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Quinn LA, Gilley SP, Ta AD, Frank BS, Foley CB, Moore JM. Case report: Pulmonary hypertensive crisis leading to cardiac arrest during endoscopic evaluation in a 6-year-old boy with autism, severe malnutrition, and undiagnosed scurvy. Front Pediatr 2022; 10:1008507. [PMID: 36389378 PMCID: PMC9650637 DOI: 10.3389/fped.2022.1008507] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 09/28/2022] [Indexed: 11/13/2022] Open
Abstract
Pediatric gastroenterologists are often responsible for the evaluation of malnutrition in the setting of selective eating. Endoscopic evaluation for conditions including eosinophilic esophagitis and celiac disease can help to identify and treat mucosal disease contributing to food selectivity. However, undiagnosed micronutrient deficiencies can cause cardiovascular derangements that significantly increase a patient's anesthetic risk. Vitamin C deficiency in particular, alone or in combination with severe malnutrition, is associated with a severe but reversible form of pulmonary arterial hypertension that, while life threatening in the acute phase, may significantly improve within days of starting ascorbic acid replacement therapy. Here we present a case of a 6-year-old boy with autism spectrum disorder (ASD), severe malnutrition, and undiagnosed chronic vitamin C deficiency who developed a pulmonary hypertensive crisis after induction of general anesthesia leading to cardiac arrest during endoscopic evaluation. While the association between food selectivity among youth with neurodevelopmental differences and vitamin C deficiency is well-described, and pulmonary hypertension is a recognized rare complication of scurvy, extant literature has not addressed next steps to improve patient outcomes. Using this case report as a foundation, we discuss specific patient populations to screen and treat for micronutrient deficiencies prior to anesthesia and propose a novel clinical algorithm for pre-anesthesia risk stratification and mitigation in patients specifically at risk for scurvy and associated pulmonary hypertension.
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Affiliation(s)
- Laura A. Quinn
- Department of Pediatrics, Section of Pediatric Gastroenterology, Hepatology and Nutrition, University of Colorado School of Medicine, Aurora, CO, United States
| | - Stephanie P. Gilley
- Department of Pediatrics, Section of Nutrition, University of Colorado School of Medicine, Aurora, CO, United States
| | - Allison D. Ta
- Department of Pediatrics, Section of Nutrition, University of Colorado School of Medicine, Aurora, CO, United States
| | - Benjamin S. Frank
- Department of Pediatrics, Section of Cardiology, University of Colorado School of Medicine, Aurora, CO, United States
| | - Carolyn B. Foley
- Department of Anesthesiology, Division of Pediatric Anesthesiology, University of Colorado School of Medicine, Aurora, CO, United States
| | - Jaime M. Moore
- Department of Pediatrics, Section of Nutrition, University of Colorado School of Medicine, Aurora, CO, United States
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Yoon H, Park HS, An X, Park SJ, Go GW, Kim H, Lee H, Kim MN, Park YK. Study on the Improvement of Health and Nutrition Status After a 12-week Protein-Rich Supplementation Regimen in Children and Adolescents With Brain Lesions Disorder. Clin Nutr Res 2022; 11:20-31. [PMID: 35223678 PMCID: PMC8844533 DOI: 10.7762/cnr.2022.11.1.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 01/21/2022] [Accepted: 01/23/2022] [Indexed: 11/19/2022] Open
Abstract
Through a survey on dietary intake of children and adolescents with brain lesions, the present study aimed to analyze the current status of nutrient intake and examine the effect of high-protein nutrient drink on their nutritional and muscle statuses. The study participants were 90 juvenile participants aged 8–19 years, with brain lesions. The participants were provided with a protein nutrient drink for 12 weeks and a questionnaire survey on dietary intake was performed to analyze the level of nutrient intake before and after ingestion. The physical measurements were taken to determine the improvements in nutrient and muscle statuses. The results showed that, before the intake of protein nutrient drink as a supplement, the participants exhibited lower height, weight, and body mass index than those of the standard levels of healthy individuals, and the level of nutrient intake through diet was lower than those of the required and recommended levels of nutrient intake for Koreans. Conversely, after the intake of protein nutrient drink for 12 weeks, the level of nutrient intake and physical statuses such as weight showed significant improvements. In addition, the muscle status had undergone approximately 10% of change during the intervention with no significant difference. Thus, to ensure an adequate level of nutrient supply to children and adolescents with brain lesions, there is an urgent need to develop a guideline of nutrient intake. The findings in this study are expected to serve as the basic data for such guidelines.
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Affiliation(s)
- Hyeji Yoon
- R&D Unit, Maeil Health Nutrition Co., Ltd, Pyeongtaek 17714, Korea
| | - Hyoung su Park
- R&D Unit, Maeil Health Nutrition Co., Ltd, Pyeongtaek 17714, Korea
| | - Xiangxue An
- R&D Unit, Maeil Health Nutrition Co., Ltd, Pyeongtaek 17714, Korea
| | - Seok Jun Park
- R&D Unit, Maeil Health Nutrition Co., Ltd, Pyeongtaek 17714, Korea
| | - Gwang Woong Go
- Department of Food and Nutrition, Hanyang University, Seoul 04763, Korea
| | | | - Hyesoon Lee
- Department of Child Care, Yuhan University, Bucheon 14780, Korea
| | - Mee Na Kim
- Korea Institute of Child Education, Bucheon 14479, Korea
| | - Yoo Kyoung Park
- Department of Medical Nutrition, Graduate School of East-West Medical Science, Kyung Hee University, Yongin 17104, Korea
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Carman KB, Aydın K, Kilic Aydin B, Cansu A, Direk MC, Durmus S, Dündar NO, Gencpinar P, Gungor S, Gurkas E, Hur O, Karadag M, Karademir CN, Ozkan Kart P, Okuyaz C, Oz NA, Peduk Y, Per H, Serin MH, Tekgul H, Unay B, Yarar C, Yildirim GK. Evaluation of micronutrient levels in children with cerebral palsy. Pediatr Int 2022; 64:e15005. [PMID: 34585809 DOI: 10.1111/ped.15005] [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: 03/25/2021] [Revised: 07/08/2021] [Accepted: 08/17/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Many studies evaluating the nutritional status of children with cerebral palsy (CP) have focused on energy requirements and protein intake. The present work aimed to assess nutritional status and micronutrient levels of children with (CP). METHODS This multicenter, cross-sectional and observational study was conducted in 10 different cities in Turkey. Data were available for 398 participants. Anthropometric measurements, feeding mode, nutritional status, and micronutrient levels were evaluated. RESULTS The study was conducted with 398 participants (303 patients and 95 healthy controls). Statistical analysis showed that according to the Gomez Classification, weight-for-age (WFA) revealed malnutrition in 92.6% of children with CP, based on Centers for Disease Control and Prevention percentiles. Measurements of micronutrient levels showed that zinc levels were low in patients, whereas vitamin A levels were low in controls. Phosphorous and manganese levels were significantly lower in malnourished children than in typical children. The results revealed that children consuming enteral nutrition solutions had higher selenium and lower zinc levels than non-consumers. CONCLUSIONS Malnutrition is not only a protein- or calorie-based problem; micronutrient deficiencies might cause severe health problems. Children with chronic neurological disabilities must be carefully evaluated for these issues. Therefore, nutritional interventions should be adapted to nutrition.
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Affiliation(s)
- Kursat Bora Carman
- Departments of Pediatric Neurology, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Kursad Aydın
- Department of Pediatric Neurology, Medipol University, Istanbul, Turkey
| | - Betul Kilic Aydin
- Department of Pediatric Neurology, Medipol University, Istanbul, Turkey
| | - Ali Cansu
- Department of Pediatric Neurology, Karadeniz Technical University, Trabzon, Turkey
| | | | - Selver Durmus
- Department of Pediatric Neurology, Erciyes University, Kayseri, Turkey
| | - Nihal Olgaç Dündar
- Department of Pediatric Neurology, Katip Celebi University, Izmir, Turkey
| | - Pinar Gencpinar
- Department of Pediatric Neurology, Katip Celebi University, Izmir, Turkey
| | - Serdal Gungor
- Department of Pediatric Neurology, Inonu University, Malatya, Turkey
| | - Esra Gurkas
- Departments of Pediatric Neurology, Saglik Bilimleri University Gulhane Faculty of Medicine, Ankara, Turkey
| | - Ozgen Hur
- Pediatric Neurology, Saglik Bilimleri University Gulhane Faculty of Medicine, Ankara, Turkey
| | - Meral Karadag
- Department of Pediatric Neurology, Inonu University, Malatya, Turkey
| | - Cefa Nil Karademir
- Departments of Pediatric Neurology, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Pinar Ozkan Kart
- Departments of Pediatric Neurology, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Cetin Okuyaz
- Department of Pediatric Neurology, Mersin University, Mersin, Turkey
| | - Nefise Arıbas Oz
- Departments of Pediatric Neurology, Saglik Bilimleri University Gulhane Faculty of Medicine, Ankara, Turkey
| | - Yakup Peduk
- Department of Pediatric Neurology, Erciyes University, Kayseri, Turkey
| | - Huseyin Per
- Department of Pediatric Neurology, Erciyes University, Kayseri, Turkey
| | | | - Hasan Tekgul
- Department of Pediatric Neurology, Ege University, Izmir, Turkey
| | - Bulent Unay
- Pediatric Neurology, Saglik Bilimleri University Gulhane Faculty of Medicine, Ankara, Turkey
| | - Coskun Yarar
- Departments of Pediatric Neurology, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Gonca Kilic Yildirim
- Pediatric Metabolic Diseases and Nutrition, Eskisehir Osmangazi University, Eskisehir, Turkey
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Irvine I, Walshe T, Capra M, Hayes R. Scurvy: an unusual complication of paediatric cancer treatment. Skeletal Radiol 2019; 48:995-998. [PMID: 30374635 DOI: 10.1007/s00256-018-3103-5] [Citation(s) in RCA: 5] [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: 08/25/2018] [Revised: 10/13/2018] [Accepted: 10/16/2018] [Indexed: 02/02/2023]
Abstract
Scurvy is a disease that is rarely encountered in modern medicine. A condition that was classically associated with sailors, its incidence has decreased dramatically since the discovery of its association with vitamin C deficiency. We present the case of a 2-year-old boy, whose treatment for neuroblastoma was complicated by gastrointestinal disease, which necessitated enteral feeding. While still undergoing treatment, he started to complain about increasing pain in his lower limbs, which appeared to be markedly tender on palpation. Radiographic findings suggested a diagnosis of scurvy, which was subsequently confirmed on serum biochemistry. This was an unexpected finding, as the child had been receiving adequate vitamin C in his enteral feeds. However, his absorption had become severely impaired due to pseudomembranous gastritis and enteritis, leading to his deficient state. He significantly improved after intravenous ascorbic acid replacement and demonstrated a full recovery, both clinically and radiologically. This case highlights the importance of considering scurvy in the differential diagnosis for at-risk patients. Early recognition can facilitate the simple treatment of this potentially serious condition.
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Affiliation(s)
- Iain Irvine
- Department of Radiology, Our Lady's Children's Hospital, Crumlin, Dublin 12, Ireland.
| | - Triona Walshe
- Department of Radiology, Our Lady's Children's Hospital, Crumlin, Dublin 12, Ireland
| | - Michael Capra
- Department of Oncology, Our Lady's Children's Hospital, Crumlin, Dublin 12, Ireland
| | - Roisin Hayes
- Department of Radiology, Our Lady's Children's Hospital, Crumlin, Dublin 12, Ireland
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Abstract
Adults and children with eosinophilic esophagitis (EoE) have distinct clinical and endoscopic presentations. Recognition of clinical signs, along with laboratory and endoscopic findings, is critical for the identification of patients with EoE because delay in diagnosis has been associated with esophageal remodeling and stricture formation. Clinical presentation varies considerably between adults and children. This is less due to differences in the disease and more due to patient differences. This article describes the similarities and differences in clinical presentation of children and adults with EoE, including areas of epidemiology, clinical and endoscopic presentation, pathophysiology, and treatment.
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Abstract
OPINION STATEMENT Spinal muscular atrophy is caused by mutations in the survival motor neuron 1 (SMN1) gene, leading to the reduction of SMN protein. The loss of alpha motor neurons in the ventral horn of the spinal cord results in progressive paralysis and premature death. There is no current treatment other than symptomatic and supportive care, although over the past decade, there has been an outstanding advancement in understanding the genetics and molecular mechanisms underlying the physiopathology of SMA. The most promising approach, from current trials, is the use of antisense oligonucleotide (ASOs) to redirect SMN2 translation and increase exon 7 inclusion in the majority of the RNA transcript, to increase the production of fully functional SMN protein. Recently, ISIS Pharmaceuticals Inc. (2855 Gazelle Court, Carlsbad CA 92010) reported an interim analysis from a multiple dose study in children with SMA between 2 and 14 years of age, using ASO therapy. The results indicated good tolerability at all dose levels, increases in muscle function in children treated with multiple doses of ISIS-SMNRx, and increase in SMN protein levels in cerebrospinal fluid (CSF) from both single and multiple dose studies. Studies in infants are ongoing in a few centers; soon other institutions may begin enrollment. Infants are fragile and their disease process may differ from the older SMA population. It is not known whether effective drug would best be given to SMA infants or older children. Other promising therapies are still in preclinical phases or early clinical phases. Gene therapy appears to be efficient in improving survival in a severe mouse model of SMA, though a better definition of the route of administration and of the safety profile of the viral vectors is needed before clinical administration is possible.
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Affiliation(s)
- Diana Castro
- Departments of Pediatrics and Neurology and Neurotherapeutics, Division of Pediatric Neurology, University of Texas Southwestern Medical Center and Children's Medical Center Dallas, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
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Lee LW, Yan AC. Skin manifestations of nutritional deficiency disease in children: modern day contexts. Int J Dermatol 2012; 51:1407-18. [DOI: 10.1111/j.1365-4632.2012.05646.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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8
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Abstract
Pediatric nutritional deficiencies are associated not only with poverty and developing countries, but also in children in the developed world who adhere to restricted diets. At times, these diets are medically necessary, such as the gluten-free diet for management of celiac disease or exclusion diets in children with food allergies. At other times, the diets are self-selected by children with behavioral disorders, or parent-selected because of nutrition misinformation, cultural preferences, alternative nutrition therapies, or misconceptions regarding food tolerance. Health care providers must be vigilant in monitoring both growth and feeding patterns to identify inappropriate dietary changes that may result in nutritional deficiencies.
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Affiliation(s)
- Midge Kirby
- Clinical Nutrition, Children's Hospital of Wisconsin, 9000 W. Wisconsin Avenue, Milwaukee, WI 53201, USA.
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Mascarenhas MR, Meyers R, Konek S. Outpatient Nutrition Management of the Neurologically Impaired Child. Nutr Clin Pract 2008; 23:597-607. [DOI: 10.1177/0884533608326228] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Maria R. Mascarenhas
- From Children's Hospital of Philadelphia, Clinical Nutrition, Philadelphia, Pennsylvania
| | - Robin Meyers
- From Children's Hospital of Philadelphia, Clinical Nutrition, Philadelphia, Pennsylvania
| | - Susan Konek
- From Children's Hospital of Philadelphia, Clinical Nutrition, Philadelphia, Pennsylvania
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10
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Dalmau Serra J, Martorell Aragonés A. [Cow milk protein allergies: primary prevention. Nutritional aspects]. An Pediatr (Barc) 2008; 68:295-300. [PMID: 18358144 DOI: 10.1157/13116713] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
In 2001 the Nutrition Committee of the Spanish Association of Pediatrics, published a position paper on "Recommendations on the use of formulae for the treatment and prevention of adverse reactions to cow milk proteins" (An Esp Pediatr. 2001;54:372-9). Since most of the recommendations given in this report still remain effective, the Nutrition Committee of the Spanish Association of Pediatrics reaffirms its support of the data expressed in it. In the present publication we only approach the aspects that have changed due to new knowledge and the accumulated clinical experience, especially on the primary prevention of allergy to cow milk proteins, and on the basis of it, the present recommendations for this prevention are set out. In addition, the importance of the nutritional aspects in all infants and small children receiving special nutritional formulae and exclusion diets are reviewed.
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Affiliation(s)
- J Dalmau Serra
- Unidad de Nutrición y Metabolopatías, Hospital Infantil La Fe, Valencia, Spain
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Aceves SS, Furuta GT, Spechler SJ. Integrated approach to treatment of children and adults with eosinophilic esophagitis. Gastrointest Endosc Clin N Am 2008; 18:195-217; xi. [PMID: 18061112 DOI: 10.1016/j.giec.2007.09.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Over the last decade, treatment plans for eosinophilic esophagitis included the use of elemental formula, elimination diets, systemic corticosteroids, and the gavage of aerosolized steroids. Except for one placebo-controlled blinded prospective study, most decision making has been based on retrospective or uncontrolled studies and clinical experience. In this article, three authors from diverse backgrounds combine their resources to propose treatment paths with justification based on their clinical experience and interpretation of the literature.
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Affiliation(s)
- Seema S Aceves
- Division of Allergy, Immunology, Rady Children's Hospital, San Diego, Pediatrics University of California, 3020 Childrens Way, San Diego, CA 92123, USA
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Abstract
AIM To investigate micronutrient status in a group of children with cerebral palsy (CP). METHODS Thirty-six children with CP, aged 1.5-17 years, completed a 4-day food diary, underwent anthropometric measurements and delivered blood for analysis of micronutrient concentrations. RESULTS Low intake of iron, folate, niacin, calcium, vitamin E and vitamin D was common, even among those who were receiving nutritional supplements. Laboratory tests revealed low serum concentration of folate in eight children, alpha-tocopherol in six children, ferritin in five children and pyridoxal-5-phosphate in three children. Two participants were low in zinc and one was low in selenium. Severely disabled children received nutrition supplements more frequently than those with less severe disability (71% vs.16%, p = 0.01). Tube feeding and use of nutrition supplements was reflected in higher concentrations of micronutrients in blood and serum. CONCLUSION Low intake of micronutrients as well as low micronutrient concentrations was common in this heterogenic group of children with CP. Children with neurological disabilities should have their nutritional status evaluated in order to ascertain sufficient intake of micronutrients.
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Wang CH, Finkel RS, Bertini ES, Schroth M, Simonds A, Wong B, Aloysius A, Morrison L, Main M, Crawford TO, Trela A. Consensus statement for standard of care in spinal muscular atrophy. J Child Neurol 2007; 22:1027-49. [PMID: 17761659 DOI: 10.1177/0883073807305788] [Citation(s) in RCA: 535] [Impact Index Per Article: 31.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Spinal muscular atrophy is a neurodegenerative disease that requires multidisciplinary medical care. Recent progress in the understanding of molecular pathogenesis of spinal muscular atrophy and advances in medical technology have not been matched by similar developments in the care for spinal muscular atrophy patients. Variations in medical practice coupled with differences in family resources and values have resulted in variable clinical outcomes that are likely to compromise valid measure of treatment effects during clinical trials. The International Standard of Care Committee for Spinal Muscular Atrophy was formed in 2005, with a goal of establishing practice guidelines for clinical care of these patients. The 12 core committee members worked with more than 60 spinal muscular atrophy experts in the field through conference calls, e-mail communications, a Delphi survey, and 2 in-person meetings to achieve consensus on 5 care areas: diagnostic/new interventions, pulmonary, gastrointestinal/nutrition, orthopedics/rehabilitation, and palliative care. Consensus was achieved on several topics related to common medical problems in spinal muscular atrophy, diagnostic strategies, recommendations for assessment and monitoring, and therapeutic interventions in each care area. A consensus statement was drafted to address the 5 care areas according to 3 functional levels of the patients: nonsitter, sitter, and walker. The committee also identified several medical practices lacking consensus and warranting further investigation. It is the authors' intention that this document be used as a guideline, not as a practice standard for their care. A practice standard for spinal muscular atrophy is urgently needed to help with the multidisciplinary care of these patients.
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Affiliation(s)
- Ching H Wang
- Department of Neurology and Neurological Sciences, Stanford University Medical Center, Stanford, California 94305-5235, USA.
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Marchand V, Motil KJ. Nutrition support for neurologically impaired children: a clinical report of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition. J Pediatr Gastroenterol Nutr 2006; 43:123-35. [PMID: 16819391 DOI: 10.1097/01.mpg.0000228124.93841.ea] [Citation(s) in RCA: 95] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
Undernutrition, growth failure, overweight, micronutrient deficiencies, and osteopenia are nutritional comorbidities that affect the neurologically impaired child. Monitoring neurologically impaired children for nutritional comorbidities is an integral part of their care. Early involvement by a multidisciplinary team of physicians, nurses, dieticians, occupational and speech therapists, psychologists, and social workers is essential to prevent the adverse outcomes associated with feeding difficulties and poor nutritional status. Careful evaluation and monitoring of severely disabled children for nutritional problems are warranted because of the increased risk of nutrition-related morbidity and mortality.
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Affiliation(s)
- Valerie Marchand
- Department of Pediatrics, University of Montreal, Montreal, Canada
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Marrimpoey P, Beitia-Pochulu C, Fallourd M, Silvie M, Poisson-Salomon AS. Évaluation du statut nutritionnel de personnes polyhandicapées adultes vivant en institution. NUTR CLIN METAB 2006. [DOI: 10.1016/j.nupar.2005.12.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Abstract
The charts of children with gastrostomy or jejunostomy tubes followed in the Tube Feeding Clinic at the Children's Hospital of Wisconsin from January 1999 to June 2002 were reviewed. Prevalence of selected nutrient deficiencies were determined and their association with growth and caloric intake was measured. One hundred fifty patients (60% male) met the inclusion criteria. The mean age of children was 7 years 6 months (SD +/- 5 years 4 months). As a proportion of total caloric intake, the mean percentage of calories from formula was 92% (+/- 15). No deficiencies of vitamins D or E were found. Ferritin concentration below lower limits of the age-appropriate range of normal (LLN) was found in 30 of 122 (25%) and hemoglobin was below LLN in 12 of 139 (9%). One patient each had vitamin A, calcium, phosphorus, and magnesium serum concentrations below LLN. Below normal serum zinc was found in 43 of 142 (30%). Ninety-one of 134 patients (68%) had below normal selenium levels, and 29 of 126 (23%) had both zinc and selenium deficiency. A significant association was found between percentage of recommended daily allowance (RDA) of calories received and selenium concentration below LLN. Patients with selenium deficiency received a mean of 75% (+/- 21) of the RDA of calories for age, whereas patients without deficiency received a mean of 91% (+/- 19) of the RDA of calories for age (p < 0.0001). There was a negative association between deficiency and weight for age: patients with selenium deficiency were 33% mean weight for age percentile (+/- 30), compared to 21% (+/- 27, p < 0.05) for those without selenium deficiency. There was a negative correlation between the percentage of RDA of calories and height for age, weight for age, and weight for height (p < 0.05).
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Affiliation(s)
- Joseph A Skelton
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI 53226, USA
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Piccoli R, Gelio S, Fratucello A, Valletta E. Risk of low micronutrient intake in neurologically disabled children artificially fed. J Pediatr Gastroenterol Nutr 2002; 35:583-4. [PMID: 12394390 DOI: 10.1097/00005176-200210000-00025] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
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Gorman SR, Armstrong G, Allen KR, Ellis J, Puntis JWL. Scarcity in the midst of plenty: enteral tube feeding complicated by scurvy. J Pediatr Gastroenterol Nutr 2002; 35:93-5. [PMID: 12142819 DOI: 10.1097/00005176-200207000-00021] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- S R Gorman
- Departments of Pediatric Gastroenterology, the General Infirmary at Leeds, Leeds, United Kingdom
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Abstract
In the past year, a number of studies were published that illustrated the importance of dietary choices at all ages and singled out pediatricians as useful and vociferous advocates for healthy nutrition in children. Obesity continues to top the list as a major threat to the health of children and adults worldwide and is increasingly being recognized as a direct result of inappropriate nutritional intake. Parental misperceptions and misinformation about their children's diets beginning in infancy and stretching into the college-age years may represent prime targets for pediatricians ready and able to provide guidance. There are more reasons than ever to encourage breastfeeding and more formal studies to help direct the various stages of transition to adult eating habits after infancy. On the other hand, parents must be encouraged to take a well-balanced and reasonable approach to their children's food choices, lest we see increasing evidence of unnecessary nutritional deficiencies.
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