miller
- the Department of Clinical Nutrition, Children's Wisconsin, Milwaukee, WI
| | - Sai Alekha Challa
- the Department of Pediatrics, Division of Quantitative Health Sciences, Medical College of Wisconsin, Milwaukee, WI
| | - Amy Y Pan
- the Department of Pediatrics, Division of Quantitative Health Sciences, Medical College of Wisconsin, Milwaukee, WI
| | - Memorie Gosa
- the Department of Communicative Disorders, University of Alabama, Tuscaloosa, AL
| | - Alan Silverman
- From the Division of Pediatric Gastroenterology, Hepatology and Nutrition, Medical College of Wisconsin, Milwaukee, WI
| | - Praveen S Goday
- the Division of Pediatric Gastroenterology, Hepatology and Nutrition, Nationwide Children's Hospital, Columbus, OH
| |
Collapse
|
40
|
Perlman M, Senger S, Verma S, Carey J, Faherty CS. A foundational approach to culture and analyze malnourished organoids. Gut Microbes 2023; 15:2248713. [PMID: 37724815 PMCID: PMC10512930 DOI: 10.1080/19490976.2023.2248713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 08/07/2023] [Indexed: 09/21/2023] Open
Abstract
The gastrointestinal (GI) epithelium plays a major role in nutrient absorption, barrier formation, and innate immunity. The development of organoid-based methodology has significantly impacted the study of the GI epithelium, particularly in the fields of mucosal biology, immunity, and host-microbe interactions. Various effects on the GI epithelium, such as genetics and nutrition, impact patients and alter disease states. Thus, incorporating these effects into organoid-based models will facilitate a better understanding of disease progression and offer opportunities to evaluate therapeutic candidates. One condition that has a significant effect on the GI epithelium is malnutrition, and studying the mechanistic impacts of malnutrition would enhance our understanding of several pathologies. Therefore, the goal of this study was to begin to develop methodology to generate viable malnourished organoids with accessible techniques and resources that can be used for a wide array of mechanistic studies. By selectively limiting distinct macronutrient components of organoid media, we were able to successfully culture and evaluate malnourished organoids. Genetic and protein-based analyses were used to validate the approach and confirm the presence of known biomarkers of malnutrition. Additionally, as proof-of-concept, we utilized malnourished organoid-derived monolayers to evaluate the effect of malnourishment on barrier formation and the ability of the bacterial pathogen Shigella flexneri to infect the GI epithelium. This work serves as the basis for new and exciting techniques to alter the nutritional state of organoids and investigate the related impacts on the GI epithelium.
Collapse
Affiliation(s)
- Meryl Perlman
- Mucosal Immunology and Biology Research Center, Division of Pediatric Gastroenterology and Nutrition, Massachusetts General Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Stefania Senger
- Mucosal Immunology and Biology Research Center, Division of Pediatric Gastroenterology and Nutrition, Massachusetts General Hospital, Boston, MA, USA
| | - Smriti Verma
- Mucosal Immunology and Biology Research Center, Division of Pediatric Gastroenterology and Nutrition, Massachusetts General Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
| | - James Carey
- Mucosal Immunology and Biology Research Center, Division of Pediatric Gastroenterology and Nutrition, Massachusetts General Hospital, Boston, MA, USA
| | - Christina S. Faherty
- Mucosal Immunology and Biology Research Center, Division of Pediatric Gastroenterology and Nutrition, Massachusetts General Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
41
|
Campos-Miño S, Figueiredo-Delgado A, Zárate P, Zamberlan P, Muñoz-Benavides E, Coss-Bu JA. Malnutrition and Nutrition Support in Latin American PICUs: The Nutrition in PICU (NutriPIC) Study. Pediatr Crit Care Med 2023; 24:1033-1042. [PMID: 37539965 DOI: 10.1097/pcc.0000000000003337] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Abstract
OBJECTIVES To characterize the nutritional status of children admitted to Latin American (LA) PICUs and to describe the adequacy of nutrition support in reference to contemporary international recommendations. DESIGN The Nutrition in PICU (NutriPIC) study was a combined point-prevalence study of malnutrition carried out on 1 day in 2021 (Monday 8 November) and a retrospective cohort study of adequacy of nutritional support in the week preceding. SETTING Four-one PICUs in 13 LA countries. PATIENTS Patients already admitted to the PICU of 1 month to 18 years old on the study day were included in the point-prevalence study. For the retrospective arm, we included patients receiving nutritional support on the study day and with a PICU length of stay (LOS) greater than or equal to 72 hours. Exclusion criteria were being a neonate, conditions that precluded accurate anthropometric measurements, and PICU LOS greater than 14 days. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Of 316 patients screened, 5 did not meet age criteria. There were 191 of 311 patients who were included in the point-prevalence study and underwent anthropometric evaluation. Underweight and length for age less than -2 z scores were present in 42 of 88 children (47.7%) and 41 of 88 children (46.6%) less than 24 months old, and 14 of 103 (13.6%) and (23/103) 22.3% of 103 children greater than or equal to 24 months, respectively. Evidence of obesity (body mass index > 2 z score) was present in 7 of 88 children (5.7%) less than 24 months old and 13 of 103 children (12.6%) greater than or equal to 24 months. In the 115 of 311 patients meeting criteria for the retrospective arm, a total of 98 patients reported complete nutritional data. The 7-day median (interquartile range) adequacy for delivered versus recommended enteral energy and protein requirement was 114% (75, 154) and 99% (60, 133), respectively. CONCLUSIONS The NutriPIC study found that in 2021 malnutrition was highly prevalent especially in PICU admissions of less than 24 months old. Retrospectively, the 7-day median nutritional support appears to meet both energy and protein requirements.
Collapse
Affiliation(s)
| | - Artur Figueiredo-Delgado
- Pediatric Intensive Care Unit, Instituto da Criança do Hospital das Clínicas, Facultade de Medicina, Universidad de São Paulo, São Paulo, Brazil
| | - Patricia Zárate
- Pediatric Intensive Care Unit, Instituto Nacional de Pediatría, Ciudad de México, México
| | - Patricia Zamberlan
- Pediatric Intensive Care Unit, Instituto da Criança do Hospital das Clínicas, Facultade de Medicina, Universidad de São Paulo, São Paulo, Brazil
| | | | - Jorge A Coss-Bu
- Division of Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine, and Texas Children´s Hospital, Houston, TX
| |
Collapse
|
42
|
Kerstein JS, Klepper CM, Finnan EG, Mills KI. Nutrition for critically ill children with congenital heart disease. Nutr Clin Pract 2023; 38 Suppl 2:S158-S173. [PMID: 37721463 DOI: 10.1002/ncp.11046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 06/28/2023] [Accepted: 07/04/2023] [Indexed: 09/19/2023] Open
Abstract
Children with congenital heart disease often require admission to the cardiac intensive care unit at some point in their lives, either after elective surgical or catheter-based procedures or during times of acute critical illness. Meeting both the macronutrient and micronutrient needs of children in the cardiac intensive care unit requires complex decision-making when considering gastrointestinal perfusion, vasoactive support, and fluid balance goals. Although nutrition guidelines exist for critically ill children, these cannot always be extrapolated to children with congenital heart disease. Children with congenital heart disease may also suffer unique circumstances, such as chylothoraces, heart failure, and the need for mechanical circulatory support, which greatly impact nutrition delivery. Guidelines for neonates and children with heart disease continue to be developed. We provide a synthesized narrative review of current literature and considerations for nutrition evaluation and management of critically ill children with congenital heart disease.
Collapse
Affiliation(s)
- Jason S Kerstein
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusettes, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusettes, USA
| | - Corie M Klepper
- Department of Pediatrics, Harvard Medical School, Boston, Massachusettes, USA
- Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, Massachusettes, USA
| | - Emily G Finnan
- Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, Massachusettes, USA
| | - Kimberly I Mills
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusettes, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusettes, USA
| |
Collapse
|
43
|
Hager A, Mazurak V, Noga M, Gilmour SM, Mager DR. Skeletal muscle fibre morphology in childhood-insights into myopenia in pediatric liver disease. Appl Physiol Nutr Metab 2023; 48:730-750. [PMID: 37319441 DOI: 10.1139/apnm-2023-0033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
TAKE-HOME MESSAGE Skeletal muscle morphology in healthy children changes with age. Liver disease may preferentially affect type II fibres in adults with end-stage liver disease (ESLD). More research is needed on the effects of ESLD on muscle morphology in children.
Collapse
Affiliation(s)
- Amber Hager
- Department of Agricultural, Food & Nutritional Sciences, University of Alberta, Edmonton, AB, Canada
| | - Vera Mazurak
- Department of Agricultural, Food & Nutritional Sciences, University of Alberta, Edmonton, AB, Canada
| | - Michelle Noga
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, AB, Canada
| | - Susan M Gilmour
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
- Division of Pediatric Gastroenterology & Nutrition/Transplant Services, The Stollery Children's Hospital, Alberta Health Services, Edmonton, AB, Canada
| | - Diana R Mager
- Department of Agricultural, Food & Nutritional Sciences, University of Alberta, Edmonton, AB, Canada
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| |
Collapse
|
44
|
Garber AK, Bennett JP, Wong MC, Tian IY, Maskarinec G, Kennedy SF, McCarthy C, Kelly NN, Liu YE, Machen VI, Heymsfield SB, Shepherd JA. Cross-sectional assessment of body composition and detection of malnutrition risk in participants with low body mass index and eating disorders using 3D optical surface scans. Am J Clin Nutr 2023; 118:812-821. [PMID: 37598747 PMCID: PMC10797509 DOI: 10.1016/j.ajcnut.2023.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 08/08/2023] [Accepted: 08/14/2023] [Indexed: 08/22/2023] Open
Abstract
BACKGROUND New recommendations for the assessment of malnutrition and sarcopenia include body composition, specifically reduced muscle mass. Three-dimensional optical imaging (3DO) is a validated, accessible, and affordable alternative to dual X-ray absorptiometry (DXA). OBJECTIVE Identify strengths and weaknesses of 3DO for identification of malnutrition in participants with low body mass index (BMI) and eating disorders. DESIGN Participants were enrolled in the cross-sectional Shape Up! Adults and Kids studies of body shape, metabolic risk, and functional assessment and had BMI of <20 kg/m2 in adults or <85% of median BMI (mBMI) in children and adolescents. A subset was referred for eating disorders evaluation. Anthropometrics, scans, strength testing, and questionnaires were completed in clinical research centers. Lin's Concordance Correlation Coefficient (CCC) assessed agreement between 3DO and DXA; multivariate linear regression analysis examined associations between weight history and body composition. RESULTS Among 95 participants, mean ± SD BMI was 18.3 ± 1.4 kg/m2 in adult women (N = 56), 19.0 ± 0.6 in men (N = 14), and 84.2% ± 4.1% mBMI in children (N = 25). Concordance was excellent for fat-free mass (FFM, CCC = 0.97) and strong for appendicular lean mass (ALM, CCC = 0.86) and fat mass (FM, CCC = 0.87). By DXA, 80% of adults met the low FFM index criterion for malnutrition, and 44% met low ALM for sarcopenia; 52% of children and adolescents were <-2 z-score for FM. 3DO identified 95% of these cases. In the subset, greater weight loss predicted lower FFM, FM, and ALM by both methods; a greater percentage of weight regained predicted a higher percentage of body fat. CONCLUSIONS 3DO can accurately estimate body composition in participants with low BMI and identify criteria for malnutrition and sarcopenia. In a subset, 3DO detected changes in body composition expected with weight loss and regain secondary to eating disorders. These findings support the utility of 3DO for body composition assessment in patients with low BMI, including those with eating disorders. This trial was registered at clinicaltrials.gov as NCT03637855.
Collapse
Affiliation(s)
- Andrea K Garber
- Department of Pediatrics, University of California, San Francisco, CA, United States.
| | - Jonathan P Bennett
- Graduate Program in Human Nutrition, University of Hawai'i Manoa, Honolulu, HI, United States; University of Hawai'i Cancer Center, Honolulu, HI, United States
| | - Michael C Wong
- University of Hawai'i Cancer Center, Honolulu, HI, United States
| | - Isaac Y Tian
- Paul G. Allen School of Computer Science and Engineering, University of Washington, Seattle, WA, United States
| | | | - Samantha F Kennedy
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA, United States
| | - Cassidy McCarthy
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA, United States
| | - Nisa N Kelly
- University of Hawai'i Cancer Center, Honolulu, HI, United States
| | - Yong E Liu
- University of Hawai'i Cancer Center, Honolulu, HI, United States
| | - Vanessa I Machen
- Department of Pediatrics, University of California, San Francisco, CA, United States
| | - Steven B Heymsfield
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA, United States
| | - John A Shepherd
- University of Hawai'i Cancer Center, Honolulu, HI, United States
| |
Collapse
|
45
|
Guenter P, Blackmer A, Malone A, Phillips W, Mogensen KM, Becker P. Current nutrition assessment practice: A 2022 survey. Nutr Clin Pract 2023; 38:998-1008. [PMID: 37060155 DOI: 10.1002/ncp.10998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 03/07/2023] [Accepted: 03/20/2023] [Indexed: 04/16/2023] Open
Abstract
BACKGROUND Malnutrition remains a significant problem in patients with acute or chronic illnesses. Nutrition assessment is an important component in detecting malnutrition; but not always performed using a standardized tool. This survey on nutrition assessment evaluates current clinical practices on the assessment, diagnosis, and treatment of malnutrition. METHODS This 2022 survey of US-based nutrition clinicians collected data on assessment parameters used in hospitals, long-term care facilities, and the home care setting. RESULTS A total of 686 surveys were available for analysis. Ninety-seven percent of adult and 91% of pediatric responding clinicians indicated that a dietitian completed the assessment. Parameters used most frequently among adult clinician respondents included nutrient intake, current weight, and weight history, those used by pediatric clinician respondents included nutrient intake, weight-for-age z score, and weight-for-length/height z score. Eighty-nine percent of adult clinicians in all care settings and 85% of pediatric clinicians use the Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition Indicators of Malnutrition (AAIM). Respondents reported malnutrition rates of 32%-40% for adults and 4%-30% for pediatric patients, depending on the setting. Appropriate interventions for those with malnutrition (as perceived by the survey respondents) were ordered 70% of the time. CONCLUSION This survey demonstrated significant use of the AAIM by both adult and pediatric clinicians across care settings. Reported malnutrition rates are consistent with others published in the literature. The authors suggest that quality improvement efforts should focus on the 30% of patients with malnutrition but without a reported appropriate nutrition intervention.
Collapse
Affiliation(s)
- Peggi Guenter
- American Society for Parenteral and Enteral Nutrition, Silver Spring, Maryland, USA
| | - Allison Blackmer
- American Society for Parenteral and Enteral Nutrition, Silver Spring, Maryland, USA
| | - Ainsley Malone
- American Society for Parenteral and Enteral Nutrition, Silver Spring, Maryland, USA
| | | | - Kris M Mogensen
- Department of Nutrition, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | |
Collapse
|
46
|
Farley E, Karinja MN, Lawal AM, Olaleye M, Muhammad S, Umar M, Gaya FK, Mbaeri SC, Sherlock M, Kabila DW, Peters M, Samuel J, Maloba G, Usman R, van der Kam S, Ritmeijer K, Ariti C, Amirtharajah M, Lenglet A, Falq G. Proportion of paediatric admissions with any stage of noma at the Anka General Hospital, northwest Nigeria. PLoS Negl Trop Dis 2023; 17:e0011508. [PMID: 37889919 PMCID: PMC10645368 DOI: 10.1371/journal.pntd.0011508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 11/14/2023] [Accepted: 10/03/2023] [Indexed: 10/29/2023] Open
Abstract
INTRODUCTION Noma is a rapidly spreading infection of the oral cavity which mainly affects young children. Without early treatment, it can have a high mortality rate. Simple gingivitis is a warning sign for noma, and acute necrotizing gingivitis is the first stage of noma. The epidemiology of noma is not well understood. We aimed to understand the prevalence of all stages of noma in hospitalised children. METHODS We conducted a prospective observational study from 1st June to 24th October 2021, enrolling patients aged 0 to 12 years who were admitted to the Anka General Hospital, Zamfara, northwest Nigeria. Consenting parents/ guardians of participants were interviewed at admission. Participants had anthropometric and oral examinations at admission and discharge. FINDINGS Of the 2346 patients, 58 (2.5%) were diagnosed with simple gingivitis and six (n = 0.3%) with acute necrotizing gingivitis upon admission. Of those admitted to the Inpatient Therapeutic Feeding Centre (ITFC), 3.4% (n = 37, CI 2.5-4.7%) were diagnosed with simple gingivitis upon admission compared to 1.7% of those not admitted to the ITFC (n = 21, CI 1.1-2.6%) (p = 0.008). Risk factors identified for having simple gingivitis included being aged over two years (2 to 6 yrs old, odds ratio (OR) 3.4, CI 1.77-6.5; 7 to 12 yrs OR 5.0, CI 1.7-14.6; p = <0.001), being admitted to the ITFC (OR 2.1; CI 1.22-3.62) and having oral health issues in the three months prior to the assessment (OR 18.75; CI 10.65, 33.01). All (n = 4/4) those aged six months to five years acute necrotizing gingivitis had chronic malnutrition. CONCLUSION Our study showed a small proportion of children admitted to the Anka General Hospital had simple or acute necrotizing gingivitis. Hospital admission with malnutrition was a risk factor for both simple and acute necrotizing gingivitis. The lack of access to and uptake of oral health care indicates a strong need for oral examinations to be included in routine health services. This provision could improve the oral status of the population and decrease the chance of patients developing noma.
Collapse
Affiliation(s)
- Elise Farley
- Médecins Sans Frontières, Noma Children’s Hospital, Sokoto, Nigeria
| | | | | | - Michael Olaleye
- Médecins Sans Frontières, Noma Children’s Hospital, Sokoto, Nigeria
| | - Sadiya Muhammad
- Médecins Sans Frontières, Nigeria Mission, Zamfara and Abuja, Nigeria
| | - Maryam Umar
- Médecins Sans Frontières, Nigeria Mission, Zamfara and Abuja, Nigeria
| | | | | | | | | | - Miriam Peters
- Médecins Sans Frontières, Nigeria Mission, Zamfara and Abuja, Nigeria
| | - Joseph Samuel
- Médecins Sans Frontières, Noma Children’s Hospital, Sokoto, Nigeria
| | - Guy Maloba
- Médecins Sans Frontières, Nigeria Mission, Zamfara and Abuja, Nigeria
| | - Rabi Usman
- Zamfara Ministry of Health, Zamfara, Nigeria
| | | | | | - Cono Ariti
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | | | | |
Collapse
|
47
|
Noel RJ. Avoidant restrictive food intake disorder and pediatric feeding disorder: the pediatric gastroenterology perspective. Curr Opin Pediatr 2023; 35:566-573. [PMID: 37461875 DOI: 10.1097/mop.0000000000001267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/14/2023]
Abstract
PURPOSE OF REVIEW Avoidant/restrictive food intake disorder (ARFID) and pediatric feeding disorder (PFD) are the newest evolutions of frameworks for dysfunctional feeding and share overlapping features but maintain notable differences. This review will compare the two frameworks, highlighting some of the latest advances in diagnosis and management. RECENT FINDINGS Dysfunctional feeding, particularly withing the PFD definition, benefits from multidisciplinary care with equal attention to medical, nutritional, skill-based, and behavioral domains. Management requires medical attention, often with functional gastrointestinal disease and anxiety. Pharmacologic appetite stimulation may play a role. A single empirically proved behavioral approach has not been described and multiple options exist regarding type, location, and intensity of feeding therapy. SUMMARY ARFID and PFD not only share areas of overlap, but also differ, likely based on the origins of each framework. Ultimately, both frameworks describe dysfunctional feeding and require input from medical providers. The more effective approaches tend to be multidisciplinary, addressing medical, nutritional, skill-based, and/or behavioral aspects of the disorder (the PFD model). Future evolution of both ARFID and PFD frameworks is likely to generate refinement in their defining criteria, hopefully generating a structured link between the two.
Collapse
Affiliation(s)
- Richard J Noel
- Department of Pediatrics, Duke University, Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Durham, North Carolina, USA
| |
Collapse
|
48
|
Pedro J, Martucci R, Monteiro G, Saraiva D. Mid-upper arm circumference in hospitalized pediatric patients with cancer: Is there an association with malnutrition? Nutr Clin Pract 2023; 38:1133-1141. [PMID: 37461825 DOI: 10.1002/ncp.11039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 05/13/2023] [Accepted: 06/11/2023] [Indexed: 09/19/2023] Open
Abstract
BACKGROUND Malnutrition is common in children/adolescents with cancer. Mid-upper arm circumference (MUAC) is recommended by the International Society of Pediatric Oncology for measuring nutrition status. The aim was to evaluate the nutrition status of pediatric patients with cancer and verify whether MUAC is associated with malnutrition and length of stay (LOS). METHODS This was an observational study of patients aged 0-19 years with solid and hematological neoplasms. Data included anthropometric measurements of nutrition status by body mass index/age (BMI/A), weight/age, weight/height, height/age, MUAC, mid-arm muscle circumference, triceps skinfold thickness (TSF), and biochemical measurements of characterizing inflammation (serum prealbumin level, serum albumin level, and C-reactive protein [CRP]). Statistical tests such as the Student t test, Mann-Whitney test, and Spearman correlation were employed to analyze the data. Logistic regression was used for multivariate analysis. RESULTS Of 111 patients, 51.7% (n = 57) were male, and solid tumors were prevalent (76.6%, n = 85). The median age was 8.5 years. The anthropometric measurements of the arm revealed a higher prevalence of malnutrition when compared with anthropometric indices. According to the Spearman correlation, a high and positive correlation was observed between MUAC and BMI/A (ρ = 0.800 and P < 0.001). There was an association between MUAC, TSF, and high CRP with LOS (P = 0.025, P = 0.003, and P < 0.001, respectively). Patients with a MUAC (less than the fifth percentile) had almost 2.73 times the chance of having a prolonged LOS. CONCLUSION MUAC was a good parameter for the classification of nutrition status and the assessment of LOS in pediatric patients with cancer.
Collapse
Affiliation(s)
- Jéssica Pedro
- Multiprofessional Residency Program in Oncology of the National Cancer Institute (INCA), Rio de Janeiro, Brazil
| | - Renata Martucci
- Nutrition and Dietetic Section, Cancer Hospital Unit I, National Cancer Institute, Rio de Janeiro, Brazil
- Nutrition Institute, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Gina Monteiro
- Department of Epidemiology and Quantitative Methods in Health, National School of Public Health Sérgio Arouca, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Danúbia Saraiva
- Nutrition and Dietetic Section, Cancer Hospital Unit I, National Cancer Institute, Rio de Janeiro, Brazil
| |
Collapse
|
49
|
Us MC, Coci K, Akkuş E, Okay B, Akkoç G. A Single-Center Evaluation of Pediatric Measles Cases in Istanbul, Türkiye, in 2019. Jpn J Infect Dis 2023; 76:267-274. [PMID: 37121672 DOI: 10.7883/yoken.jjid.2022.701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Although measles can be prevented and eliminated by vaccination, it is a highly contagious viral disease that can lead to serious complications, disability, and death. The aim of this retrospective study was to evaluate the characteristics of measles cases in a single center. All children with clinically suspected measles who attended the Pediatric Clinic at Esenler Maternity and Child Health Hospital in Istanbul, Türkiye, between January 1 and June 30, 2019 were included in the analysis. None of the children with measles were fully vaccinated. The incidence and duration of conjunctivitis were significantly higher in the unvaccinated group than in the partially vaccinated group (P = 0.027 and P = 0.019, respectively). Unvaccinated patients had a significantly lower median leukocyte count (P = 0.019) and significantly higher median C-reactive protein level (P = 0.021). The vitamin A level and leukocyte count were moderately positively correlated (r = 0.698; P = 0.008). Children should be fully vaccinated in order to prevent measles.
Collapse
Affiliation(s)
- Mahmut Caner Us
- Department of Pediatrics, Maternity Ward, Esenler Maternity and Child Health Hospital, Türkiye
- Department of Pediatrics, Haseki Training and Research Hospital, Türkiye
| | - Kübra Coci
- Department of Pediatrics, Maternity Ward, Esenler Maternity and Child Health Hospital, Türkiye
| | - Erkan Akkuş
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Cerrahpasa Medical Faculty, Istanbul University, Türkiye
| | - Berker Okay
- Department of Pediatrics, Maternity Ward, Esenler Maternity and Child Health Hospital, Türkiye
| | - Gülşen Akkoç
- Department of Infectious Diseases, Haseki Training and Research Hospital, Türkiye
| |
Collapse
|
50
|
Weeks I, Abber SR, Thomas JJ, Calabrese S, Kuo B, Staller K, Murray HB. The Intersection of Disorders of Gut-Brain Interaction With Avoidant/Restrictive Food Intake Disorder. J Clin Gastroenterol 2023; 57:651-662. [PMID: 37079861 PMCID: PMC10623385 DOI: 10.1097/mcg.0000000000001853] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/22/2023]
Abstract
High rates of overlap exist between disorders of gut-brain interaction (DGBI) and eating disorders, for which common interventions conceptually conflict. There is particularly increasing recognition of eating disorders not centered on shape/weight concerns, specifically avoidant/restrictive food intake disorder (ARFID) in gastroenterology treatment settings. The significant comorbidity between DGBI and ARFID highlights its importance, with 13% to 40% of DGBI patients meeting full criteria for or having clinically significant symptoms of ARFID. Notably, exclusion diets may put some patients at risk for developing ARFID and continued food avoidance may perpetuate preexisting ARFID symptoms. In this review, we introduce the provider and researcher to ARFID and describe the possible risk and maintenance pathways between ARFID and DGBI. As DGBI treatment recommendations may put some patients at risk for developing ARFID, we offer recommendations for practical treatment management including evidence-based diet treatments, treatment risk counseling, and routine diet monitoring. When implemented thoughtfully, DGBI and ARFID treatments can be complementary rather than conflicting.
Collapse
Affiliation(s)
- Imani Weeks
- Division of Gastroenterology, Massachusetts General Hospital, Boston, MA
| | - Sophie R. Abber
- Department of Psychology, Florida State University, Tallahassee, FL
| | - Jennifer J. Thomas
- Harvard Medical School, Boston, MA
- Eating Disorders Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, MA
| | - Samantha Calabrese
- Division of Gastroenterology, Massachusetts General Hospital, Boston, MA
- Center for Neurointestinal Health, Massachusetts General Hospital, Boston, MA
| | - Braden Kuo
- Division of Gastroenterology, Massachusetts General Hospital, Boston, MA
- Center for Neurointestinal Health, Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Kyle Staller
- Division of Gastroenterology, Massachusetts General Hospital, Boston, MA
- Center for Neurointestinal Health, Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Helen Burton Murray
- Center for Neurointestinal Health, Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
- Eating Disorders Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, MA
| |
Collapse
|