The long-term effects of protein energy malnutrition in early childhood on bone age, bone cortical thickness and height

Three groups of Ugandan children, 18 in each group, and one comparison group of 18 children were examined at 11-17 years of age. The three groups had previously been admitted for treatment of protein energy malnutrition between the ages of 8 to 15, 16 to 21 and 22 to 27 months respectively. The comparison group had not been clinically malnourished throughout the period up to 27 months of age. The children came from one tribe and from similar socio-economic background, and were individually matched on age and sex. The bone age was estimated by hand wrist radiography scored for maturity by the Tanner & Whitehouse method. The metacarpal index, a ratio derived from the medullary width and full diameter of the mid-point of the second metacarpal, was used as a measure of bone cortical thickness. The three malnourished groups are significantly shorter in height than the comparison group, but are not different in bone age and metacarpal index. No differences are observed between the three groups of children who had been admitted for protein energy malnutrition at different ages. The findings are discussed as they relate to the existing literature.

Peripheral gangrene in hypernatraemic dehydration of infancy

Gangrene of the extremities complicating diarrhoea and severe hypernatraemic dehydration occurred in 6 infants. This is a rare complication of gastroenteritis, and its association with hypernatraemia does not seem to have previously been emphasized. The increased blood viscosity resulting from serum hyperosmolarity may have been responsible for the gangrene, and studies in our patients suggested that disseminated intravascular coagulation was present. In addition to fluid and electrolyte replacement, the infants were treated with heparin with some recovery of the affected extremities.

Nutritional status as an important factor in the health status of the adult

Malnutrition in the first year of life may cause permanent damage to the individual. There may be a permanent retardation in growth if the malnutrition is a serious one and the food intake is severely insufficient over a longer, period. Specially when malnutrition occurs in the first months after birth, it may cause damage to the central nervous system.As long as the breast-fed child gets enough breastmilk, it is unlikely that serious problems  arise. The declinein feeding in many developing countries is a serious problem, especially because the alternatives for human milk are not always available, owing to economic factors. In the, countries of the Western world there exists just, the opposite problem owing to partial over-nutrition abnormalities in fat metabolism may occur, which may influence the health of the individual later on in life.

Gastrointestinal disease in malnourished children

In communities where malnutrition is common, gastrointestinal diseases are prominent and contribute largely to unfavourable morbidity and mortality statistics. Patterns of gastrointestinal disease were studied in two such cotnmunities; Aboriginal children in Western Australia and children admitted to the Dr. Cipto Mangunkusumo General Hospital, Jakarta.Two hundred and fifty one (251) young Aborigines were studied. Forty percent of them malnourished, 37% were anaemic and more than 50% had enteric pathogens in their stools. Sugar intolerance was also common (25%). Similar clinical features are seen in the children from Jakarta but more severe forms of malnutrition and gross vitamin deficiency occurred more often.Thirteen of the Aboriginal children died; at necropsy the most remarkable finding wass fatty infiltration of the liver which some cases was extreme. This, of course, is characteristic of protein-calorie malnutrition add has been well documented in other studies. Other pathological findings included severe purulent infections, septic infarcts, haemolysis, acanthocytosis, thrombocytopenia and vascular catastrophes.

Candida endocarditis and encephalitis in an infant

A one-month-old infant with chronic diarrhea, staphylococcus septicemia, otitis, mastoiditis, and malnutrition was treated by intravenous alimentation and multiple antibiotics. He developed an abscess at the site of an intrajugular indwelling plastic catheter, from which Candida was grown. He died suddenly with signs of endocarditis with embolization. Autopsy revealed disseminated candidiasis, endocarditis with large candidal vegetations on all valves, with multiple granulomata and microabscesses in the brain. The possible role of indwelling plastic catheters, mastoiditis, malnutrition, and antibiotics in the pathogenesis of disseminated candidiasis in infants is discussed. Candida endocarditis is very rare in children, and this case is the fourth to be reported in the literature.