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Shaw V, Anderson C, Desloovere A, Greenbaum LA, Haffner D, Nelms CL, Paglialonga F, Polderman N, Qizalbash L, Renken-Terhaerdt J, Stabouli S, Tuokkola J, Vande Walle J, Warady BA, Shroff R. Nutritional management of the infant with chronic kidney disease stages 2-5 and on dialysis. Pediatr Nephrol 2023; 38:87-103. [PMID: 35378603 PMCID: PMC9747855 DOI: 10.1007/s00467-022-05529-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 03/05/2022] [Accepted: 03/07/2022] [Indexed: 01/10/2023]
Abstract
The nutritional management of children with chronic kidney disease (CKD) is of prime importance in meeting the challenge of maintaining normal growth and development in this population. The objective of this review is to integrate the Pediatric Renal Nutrition Taskforce clinical practice recommendations for children with CKD stages 2-5 and on dialysis, as they relate to the infant from full term birth up to 1 year of age, for healthcare professionals, including dietitians, physicians, and nurses. It addresses nutritional assessment, energy and protein requirements, delivery of the nutritional prescription, and necessary dietary modifications in the case of abnormal serum levels of calcium, phosphate, and potassium. We focus on the particular nutritional needs of infants with CKD for whom dietary recommendations for energy and protein, based on body weight, are higher compared with children over 1 year of age in order to support both linear and brain growth, which are normally maximal in the first 6 months of life. Attention to nutrition during infancy is important given that growth is predominantly nutrition dependent in the infantile phase and the growth of infants is acutely impaired by disruption to their nutritional intake, particularly during the first 6 months. Inadequate nutritional intake can result in the failure to achieve full adult height potential and an increased risk for abnormal neurodevelopment. We strongly suggest that physicians work closely with pediatric renal dietitians to ensure that the infant with CKD receives the best possible nutritional management to optimize their growth and development.
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Affiliation(s)
- Vanessa Shaw
- University College London Great Ormond Street Hospital Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK.
| | - Caroline Anderson
- grid.430506.40000 0004 0465 4079University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - An Desloovere
- grid.410566.00000 0004 0626 3303University Hospital Ghent, Ghent, Belgium
| | | | - Dieter Haffner
- grid.10423.340000 0000 9529 9877Children’s Hospital, Hannover Medical School, Hannover, Germany
| | | | - Fabio Paglialonga
- grid.414818.00000 0004 1757 8749Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Nonnie Polderman
- grid.414137.40000 0001 0684 7788British Columbia Children’s Hospital, Vancouver, Canada
| | - Leila Qizalbash
- grid.459561.a0000 0004 4904 7256Great North Children’s Hospital, Newcastle upon Tyne, UK
| | - José Renken-Terhaerdt
- grid.417100.30000 0004 0620 3132Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Stella Stabouli
- grid.4793.900000001094570051st Department of Pediatrics, Aristotle University Thessaloniki, Thessaloniki, Greece
| | - Jetta Tuokkola
- grid.7737.40000 0004 0410 2071Children’s Hospital and Clinical Nutrition Unit, Internal Medicine and Rehabilitation, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Johan Vande Walle
- grid.410566.00000 0004 0626 3303University Hospital Ghent, Ghent, Belgium
| | - Bradley A. Warady
- grid.239559.10000 0004 0415 5050Children’s Mercy Kansas City, Kansas City, MO USA
| | - Rukshana Shroff
- grid.83440.3b0000000121901201University College London Great Ormond Street Hospital Institute of Child Health, 30 Guilford Street, London, WC1N 1EH UK
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2
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Rees L, Shaw V, Qizalbash L, Anderson C, Desloovere A, Greenbaum L, Haffner D, Nelms C, Oosterveld M, Paglialonga F, Polderman N, Renken-Terhaerdt J, Tuokkola J, Warady B, Walle JVD, Shroff R. Delivery of a nutritional prescription by enteral tube feeding in children with chronic kidney disease stages 2-5 and on dialysis-clinical practice recommendations from the Pediatric Renal Nutrition Taskforce. Pediatr Nephrol 2021; 36:187-204. [PMID: 32728841 PMCID: PMC7701061 DOI: 10.1007/s00467-020-04623-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 05/14/2020] [Accepted: 05/19/2020] [Indexed: 12/14/2022]
Abstract
The nutritional prescription (whether in the form of food or liquid formulas) may be taken orally when a child has the capacity for spontaneous intake by mouth, but may need to be administered partially or completely by nasogastric tube or gastrostomy device ("enteral tube feeding"). The relative use of each of these methods varies both within and between countries. The Pediatric Renal Nutrition Taskforce (PRNT), an international team of pediatric renal dietitians and pediatric nephrologists, has developed clinical practice recommendations (CPRs) based on evidence where available, or on the expert opinion of the Taskforce members, using a Delphi process to seek consensus from the wider community of experts in the field. We present CPRs for delivery of the nutritional prescription via enteral tube feeding to children with chronic kidney disease stages 2-5 and on dialysis. We address the types of enteral feeding tubes, when they should be used, placement techniques, recommendations and contraindications for their use, and evidence for their effects on growth parameters. Statements with a low grade of evidence, or based on opinion, must be considered and adapted for the individual patient by the treating physician and dietitian according to their clinical judgement. Research recommendations have been suggested. The CPRs will be regularly audited and updated by the PRNT.
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Affiliation(s)
- Lesley Rees
- The Biomedical Research Centre at Great Ormond Street Hospital for Children NHS Foundation Trust and Institute of Child Health, University College Londonfig, WC1N 3JH, London, UK.
| | - Vanessa Shaw
- grid.83440.3b0000000121901201The Biomedical Research Centre at Great Ormond Street Hospital for Children NHS Foundation Trust and Institute of Child Health, University College Londonfig, WC1N 3JH, London, UK ,grid.11201.330000 0001 2219 0747University of Plymouth, Plymouth, UK
| | - Leila Qizalbash
- Great Northern Children’s Hospital, Upon Tyne, Newcastle, UK
| | - Caroline Anderson
- grid.430506.4Southampton Children’s Hospital, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - An Desloovere
- grid.410566.00000 0004 0626 3303University Hospital Ghent, Ghent, Belgium
| | - Laurence Greenbaum
- grid.428158.20000 0004 0371 6071Emory University and Children’s Healthcare of Atlanta, Atlanta, USA
| | - Dieter Haffner
- grid.10423.340000 0000 9529 9877Children’s Hospital, Hannover Medical School, Hannover, Germany
| | - Christina Nelms
- grid.24434.350000 0004 1937 0060PedsFeeds LLC, University of Nebraska, Lincoln, USA
| | - Michiel Oosterveld
- grid.414503.70000 0004 0529 2508Emma Children’s Hospital, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Fabio Paglialonga
- grid.414818.00000 0004 1757 8749Fondazione IRCCS Ca’Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Nonnie Polderman
- grid.414137.40000 0001 0684 7788British Columbia Children’s Hospital, Vancouver, Canada
| | - José Renken-Terhaerdt
- grid.7692.a0000000090126352Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jetta Tuokkola
- grid.7737.40000 0004 0410 2071Children’s Hospital and Clinical Nutrition Unit, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Bradley Warady
- grid.239559.10000 0004 0415 5050Children’s Mercy, Kansas City, USA
| | - Johan Van de Walle
- grid.410566.00000 0004 0626 3303University Hospital Ghent, Ghent, Belgium
| | - Rukshana Shroff
- grid.83440.3b0000000121901201The Biomedical Research Centre at Great Ormond Street Hospital for Children NHS Foundation Trust and Institute of Child Health, University College Londonfig, WC1N 3JH, London, UK
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Shaw V, Polderman N, Renken-Terhaerdt J, Paglialonga F, Oosterveld M, Tuokkola J, Anderson C, Desloovere A, Greenbaum L, Haffner D, Nelms C, Qizalbash L, Vande Walle J, Warady B, Shroff R, Rees L. Energy and protein requirements for children with CKD stages 2-5 and on dialysis-clinical practice recommendations from the Pediatric Renal Nutrition Taskforce. Pediatr Nephrol 2020; 35:519-531. [PMID: 31845057 PMCID: PMC6968982 DOI: 10.1007/s00467-019-04426-0] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 11/08/2019] [Accepted: 11/19/2019] [Indexed: 02/08/2023]
Abstract
Dietary management in pediatric chronic kidney disease (CKD) is an area fraught with uncertainties and wide variations in practice. Even in tertiary pediatric nephrology centers, expert dietetic input is often lacking. The Pediatric Renal Nutrition Taskforce (PRNT), an international team of pediatric renal dietitians and pediatric nephrologists, was established to develop clinical practice recommendations (CPRs) to address these challenges and to serve as a resource for nutritional care. We present CPRs for energy and protein requirements for children with CKD stages 2-5 and those on dialysis (CKD2-5D). We address energy requirements in the context of poor growth, obesity, and different levels of physical activity, together with the additional protein needs to compensate for dialysate losses. We describe how to achieve the dietary prescription for energy and protein using breastmilk, formulas, food, and dietary supplements, which can be incorporated into everyday practice. Statements with a low grade of evidence, or based on opinion, must be considered and adapted for the individual patient by the treating physician and dietitian according to their clinical judgment. Research recommendations have been suggested. The CPRs will be regularly audited and updated by the PRNT.
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Affiliation(s)
- Vanessa Shaw
- University of Plymouth, Plymouth, PL6 8BH, UK.
- University College London Institute of Child Health, London, UK.
| | | | - José Renken-Terhaerdt
- Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Fabio Paglialonga
- Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Michiel Oosterveld
- Emma Children's Hospital, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Jetta Tuokkola
- Children's Hospital and Clinical Nutrition Unit, Internal Medicine and Rehabilitation, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Caroline Anderson
- Southampton Children's Hospital, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | | | | | - Dieter Haffner
- Children's Hospital, Hannover Medical School, Hannover, Germany
| | | | | | | | | | - Rukshana Shroff
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- The Biomedical Research Centre at Great Ormond Street Hospital for Children NHS Foundation Trust and Institute of Child Health, University College London, London, UK
| | - Lesley Rees
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- The Biomedical Research Centre at Great Ormond Street Hospital for Children NHS Foundation Trust and Institute of Child Health, University College London, London, UK
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Catch-up growth in children with chronic kidney disease started on enteral feeding after 2 years of age. Pediatr Nephrol 2020; 35:113-118. [PMID: 31646404 PMCID: PMC6901400 DOI: 10.1007/s00467-019-04382-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 07/27/2019] [Accepted: 09/25/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Enteral feeding by tube in chronic kidney disease (CKD) before 2 years of age improves growth. Whether it is effective after this age is unknown. We assessed whether height and weight SDS changed after tube feeding was started in children with CKD above 2 years of age. METHODS Retrospective study of pre-transplant, pre-pubertal children (< 11 years) with CKD stages 2-5 started on nasogastric tube or gastrostomy feeds for the first time after age 2 years. Children were identified by searching dietetic records and the renal database. Children on growth hormone were excluded. Height, weight, and BMI were documented 1 year prior to and at the start of tube feeds, and after 1 and 2 years. Data collection ceased at transplantation. RESULTS Fifty children (25 male) were included. The median (range) age at start of tube feeds was 5.6 (2.1-10.9) years. Sixteen children were dialysed (1 haemodialysis, 15 peritoneal dialysis); 34 predialysis patients had a median (range) eGFR of 22 (6-88) ml/min/1.73 m2. Overall height SDS (Ht SDS) improved from - 2.39 to - 2.27 at 1 year and - 2.18 after 2 years (p = 0.02). BMI SDS improved from - 0.72 to 0.23 after 1 year and was 0.09 after 2 years of enteral feeding (p < 0.0001). Height SDS improved more in children aged 2-6 years (- 2.13 to - 1.68, p = 0.03) and in children not on dialysis (- 2.33 to - 1.99, p = 0.002). CONCLUSIONS Enteral tube feeding commenced after 2 years of age in prepubertal children with CKD improves height and weight SDS, with stability of BMI during the second year. Younger children and those not on dialysis had the greatest benefit.
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Stahl M, Wielpütz MO, Ricklefs I, Dopfer C, Barth S, Schlegtendal A, Graeber SY, Sommerburg O, Diekmann G, Hüsing J, Koerner-Rettberg C, Nährlich L, Dittrich AM, Kopp MV, Mall MA. Preventive Inhalation of Hypertonic Saline in Infants with Cystic Fibrosis (PRESIS). A Randomized, Double-Blind, Controlled Study. Am J Respir Crit Care Med 2019; 199:1238-1248. [DOI: 10.1164/rccm.201807-1203oc] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Affiliation(s)
- Mirjam Stahl
- Department of Translational Pulmonology
- Division of Pediatric Pulmonology and Allergy and Cystic Fibrosis Center, Department of Pediatrics, and
- Translational Lung Research Center Heidelberg, German Center for Lung Research, Heidelberg, Germany
| | - Mark O. Wielpütz
- Department of Diagnostic and Interventional Radiology, University of Heidelberg, Heidelberg, Germany
- Translational Lung Research Center Heidelberg, German Center for Lung Research, Heidelberg, Germany
- Department of Radiology, German Cancer Research Center, Heidelberg, Germany
| | - Isabell Ricklefs
- Division of Pediatric Allergology and Pneumology, Department of Pediatrics, Medical University of Lübeck, Lübeck, Germany
- Airway Research Center North, German Center for Lung Research, Lübeck, Germany
| | - Christian Dopfer
- Department of Pediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany
- Biomedical Research in Endstage and Obstructive Lung Disease, German Center for Lung Research, Hannover, Germany
| | - Sandra Barth
- Department of Pediatrics, Justus-Liebig-University Giessen, Giessen, Germany
- Universities Giessen and Marburg Lung Center, German Center for Lung Research, Giessen, Germany
| | - Anne Schlegtendal
- Department of Pediatric Pulmonology, University Children’s Hospital of Ruhr University Bochum at St. Josef-Hospital, Bochum, Germany
| | - Simon Y. Graeber
- Department of Translational Pulmonology
- Division of Pediatric Pulmonology and Allergy and Cystic Fibrosis Center, Department of Pediatrics, and
- Translational Lung Research Center Heidelberg, German Center for Lung Research, Heidelberg, Germany
- Department of Pediatric Pulmonology, Immunology and Intensive Care Medicine, Charité–Universitätsmedizin Berlin, Berlin, Germany
- Berlin Institute of Health, Berlin, Germany; and
| | - Olaf Sommerburg
- Division of Pediatric Pulmonology and Allergy and Cystic Fibrosis Center, Department of Pediatrics, and
- Translational Lung Research Center Heidelberg, German Center for Lung Research, Heidelberg, Germany
| | - Gesa Diekmann
- Division of Pediatric Allergology and Pneumology, Department of Pediatrics, Medical University of Lübeck, Lübeck, Germany
- Airway Research Center North, German Center for Lung Research, Lübeck, Germany
| | - Johannes Hüsing
- Coordination Center for Clinical Trials, Heidelberg University Hospital, Heidelberg, Germany
| | - Cordula Koerner-Rettberg
- Department of Pediatric Pulmonology, University Children’s Hospital of Ruhr University Bochum at St. Josef-Hospital, Bochum, Germany
| | - Lutz Nährlich
- Department of Pediatrics, Justus-Liebig-University Giessen, Giessen, Germany
- Universities Giessen and Marburg Lung Center, German Center for Lung Research, Giessen, Germany
| | - Anna-Maria Dittrich
- Department of Pediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany
- Biomedical Research in Endstage and Obstructive Lung Disease, German Center for Lung Research, Hannover, Germany
| | - Matthias V. Kopp
- Division of Pediatric Allergology and Pneumology, Department of Pediatrics, Medical University of Lübeck, Lübeck, Germany
- Airway Research Center North, German Center for Lung Research, Lübeck, Germany
| | - Marcus A. Mall
- Department of Translational Pulmonology
- Division of Pediatric Pulmonology and Allergy and Cystic Fibrosis Center, Department of Pediatrics, and
- Translational Lung Research Center Heidelberg, German Center for Lung Research, Heidelberg, Germany
- Department of Pediatric Pulmonology, Immunology and Intensive Care Medicine, Charité–Universitätsmedizin Berlin, Berlin, Germany
- Berlin Institute of Health, Berlin, Germany; and
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Silverstein DM. Growth and Nutrition in Pediatric Chronic Kidney Disease. Front Pediatr 2018; 6:205. [PMID: 30155452 PMCID: PMC6103270 DOI: 10.3389/fped.2018.00205] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 06/28/2018] [Indexed: 12/14/2022] Open
Abstract
Children with chronic kidney disease (CKD) feature significant challenges to the maintenance of adequate nutrition and linear growth. Moreover, the impaired nutritional state contributes directly to poor growth. Therefore, it is necessary to consider nutritional status in the assessment of etiology and treatment of sub-optimal linear growth. The major causes of poor linear growth including dysregulation of the growth hormone/insulin-like growth factor-I (IGF-I) axis, nutritional deficiency, metabolic acidosis, anemia, renal osteodystrophy/bone mineral disease, and inflammation. This review summarizes the causes and assessment tools of growth and nutrition while providing a summary of state of the art therapies for these co-morbidities of pediatric CKD.
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Affiliation(s)
- Douglas M Silverstein
- Division of Reproductive, Gastrorenal, and Urology Devices, Office of Device Evaluation, Center for Devices and Radiological Health, United States Food and Drug Administration, Silver Spring, MD, United States
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Ayestaran FW, Schneider MF, Kaskel FJ, Srivaths PR, Seo-Mayer PW, Moxey-Mims M, Furth SL, Warady BA, Greenbaum LA. Perceived appetite and clinical outcomes in children with chronic kidney disease. Pediatr Nephrol 2016; 31:1121-7. [PMID: 26857711 PMCID: PMC5627603 DOI: 10.1007/s00467-016-3321-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Revised: 01/11/2016] [Accepted: 01/11/2016] [Indexed: 12/22/2022]
Abstract
BACKGROUND Children with chronic kidney disease (CKD) may have impaired caloric intake through a variety of mechanisms, with decreased appetite as a putative contributor. In adult CKD, decreased appetite has been associated with poor clinical outcomes. There is limited information about this relationship in pediatric CKD. METHODS A total of 879 participants of the Chronic Kidney Disease in Children (CKiD) study were studied. Self-reported appetite was assessed annually and categorized as very good, good, fair, or poor/very poor. The relationship between appetite and iohexol or estimated glomerular filtration rate (ieGFR), annual changes in anthropometrics z-scores, hospitalizations, emergency room visits, and quality of life were assessed. RESULTS An ieGFR < 30 ml/min per 1.73 m(2) was associated with a 4.46 greater odds (95 % confidence interval: 2.80, 7.09) of having a worse appetite than those with ieGFR >90. Appetite did not predict changes in height, weight, or BMI z-scores. Patients not reporting a very good appetite had more hospitalizations over the next year than those with a very good appetite. Worse appetite was significantly associated with lower parental and patient reported quality of life. CONCLUSIONS Self-reported appetite in children with CKD worsens with lower ieGFR and is correlated with clinical outcomes, including hospitalizations and quality of life.
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Affiliation(s)
| | | | | | | | | | - Marva Moxey-Mims
- National Institute of Diabetes and Digestive Kidney Disease, National Institutes of Health, Bethesda, MD
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8
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Infectious outcomes following gastrostomy in children receiving peritoneal dialysis. Pediatr Nephrol 2015; 30:849-54. [PMID: 25472828 DOI: 10.1007/s00467-014-2951-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Revised: 07/22/2014] [Accepted: 08/26/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Early institution of enteral feeding in paediatric end-stage kidney disease (ESKD) is recommended. For patients on peritoneal dialysis (PD) there is concern that gastrostomy tube (GT) insertion may be complicated by increased peritonitis, in particular fungal. Our unit favours early planned GT insertion, and for those with late presentation, there is prompt consideration of GT insertion following dialysis initiation. This study evaluates our rates of peritonitis with GT insertion following or concurrent with PD initiation. METHODS This was a retrospective, single-centre, cross-sectional study of of 17 New Zealand children with ESKD who received PD in the period 2000-2011. Inclusion criteria were GT placement while on PD or initiation of PD within 72 h of GT insertion. RESULTS There were no cases of fungal peritonitis among the 17 children; however, two cases of early peritonitis with organisms derived from the gastrointestinal tract were identified. No statistically significant difference was found between incident rates of bacterial peritonitis before GT placement (0.6 episodes per patient-year; 95% confidence interval (CI) 0.26-1.18) and post-GT placement (1.21 episodes per patient-year; 95% CI 0.69-1.97). CONCLUSION Fungal peritonitis has never been encountered by out unit during its many years of experience in GT placement in patients without advanced malnutrition. When children on PD have insufficient dietary intake to maintain appropriate growth velocity, enteral feeding should be initiated promptly. A GT is considered to be safe for long-term use in selected patients.
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9
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Rees L, Jones H. Nutritional management and growth in children with chronic kidney disease. Pediatr Nephrol 2013; 28:527-36. [PMID: 22825360 DOI: 10.1007/s00467-012-2258-x] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2012] [Revised: 05/18/2012] [Accepted: 06/09/2012] [Indexed: 01/06/2023]
Abstract
Despite continuing improvements in our understanding of the causes of poor growth in chronic kidney disease, many unanswered questions remain: why do some patients maintain a good appetite whereas others have profound anorexia at a similar level of renal function? Why do some, but not all, patients respond to increased nutritional intake? Is feed delivery by gastrostomy superior to oral and nasogastric routes? Do children who are no longer in the 'infancy' stage of growth benefit from enteral feeding? Do patients with protein energy wasting benefit from increased nutritional input? How do we prevent obesity, which is becoming so prevalent in the developed world? This review will address these issues.
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Affiliation(s)
- Lesley Rees
- Department of Nephrology, Gt Ormond St Hospital for Children Foundation Trust, Gt Ormond St, London, WC1N 3JH, UK.
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10
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Rees L, Azocar M, Borzych D, Watson AR, Büscher A, Edefonti A, Bilge I, Askenazi D, Leozappa G, Gonzales C, van Hoeck K, Secker D, Zurowska A, Rönnholm K, Bouts AHM, Stewart H, Ariceta G, Ranchin B, Warady BA, Schaefer F. Growth in very young children undergoing chronic peritoneal dialysis. J Am Soc Nephrol 2011; 22:2303-12. [PMID: 22021715 DOI: 10.1681/asn.2010020192] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Very young children with chronic kidney disease often have difficulty maintaining adequate nutrition, which contributes to the high prevalence of short stature in this population. Characteristics of the dialysis prescription and supplemental feeding via a nasogastric (NG) tube or gastrostomy may improve growth, but this is not well understood. Here, we analyzed data from 153 children in 18 countries who commenced chronic peritoneal dialysis at <24 months of age. From diagnosis to last observation, 57 patients were fed on demand, 54 by NG tube, and 10 by gastrostomy; 26 switched from NG to gastrostomy; and 6 returned from NG to demand feeding. North American and European centers accounted for nearly all feeding by gastrostomy. Standardized body mass index (BMI) uniformly decreased during periods of demand feeding and increased during NG and gastrostomy feeding. Changes in BMI demonstrated significant regional variation: 26% of North American children were obese and 50% of Turkish children were malnourished at last observation (P < 0.005). Body length decreased sharply during the first 6 to 12 months of life and then tended to stabilize. Time fed by gastrostomy significantly associated with higher lengths over time (P < 0.001), but adjustment for baseline length attenuated this effect. In addition, the use of biocompatible peritoneal dialysate and administration of growth hormone independently associated with improved length, even after adjusting for regional factors. In summary, growth and nutritional status vary regionally in very young children treated with chronic peritoneal dialysis. The use of gastrostomy feeding, biocompatible dialysis fluid, and growth hormone therapy associate with improved linear growth.
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Affiliation(s)
- Lesley Rees
- Renal Office, Great Ormond Street Hospital for Children NHS Trust, London WC1N 3JH, United Kingdom.
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11
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Cephalometric craniofacial features of growing patients with chronic renal failure. Arch Oral Biol 2011; 57:257-63. [PMID: 22000306 DOI: 10.1016/j.archoralbio.2011.09.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2011] [Revised: 09/08/2011] [Accepted: 09/21/2011] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Chronic renal failure (CRF) in growing children can affect their physical growth status. The objective of this research was to study the craniofacial morphology of children with CRF as evaluated by cephalometric analysis. METHODS Twenty-three growing children with CRF were included in this study. They were divided into three groups according to age ranges. The age ranges were >5-11 (group 1); >11-14 (group 2); >14-16 (group 3). Another twenty-three matching controls (in age and gender) were also included. Lateral cephalometric radiographs were taken as part of these children's orthodontic records. Lateral cephalometric radiographs were corrected for magnification distortion, digitized, and cephalometric analysis was performed. Data were analysed using ANOVA test. RESULTS The results showed that CRF patients in all age groups have statistically significantly decreased posterior cranial base lengths. Posterior facial heights showed a significant decrease in CRF patients in groups 1 and 2. Younger CRF patients (group 1) showed statistically significant increased gonial angle and FH-Mandibular plane angle, SN-Mandibular plane angle and decreased posterior to anterior face height ratio, total anterior facial height (N-Me), Mandibular body length (Go-Me), upper anterior facial height (N-ANS), Y axis length, pterygomaxillary-A point length. CONCLUSION Younger children (groups 1 and 2) with CRF showed a decrease in posterior facial growth (posterior facial height and posterior cranial base) when compared to matching normal controls. This decrease is not significant in older group (group 3). This finding suggests that children with CRF might catch up in growth with normal subjects and most of the earlier retarded growth features disappear with age.
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Lima EM, Gesteira MDFC, Bandeira MDFS. Diretrizes do distúrbio do metabolismo mineral e ósseo na doença renal crônica da criança. J Bras Nefrol 2011; 33:232-247. [DOI: 10.1590/s0101-28002011000200021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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13
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Smell and taste function in children with chronic kidney disease. Pediatr Nephrol 2010; 25:1497-504. [PMID: 20446097 DOI: 10.1007/s00467-010-1529-7] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2009] [Revised: 03/23/2010] [Accepted: 03/23/2010] [Indexed: 10/19/2022]
Abstract
Loss of appetite and poor growth are common in children with chronic kidney disease (CKD), and changes in smell and/or taste function may be responsible, but the hypothesis has not been proven. This aims of this prospective age- and gender-controlled study were to determine whether: (1) changes in smell and taste function occur in children with CKD; (2) smell or taste dysfunction are associated with estimated glomerular filtration rate (eGFR); (3) there is an association between smell or taste loss and body mass index (BMI). The study cohort consisted of 72 children of whom 20 were CKD stage 3-5 patients, 12 were CKD stage 2 patients, 20 were clinical controls (CC) and 20 were healthy children (HC). The CKD patients and clinical controls were recruited from Sydney Children's Hospital and The Children's Hospital, Westmead, and healthy controls were recruited from a local school. Scores for each group from taste and smell chemosensory function tests were compared, and their relationship with renal function and BMI investigated. The CKD stage 3-5 group had a significantly lower taste identification score (85.6%, P < 0.001) than the CC (94.8%) and HC (94.8%) groups, with almost one third of the children in the CKD stage 3-5 group exhibiting taste loss. Decreased taste function was associated with decreased eGFR (r = 0.43, P < 0.01), but no association between BMI and taste function was found (r = 0.001, P > 0.9). Odour identification scores were not different; however, there was a positive relationship with BMI (r = 0.427, P = 0.006). We conclude that a loss of taste can occur in children with CKD and that when it occurs, it worsens as eGFR declines and is found early in kidney disease.
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Rees L, Brandt ML. Tube feeding in children with chronic kidney disease: technical and practical issues. Pediatr Nephrol 2010; 25:699-704. [PMID: 19949817 DOI: 10.1007/s00467-009-1309-4] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2009] [Revised: 08/06/2009] [Accepted: 08/06/2009] [Indexed: 11/25/2022]
Abstract
This review discusses the indications for enteral feeding in children with chronic kidney disease, the types of feeding tubes that can be used, methods of insertion and their benefits and complications.
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Affiliation(s)
- Lesley Rees
- Department of Nephrology, Great Ormond Street Hospital for Children NHS Trust, London WC1N 3JH, UK.
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15
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Abstract
Growth may be severely impaired in children with chronic renal insufficiency. Since short stature can have major consequences on quality of life and self-esteem, achieving a 'normal' height is a crucial issue for renal transplant recipients. However, despite successful renal transplantation, the final height attained by most recipients is not the calculated target height. Catch-up growth spurts post-transplantation are usually insufficient to compensate for the retardation in growth that has occurred during the pre-transplant period. Longitudinal growth post-transplantation is therefore influenced by the age at transplantation but also by subsequent allograft function and steroid exposure, both of which interfere with the growth hormone/insulin-like growth factor axis. The management of growth retardation in renal transplant recipients includes adequate nutritional intake, correction of metabolic acidosis, prevention of bone disease, steroid-sparing strategies and a supraphysiological dose of recombinant human growth hormone in selected cases.
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Affiliation(s)
- Jérôme Harambat
- Département de Pédiatrie and Inserm U820, Hôpital Edouard-Herriot and Université Claude-Bernard Lyon 1, Lyon, France
| | - Pierre Cochat
- Département de Pédiatrie and Inserm U820, Hôpital Edouard-Herriot and Université Claude-Bernard Lyon 1, Lyon, France
- Département de Pédiatrie, Unité de Néphrologie Pédiatrique, Hôpital Edouard Herriot, place d’Arsonval, 69437 Lyon, France
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16
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Franke D, Zivicnjak M, Ehrich JHH. Growth hormone treatment of renal growth failure during infancy and early childhood. Pediatr Nephrol 2009; 24:1093-6. [PMID: 19367419 DOI: 10.1007/s00467-009-1190-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2009] [Accepted: 03/26/2009] [Indexed: 11/26/2022]
Abstract
Despite major progress in dialysis, nutrition and drug treatment in the past 20 years, growth of infants and toddlers with chronic kidney disease (CKD) remains a major challenge in paediatric nephrology. Our hypothesis is that early growth deficit is one of the most important factors for impaired final height in children with CKD, and we conclude that early implementation of recombinant human growth hormone (rhGH) therapy should be offered to infants with growth failure. Infants with delayed growth, adequate caloric intake and stable parameters of bone metabolism are candidates for rhGH therapy. One predictive factor for the selection of infants for rhGH treatment may be growth retardation at birth. Our conclusion from the limited published data is that the use of rhGH in young children with CKD is effective and safe. Compared with its use in older children, the early use of growth hormone requires lower absolute dosages of rhGH, which therefore reduce the annual treatment costs and allow earlier renal transplantation. Furthermore, an early start on rhGH improves the psychosocial situation later in childhood and may lead to a further improvement in adult height. A multi-centre randomised controlled study should be initiated to analyse the short-term and long-term effects of early rhGH therapy on infants with CKD.
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17
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Mencarelli F, Kiepe D, Leozappa G, Stringini G, Cappa M, Emma F. Growth hormone treatment started in the first year of life in infants with chronic renal failure. Pediatr Nephrol 2009; 24:1039-46. [PMID: 19159957 DOI: 10.1007/s00467-008-1084-7] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2008] [Revised: 11/14/2008] [Accepted: 11/18/2008] [Indexed: 12/21/2022]
Abstract
Infants with chronic renal failure (CRF) are at high risk of experiencing severe growth retardation. We report a study of 12 infants with CRF who have been treated with recombinant human growth hormone (rhGH) since the age of 0.5 +/- 0.3 years. A control group comprised 15 infants with less severe CRF who were being treated during the same period, but who did not receive rhGH. Despite the infants in the rhGH group had more severe renal failure, they grew at least as well as those in the control group and experienced catch-up growth that started earlier and was more sustained; they also gained more weight. Between the age of 0.5 and 2.5 years, the height standard deviation score (HtSDS) improved from -2.0 +/- 1.2 to -0.9 +/- 0.9 in the rhGH group (p < 0.005) and from -1.6 +/- 1.6 to -1.0 +/- 1.9 in the control group (p=non significant, n.s.). The average gain in HtSDS was +1.1 +/- 0.8 in the treated group and +0.6 +/- 1.4 in the control group (p = n.s.). During the same period, the weight SDS improved from -2.2 +/- 0.9 to -0.6 +/- 1.2 (p < 0.005) and from -1.9 +/- 1.2 to -1.3 +/- 1.2 (p=n.s.) in the treatment and control groups, respectively. Nutritional intake was similar in both groups, while parathyroid hormone levels tended to increase, although not significantly, after rhGH treatment (p=n.s.). The results of this pilot study suggest that very early treatment with rhGH in patients with early-onset CRF may improve growth.
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Affiliation(s)
- Francesca Mencarelli
- Department of Nephrology and Urology, Division of Nephrology and Dialysis, Bambino Gesù Children's Hospital and Research Institute (IRCCS), Piazza S Onofrio, Rome, Italy
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18
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19
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Stefanidis CJ, Klaus G. Growth of prepubertal children on dialysis. Pediatr Nephrol 2007; 22:1251-9. [PMID: 17401584 PMCID: PMC6904393 DOI: 10.1007/s00467-007-0481-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2006] [Revised: 02/26/2007] [Accepted: 03/01/2007] [Indexed: 11/26/2022]
Abstract
Growth failure is a common and significant clinical problem for children on dialysis and often remains a major impediment to their rehabilitation. Early referral to a paediatric nephrology centre and appropriate management before the initiation of dialysis may significantly prevent growth deterioration. Growth in children on dialysis can be affected by nutritional, metabolic, and hormonal changes. Early diagnosis of malnutrition and aggressive management should be a priority. Gastrostomy feeding should be used when adequate oral intake to maintain normal height and weight velocity cannot be achieved. Active vitamin D metabolites should be used carefully, to prevent low-turnover bone disease. All children should have an adequate regimen of dialysis and an appropriate management of malnutrition, renal osteodystrophy, metabolic acidosis, salt wasting and anaemia, before recombinant human growth hormone (rhGH) administration is considered. The current challenge of reversing growth impairment in children on dialysis can only be achieved by optimization of their care.
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Affiliation(s)
- Constantinos J Stefanidis
- Department of Nephrology, P. & A. Kyriakou Children's Hospital of Athens, Goudi, 14562, Athens, Greece.
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21
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Rashid R, Neill E, Maxwell H, Ahmed SF. Growth and body composition in children with chronic kidney disease. Br J Nutr 2007; 97:232-8. [PMID: 17298690 DOI: 10.1017/s0007114507252675] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Growth failure is a common yet complex problem of childhood chronic kidney disease caused by multiple factors encountered due to the primary disease or secondary to the renal impairment. This review seeks to describe the various patho-physiological mechanisms contributing to growth failure in the various stages of childhood with particular emphasis on nutritional problems and endocrine dysfunction encountered whilst managing these children. In addition, we shall examine the role of body composition in chronic kidney disease, their relationship with growth and nutrition and the potential effect of abnormalities in fat mass and lean mass on long-term morbidity and mortality.
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Affiliation(s)
- R Rashid
- Bone & Endocrine Research Group, Royal Hospital for Sick Children, Yorkhill, Glasgow, G3 8SJ, UK
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22
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Wong H, Mylrea K, Feber J, Drukker A, Filler G. Prevalence of complications in children with chronic kidney disease according to KDOQI. Kidney Int 2006; 70:585-90. [PMID: 16788689 DOI: 10.1038/sj.ki.5001608] [Citation(s) in RCA: 99] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The Kidney Disease Outcome and Quality Initiative (KDOQI) Group recommended guidelines for the monitoring and treatment of chronic kidney disease (CKD) in 2002. These recommendations were based on the prevalence of known complications as seen in adults. In children, the exact prevalence of these complications is unknown. We therefore conducted a cross-sectional study of 366 patients with CKD in a single center to analyze the prevalence of these complications across all stages of kidney disease. Patients were categorized to their KDOQI stage of CKD according to their estimated renal function as determined from serum cystatin C. Fifty seven percent of patients had CKD stage 1, 29.0% stage 2, 10.4% stage 3 and 4.1% stages 4+5. Uropathies (31%) were the most prevalent causes of CKD. Glomerular disease accounted for 27%. The overall prevalence of complications was as follows: hypertension 70.2%, anemia 36.6%, proteinuria 11.5%, and metabolic bone disease 16.9%. Metabolic bone disease and anemia occurred frequently, even with a glomerular filtration rate >60 ml/min/1.73 m2. Growth failure (11.5%) was also common and is not a component of the KDOQI guidelines for CKD in children. The prevalence of all complications increased with worsening stage of kidney disease (all P-values significant). In summary, this study supports the KDOQI guidelines in defining and staging CKD in children. This study also highlights the differences in the causes and complications that occur in CKD between adults and pediatrics. We recommend modification of the KDOQI guidelines for children to reflect the differences described in this paper.
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Affiliation(s)
- H Wong
- Department of Pediatrics, Division of Nephrology, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
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23
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Wong H, Mylrea K, Cameron A, Manion I, Bass J, Feber J, Filler G. Caregiver attitudes towards gastrostomy removal after renal transplantation. Pediatr Transplant 2005; 9:574-8. [PMID: 16176412 DOI: 10.1111/j.1399-3046.2005.00341.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Gastrostomy tube (G-tube) removal has been suggested at 3 months following successful renal transplantation (Tx). We noticed a delay in the removal of G-tubes in our pediatric patients following Tx and therefore conducted a cross-sectional single center survey on all renal transplant recipients to assess the causes of delayed G-tube removal. In total, 17 of 23 patients completed the survey, including all patients with G-tubes (n = 10) and seven patients without G-tubes. Median age at Tx of gastrostomy patients was significantly lower than that of patients without a G-tube (median 3.0 yr, range 1.2-4.7 yr vs. median 14 yr, range 6-17 yr, p < 0.0001) and significantly younger than in previous studies on gastrostomies. At the time of the survey, only three of 10 patients had their G-tube removed at 22, 41 and 61 months after Tx at the ages of 3, 5.5 and 9 yr, respectively. The median age at recent follow up of the remaining seven patients was 4.7 yr (range 2.6-8.75 yr). The most important reason for continued use was fluid intake and medication. Results of our survey showed appropriate concern regarding the risk of prolonged use of the gastrostomy. Caregivers felt that benefits of the gastrostomy in the post-transplant period outweighed the risks. Caregivers felt pressured towards removal by the physicians. Our findings support the decision to remove gastrostomies based on individual patient needs and total fluid intake rather than a fixed time following successful Tx.
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Affiliation(s)
- Hubert Wong
- Divisions of Nephrology, Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
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24
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Wühl E, Haffner D, Offner G, Broyer M, van't Hoff W, Mehls O. Long-term treatment with growth hormone in short children with nephropathic cystinosis. J Pediatr 2001; 138:880-7. [PMID: 11391333 DOI: 10.1067/mpd.2001.113263] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The objective was to assess the efficacy and safety of growth hormone (GH) treatment in severely growth retarded children with nephropathic cystinosis during conservative treatment and during renal replacement therapy. STUDY DESIGN The design was an open-labeled prospective trial with a run-in period of 1 year. RESULTS A total of 74 children with cystinosis (age 3.0 to 18 years) were treated with GH over a mean period of 3.1 years (range 1 to 10 years); 52 patients were receiving conservative treatment (mean age 7.1 years), 7 were receiving dialysis (12.5 years), and 15 had received a renal transplant (14.8 years). The mean standardized height (SD score) was -4.0 in the conservative treatment group, -4.4 in the dialysis group, and -4.9 in the renal transplant group. During the first treatment year, height velocity doubled in the conservative treatment group, increased by 80% in the dialysis group, and increased by 45% in renal transplant group. Within 3 years the height SD score increased by +1.6 (P <.001) in prepubertal patients receiving conservative treatment, and percentile parallel growth was maintained thereafter. These effects of GH were less expressed in peripubertal patients receiving renal replacement therapy. No major side effects were observed. CONCLUSION Long-term GH treatment is safe and effective in young children with nephropathic cystinosis. GH treatment should be started early in the course of the disease if adequate nutrition and cysteamine treatment do not prevent growth retardation.
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Affiliation(s)
- E Wühl
- Renal Units, the Department of Pediatrics, University Hospital of Heidelberg, 69120 Heidelberg, Germany
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25
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Flynn JT, Warady BA. Peritoneal dialysis in children: challenges for the new millennium. ADVANCES IN RENAL REPLACEMENT THERAPY 2000; 7:347-54. [PMID: 11073566 DOI: 10.1053/jarr.2000.16271] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Advances in technology and experience accumulated over the past 2 decades have resulted in the ability to successfully provide chronic peritoneal dialysis (PD) to children of all ages and sizes. However, many important clinical issues remain, including uncertainty regarding the "optimal" dialysis dose for children, the treatment of growth retardation associated with renal insufficiency, prevention of peritonitis, and the challenge of caring for newborn infants with end-stage renal disease (ESRD). This article summarizes current knowledge in each of these 4 areas, highlighting not only the advances of the past quarter-century, but also the questions that persist as we initiate the new millennium. The outcome of children receiving PD will be markedly improved only when ongoing and future research efforts reveal the optimal solutions to these important issues.
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Affiliation(s)
- J T Flynn
- Division of Pediatric Nephrology, Department of Pediatrics and Communicable Diseases, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, MI, USA.
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26
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Cabrol S, Houang M, Le Bouc Y. [Physiopathology of the somatotropin axis in chronic renal insufficiency]. Arch Pediatr 2000; 5 Suppl 4:348S-353S. [PMID: 9853082 DOI: 10.1016/s0929-693x(99)80189-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Many factors contribute to the growth failure of chronic renal failure: water and electrolytes disturbances, hypertonicity, phosphate or calcium wasting, secondary hyperparathyroidism, anemia, hypertension, metabolic acidosis, and malnutrition. In addition, the pubertal growth spurt is usually stunted. Growth hormone (GH) resistance is observed with low GH binding protein (GHBP) level, and normal or low IGF I levels despite elevated GH level. Elevated IGFBP levels may contribute to a reduced IGF activity, especially in dialysed patients. Glucocorticoid therapy in transplanted patients further contribute to poor growth and inhibited IGF I activity. As conventional treatments have a limited effect to improve growth, adult height is often far below -2 SD. GH therapy has proved to be successful, especially in young children, overpassing the hormonal resistance so that an adult height within the normal range may be reached.
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Affiliation(s)
- S Cabrol
- Service d'explorations fonctionnelles endocriniennes, hôpital d'enfants Armand-Trousseau, Paris, France
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27
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Kari JA, Gonzalez C, Ledermann SE, Shaw V, Rees L. Outcome and growth of infants with severe chronic renal failure. Kidney Int 2000; 57:1681-7. [PMID: 10760104 DOI: 10.1046/j.1523-1755.2000.00013.x] [Citation(s) in RCA: 92] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND We aimed to assess the outcome and growth of infants with severe chronic renal failure (CRF). One hundred and one children presented between January 1, 1986, and December 12, 1998, with a glomerular filtration rate (GFR) of <20 mL/min/1.73 m2. The median (range) age at presentation was 0.3 (0 to 1.5) years, and follow-up was 7.6 (1.5 to 13) years. One- and five-year survival rates were 87 and 78%, respectively. The growth of the 81 children who survived over two years was evaluated. Eighty-one percent were enterally fed from age 0.7 (0 to 4.5) years for 1.9 (0.1 to 6.8) years. Forty-six percent had a gastrostomy, and 22% a Nissen fundoplication. Twenty-five were managed conservatively. Twenty were transplanted without dialysis at age 4 (1.7 to 8.5) years, and 36 were dialyzed at age 1.1 (0 to 9.8) before transplantation at age 2. 4 (1.3 to 10) years. RESULTS The mean (SD) height standard deviation score increased from -2.16 (1.34) at 6 months (N = 63) to -1.97 (1.37) at 1 year (N = 75), -1.79 (1.29) at 2 years (N = 75), -1.33 (1.29) at 3 years (N = 68, P = 0.0006), -1.27 (1.04) at 5 years (N = 47, P = 0.0001), and -0.85 (0.82) at 10 years (N = 18, P = 0.001). The body mass index was in the normal range in the majority of patients. CONCLUSION Mortality in infants with CRF occurs mainly in the first year of life. With early enteral feeding, the mean height standard deviation score is within the normal range from one year of age.
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Affiliation(s)
- J A Kari
- Renal Unit, Gt. Ormond St. Hospital for Children NHS Trust, London, England, United Kingdom
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28
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Reed EE, Roy LP, Gaskin KJ, Knight JF. Nutritional intervention and growth in children with chronic renal failure. J Ren Nutr 1998; 8:122-6. [PMID: 9724500 DOI: 10.1016/s1051-2276(98)90002-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To assess whether improving energy intake by tube feeding could prevent growth failure and improve growth rates in children with congenital renal failure. DESIGN Prospective descriptive study. SETTING Renal Units, Royal Alexandra Hospital for Children, and Westmead Hospitals. PATIENTS All children with advanced chronic renal disease (glomerular filtration rate < 30 mL/min/1.73 m2) between 1992 and 1994. INTERVENTION Tube feeding was commenced if height or weight standard deviation score (SDS) was below the normal range (> -2 SDS) or when height SDS was decreasing and oral intake was not meeting energy requirements. Energy requirements were calculated for median weight for chronological age and sex to provide for catch-up growth. MAIN OUTCOME MEASURES Growth rate was measured by comparing height and weight SDS at the beginning and end of the study period. Normal growth rate is defined as no change in SDS over time, whereas catch-up growth is defined as an increase in SDS over time. RESULTS Seven children, mean age 0.6 +/- 0.7 years, with advanced renal failure (mean glomerular filtration rate = 17 mL/min/1.73 m2) caused by congenital renal hypoplasia/dysplasia were studied. All subjects were eventually tube fed for a mean time of 18. 6 +/- 4.5 months. There was no significant change in height SDS (-0. 9 to -1.1) or weight SDS (-0.4 to -0.2). CONCLUSION Optimizing nutritional intake by tube feeding children with advanced chronic renal failure from an early age resulted in no decline in growth rate; however, catch-up growth was not achieved.
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Affiliation(s)
- E E Reed
- Department of Nephrology, Royal Alexandra Hospital for Children, Westmead, Australia
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29
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Zadik Z, Frishberg Y, Drukker A, Blachar Y, Lotan D, Levi S, Reifen R. Excessive dietary protein and suboptimal caloric intake have a negative effect on the growth of children with chronic renal disease before and during growth hormone therapy. Metabolism 1998; 47:264-8. [PMID: 9500560 DOI: 10.1016/s0026-0495(98)90254-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Although diet and nutrition are an integral part of the management of individuals with chronic renal failure (CRF), little has been written on the effect of nutrition on the growth response to growth hormone (GH) in CRF. We studied the GH axis and nutritional status of 31 prepubertal children aged 8.7 +/- 0.5 years with a height standard deviation score (SDS) of -3.2 +/- 0.2 (mean +/- SEM) with CRF. Sixteen CRF patients on hemodialysis and 15 on peritoneal dialysis were studied. Forty-four age-matched normal short children without GH deficiency served as controls. Spontaneous 12-hour GH and stimulated GH values were significantly higher and GH binding protein (GHBP) was significantly lower in the CRF patients than in the normal short children. Both before the initiation of GH therapy and after the first year of treatment, the growth velocity (SDS) was inversely correlated with dietary protein intake and positively correlated with caloric intake. GH was administered at a dosage of 28 and 21 IU/m2/wk to the CRF group and the normal short children, respectively, divided into seven daily doses. The growth response of the normal short children was significantly greater than that of the CRF patients. GH therapy induced a smaller increment in GHBP and IGF-I in the CRF patients versus the normal short children (8.8 +/- 2.2 and 10.2 +/- 2.7 v 24.8 +/- 1.3 and 27.6 +/- 2.5 nmol/L, respectively, P < .01). The 1-year growth velocity of the CRF children was most closely correlated with dietary protein and caloric intake. The nutritional status of CRF patients is concluded to be a major factor in growth both before and during GH therapy.
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Affiliation(s)
- Z Zadik
- Pediatric Endocrine Unit, Kaplan Medical Center, Rehovot, Israel
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30
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Davidowitz M, Eisenstein B, Yussim A, Erman A, Boner G, Zandbank J, Silbergend A, Eshed R, Shohat J. Renal effects of long-term administration of growth hormone in prepubertal uninephrectomized rats. Transplant Proc 1997; 29:3039-43. [PMID: 9365659 DOI: 10.1016/s0041-1345(97)00775-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- M Davidowitz
- Nephrology Unit, Children's Medical Center of Israel, Petah Tikva, Israel
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31
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Turenne MN, Port FK, Strawderman RL, Ettenger RB, Alexander SR, Lewy JE, Jones CA, Agodoa LY, Held PJ. Growth rates in pediatric dialysis patients and renal transplant recipients. Am J Kidney Dis 1997; 30:193-203. [PMID: 9261029 DOI: 10.1016/s0272-6386(97)90052-4] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
We compared growth rates by modality over a 6- to 14-month period in 1,302 US pediatric end-stage renal disese (ESRD) patients treated during 1990. Modality comparisons were adjusted for age, sex, race, ethnicity, and ESRD duration using linear regression models by age group (0.5 to 4 years, 5 to 9 years, 10 to 14 years, and 15 to 18 years). Growth rates were higher in young children receiving a transplant compared with those receiving dialysis (ages 0.5 to 4 years, delta = 3.1 cm/yr v continuous cycling peritoneal dialysis [CCPD], P < 0.01; ages 5 to 9 years, delta = 2.0 to 2.6 cm/yr v CCPD, chronic ambulatory peritoneal dialysis (CAPD), and hemodialysis, P < 0.01). In contrast, growth rates in older children were not statistically different when comparing transplantation with each dialysis modality. For most age groups of transplant recipients, we observed faster growth with alternate-day versus daily steroids that was not fully explained by differences in allograft function. Younger patients (<15 years) grew at comparable rates with each dialysis modality, while older CAPD patients grew faster compared with hemodialysis or CCPD patients (P < 0.02). There was no substantial pubertal growth spurt in transplant or dialysis patients. This national US study of pediatric growth rates with dialysis and transplantation shows differences in growth by modality that vary by age group.
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Affiliation(s)
- M N Turenne
- United States Renal Data System Coordinating Center and Department of Medicine, University of Michigan, Ann Arbor 48103, USA.
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32
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Simon D, Neol M, Brun P, Porquet D, Rocchicioli P, Loirat C, Czernichow P. Evaluation of clinical and laboratory parameters during 2 years of growth hormone treatment in prepubertal children with chronic renal failure. Eur J Pediatr 1996; 155:688-94. [PMID: 8839726 DOI: 10.1007/bf01957154] [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: 02/02/2023]
Abstract
UNLABELLED Twelve prepubertal children with chronic renal failure (CRF) were treated with human growth hormone (GH) (1.2 IU/kg/week) for 2 years. High doses of GH clearly increased growth velocity, from 3.8 +/- 1.3 to 9.6 +/- 1.5 (P = 0.0001) and 6.9 +/0 0.8 cm/year (P = 0.0001) after the 1st and 2nd year of treatment, respectively, leading to a mean height gain of 1.4 SD. During the 1st year of treatment the height increment, expressed in SDS, correlated negatively with chronological age (P = 0.003). Basal insulin-like growth factor 1 (IGF 1) levels were normal or elevated (7/12 patients) and correlated positively with the overnight integrated GH concentration (r = 0.68, P < 0.001). Basal insulin-like growth factor binding protein 3 (IGF-BP3) levels were elevated in 8/12 patients. GH induced a significant increase in IGF 1 and IGF-BP3 levels; IGF 1 peaked after 6 months (when growth velocity was optimal) and IGF-BP3 peaked after 12 months. The mean glomerula filtration rate, measured by inulin clearance and corrected for body surface area, fell after the 1st year of treatment, and significantly so at the end of the 2nd year (P = 0.02). CONCLUSION Early initiation of GH therapy during CRF may prevent severe growth retardation and allow these children to attain normal height before dialysis and transplantation.
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Affiliation(s)
- D Simon
- Service d'Endocrinologie Pédiatrique, Hôpital Robert DEBRE, Paris, France
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Karlberg J, Schaefer F, Hennicke M, Wingen AM, Rigden S, Mehls O. Early age-dependent growth impairment in chronic renal failure. European Study Group for Nutritional Treatment of Chronic Renal Failure in Childhood. Pediatr Nephrol 1996; 10:283-7. [PMID: 8792391 DOI: 10.1007/bf00866761] [Citation(s) in RCA: 48] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
We report early linear growth in 73 children (51 boys, 22 girls) with early onset of chronic renal failure (CRF). The inclusion criteria was onset of CRF before 6 months of age, two or more height measurements during the 1st year of life, follow-up for at least 3 years and continuously impaired renal function with a glomerular filtration rate below 50 ml/min per 1.73 m2 at 1 year or later. Only height measurements taken during conservative treatment or dialysis were included. The data were analysed in terms of the infancy-childhood-puberty growth model. There was an age-dependent growth failure in early life leading to an attained height of -3 standard deviation score (SDS) at 3 years of age. Approximately one-third of the reduction in height occurred during fetal life and one-third during the first postnatal months. Between 0.75 and 1.5 years of age height also decreased by 1 SD as a consequence of a delayed onset of the second, the 'childhood', phase of growth in 36% of the patients and by an 'offset childhood' growth pattern--i.e. a return to the infancy phase pattern after onset of the childhood phase--in 60% of the patients. Growth between 0.25-0.75 and 1.5-5 years of age was generally percentile parallel and thus less likely to be affected in CRF with early disease onset. The glomerular filtration rate was not related to the height gain in early life. We speculate that the growth failure during fetal life and the first postnatal months reflects metabolic and/or nutritional influences and the impaired growth at 0.75-1.5 years of age is related to a partial insensitivity to growth hormone.
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Affiliation(s)
- J Karlberg
- Department of Paediatrics, Queen Mary Hospital, University of Hong Kong, Hong Kong
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34
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Schaefer F, Wingen AM, Hennicke M, Rigden S, Mehls O. Growth charts for prepubertal children with chronic renal failure due to congenital renal disorders. European Study Group for Nutritional Treatment of Chronic Renal Failure in Childhood. Pediatr Nephrol 1996; 10:288-93. [PMID: 8792392 DOI: 10.1007/bf00866762] [Citation(s) in RCA: 48] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Despite the high prevalence of and therapeutic attention to growth failure in children with chronic renal failure (CRF), systematic evaluations of spontaneous growth in CRF are lacking. Therefore, we collected retrospectively longitudinal growth and biochemical data in 321 prepubertal patients treated for CRF due to congenital renal disorders. Data were recorded at 3-month intervals during the first 2 years of life and 6-monthly thereafter, up to the age of 10 years. Around 100 measurements were available per age interval. Mixed-longitudinal percentile curves of height and height velocity were constructed. Moreover, a statistical comparison with the heights and height velocities of healthy children and an evaluation of the effect of biochemical parameters on growth was performed. The CRF children had normal heights at birth but dropped below the 3rd normal percentile during the first 15 months of life. Thereafter, growth patterns usually were percentile parallel, with a mean height standard deviation score (SDS) of -2.37 +/- 1.6. Height velocities were consistently lower in patients with glomerular filtration rates (GFRs) below one-third of the lower normal limit (25 ml/min per 1.73 m2 for patients > 1 year) than in patients with better renal function. This difference in growth rates resulted in a mean height SDS of -1.65 +/- 1.5 SDS and -2.79 +/- 1.4 SDS (age 1-10 years) in the subgroups with relatively better and worse GFR, respectively. Regression analysis confirmed that GFR was a weak but significant predictor of height velocity SDS in most age groups.
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Affiliation(s)
- F Schaefer
- Division of Pediatric Nephrology, University Children's Hospital, Heidelberg, Germany
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35
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Abstract
Poor growth is a particular problem for children with congenital renal disease. A one year trial of the use of recombinant human growth hormone (rhGH) in eight infants and young children with chronic renal failure is reported here. At entry bone age was less than 2 years, mean (range) chronological age 1.9 (1.3-2.7) years, and glomerular filtration rate (GFR) was 17 (9-42) ml/min/1.73 m2. Height standard deviation score (SDS) was -3.3 (-4.6 to -2.0) and height velocity SDS was -1.3 (-3.1 to 0.7). One child was withdrawn when he received a renal transplant after 9.5 months. Two children required dialysis, but remained in the trial. Treatment with rhGH resulted in an increase in height SDS to -2.2 (-4.2 to -0.9), p = 0.0002, and height velocity SDS to 1.1 (-0.7 to 2.6), p = 0.006. There was no change in GFR and no serious adverse events. There was no effect on plasma lipids, calcium, phosphate, intact parathyroid hormone, or glucose. Alkaline phosphatase rose significantly. Thus rhGH improved growth in eight infants with chronic renal failure, with four children entering the normal range.
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Affiliation(s)
- H Maxwell
- British Association for Paediatric Nephrology
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36
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Neu AM, Warady BA. Dialysis and renal transplantation in infants with irreversible renal failure. ADVANCES IN RENAL REPLACEMENT THERAPY 1996; 3:48-59. [PMID: 8620368 DOI: 10.1016/s1073-4449(96)80040-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Historically, infants with irreversible renal failure fared poorly, and aggressive medical intervention was considered futile. Although the care of this population clearly remains a challenge, technical advances and clinical experience have now made dialysis and transplantation reasonable and successful therapeutic options. This report provides a discussion of practical guidelines and patient care issues particular to the infant with end-stage renal disease. Topics addressed include nutritional requirements, neurodevelopmental abnormalities, and the possible contribution of alterations of the immune system to patient morbidity. Specific technical considerations for the performance of peritoneal dialysis, hemodialysis, and transplantation in the very small infant are also presented.
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Affiliation(s)
- A M Neu
- Johns Hopkins School of Medicine, Baltimore, MD 21287-2535, USA
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37
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Warady BA, Jabs K. New hormones in the therapeutic arsenal of chronic renal failure. Growth hormone and erythropoietin. Pediatr Clin North Am 1995; 42:1551-77. [PMID: 8614600 DOI: 10.1016/s0031-3955(16)40098-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Although the benefits of rhGH and r-HuEPO therapy in children with CRF and on dialysis are already significant, further study of these new additions to the therapeutic arsenal remains necessary. Data on the final adult height achieved in patients who receive rhGH are extremely important information that is as yet unavailable. The risks and benefits of raising the target hematocrit to a "normal" value in patients receiving r-HuEPO remains under study. Only when these and other issues are soundly evaluated will the full impact of these medications be understood.
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Affiliation(s)
- B A Warady
- Department of Pediatrics, University of Missouri, Kansas City School of Medicine, USA
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38
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Abstract
Feeding problems, anorexia and vomiting are common in infants and children with chronic renal failure (CRF), and play a major role in the growth failure often found in this condition. However, the gastroenterological and nutritional aspects of CRF in children have received little attention, hence therapeutic interventions are usually empirical and often ineffective. Gastritis, duodenitis and peptic ulcer are often found in adults with CRF on regular haemodialysis and following renal transplantation. Despite persistent hypergastrinaemia, gastric acid secretion is decreased rather than increased in most of these patients, and active peptic disease appears to be promoted by the removal of the acid output inhibition (neutralisation of gastric acid by ammonia) that follows active treatment. Helicobacter pylori, on the other hand, does not seem to play a significant role in the pathogenesis of peptic disease in CRF. Gastro-oesophageal reflux has been found in about 70% of infants and children with CRF suffering from vomiting and feeding problems, and thus appears to be a major problem in these patients. In a number of symptomatic patients with CRF, gastric dysrhythmias and delayed gastric emptying have also been found; hence there appears to be a complex disorder of gastrointestinal motility in CRF. Serum levels of several polypeptide hormones involved in the modulation of gastrointestinal motility [e.g. gastrin, cholecystokinin (CCK), neurotensin] and the regulation of hunger and satiety (e.g. glucagon, CCK) are significantly raised as a consequence of renal insufficiency, and can be reverted to normal by renal transplantation. Furthermore, several other humoral abnormalities (e.g. hypercalcaemia, hypokalaemia, acidosis, etc.) are not uncommon in CRF. By directly affecting the smooth muscle of the gut or stimulating particular areas within the central nervous system, all these humoral alterations may well play a major role in the gastrointestinal dysmotility, anorexia, nausea and vomiting in patients with CRF. Specific pharmacological and nutritional interventions should thus be considered for the treatment of vomiting and feeding problems in CRF.
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Affiliation(s)
- A M Ravelli
- Department of Paediatrics, University of Brescia, Italy
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39
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Hyer W, Cotterill AM, Savage MO. Common causes of short stature detectable by a height surveillance programme. J Med Screen 1995; 2:150-3. [PMID: 8536185 DOI: 10.1177/096914139500200310] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- W Hyer
- Department of Endocrinology, St Bartholomew's Hospital, London, United Kingdom
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40
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Reynolds JM, Wood AJ, Eminson DM, Postlethwaite RJ. Short stature and chronic renal failure: what concerns children and parents? Arch Dis Child 1995; 73:36-42. [PMID: 7639547 PMCID: PMC1511173 DOI: 10.1136/adc.73.1.36] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Multicentre trials are evaluating growth hormone treatment in short children (height > 2 SDs below mean) with chronic renal failure (CRF), on dialysis, or with a transplant. Thirty children and parents from four centres were interviewed to assess psychological functioning and evaluate their concerns about growth in the context of CRF. There were 24 males and six females, age range 2-18 years. Fifty per cent of patients had additional non-renal complications and 30% had learning difficulties. Differences between the respective concerns of parents and children were striking. Parents' predominant concern was their child's future health (50%) and prospects (37%) while children's main concern was the impact of illness on their family (50%). Growth was a major concern for 30% of parents and 28% of children. Growth problems are important and should be considered within the context of other illness issues. Improved understanding of parental and child concerns may help maximise the benefits of growth hormone and assist in the management of children with CRF.
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Affiliation(s)
- J M Reynolds
- Royal Manchester Children's Hospital, Department of Child and Adolescent Psychiatry
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41
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Vaisman N, Zadik Z, Duchan R, Voet H, Lotan D, Drukker A. Changes in body composition of children with chronic renal failure during growth hormone treatment. Pediatr Nephrol 1994; 8:201-4. [PMID: 8018499 DOI: 10.1007/bf00865478] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Growth hormone (GH) has different known metabolic effects, among which are lipolysis and anabolic action. We have studied the changes in body composition of children with chronic renal failure (CRF) after 1 year of daily treatment with GH. Body fat percentage and fat body mass (FBM) were derived from four site skinfold measurements; lean body mass (LBM) from total body potassium (TBK) and mid-arm muscle circumference (MAMC); bone mineral density (BMD) was measured by dual photon absorptiometry. GH treatment had a positive effect on weight, height and MAMC, but no effect on LBM (as reflected by TBK), FBM and BMD. Z-scores were derived in order to compare subjects with a normal population. While no significant change in z-score was noticed for weight, height, MAMC, FBM and BMD, TBK decreased during treatment. We conclude that GH therapy does not ultimately increase LBM in CRF patients compared with other GH-treated groups.
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Affiliation(s)
- N Vaisman
- Department of Paediatrics B, Kaplan Hospital, Rehovot, Israel
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42
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Ito K, Kawaguchi H. Treatment of uremic children in Japan with recombinant human growth hormone (rhGH). Japanese Multi-Center Open Study Group on Children with Renal Disease. J Pediatr Endocrinol Metab 1994; 7:115-8. [PMID: 8061756 DOI: 10.1515/jpem.1994.7.2.115] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- K Ito
- Department of Pediatric Nephrology, Tokyo Women's Medical College, Japan
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43
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Brocklebank JT, Wolfe S. Dietary treatment of renal insufficiency. Arch Dis Child 1993; 69:704-8. [PMID: 8285787 PMCID: PMC1029661 DOI: 10.1136/adc.69.6.704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- J T Brocklebank
- Academic Unit of Paediatrics and Child Health, St James's University Hospital, Leeds
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44
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Trachtman H, Futterweit S, Schwob N, Maesaka J, Valderrama E. Recombinant human growth hormone exacerbates chronic puromycin aminonucleoside nephropathy in rats. Kidney Int 1993; 44:1281-8. [PMID: 8301930 DOI: 10.1038/ki.1993.380] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Growth failure is a cardinal feature of chronic renal failure in children. Administration of recombinant human growth hormone (rhGH) ameliorates this problem but may adversely affect the kidney and hasten the progression to end-stage renal disease. We conducted experiments to examine the impact of rhGH on the severity of chronic puromycin aminonucleoside (PAMN) nephropathy in rats. The glomerulopathy was induced by serial injections of PAMN over a 12 week period. Experimental animals (N = 6) received rhGH, 0.5 mg per dose, three times weekly, while control rats (N = 6) received hormone vehicle. rhGH had no effect on weight gain, hematocrit, or blood pressure in rats with the experimental renal disease. Urinary protein excretion increased approximately 50% in rhGH-treated rats with chronic PAMN nephropathy compared to untreated animals between four to eight weeks of the observation period. After 12 weeks, the inulin clearance was significantly lower in rhGH-treated rats, 0.26 +/- 0.05 versus 0.50 +/- 0.06 ml/min/100 g body wt in control PAMN animals, P < 0.05. Compared to untreated rats with PAMN nephropathy, administration of rhGH increased the extent of segmental glomerulosclerosis from 11 +/- 3 to 46 +/- 9% (P < 0.005) and elevated the tubulointerstitial injury score from 0.5 +/- 0.1 to 1.4 +/- 0.4 (P < 0.05). Furthermore, glomerular hypertrophy was enhanced in animals with chronic PAMN nephropathy given rhGH, as evidenced by a larger glomerular planar area, 9.2 +/- 0.3 x 10(-3) versus 11.9 +/- 0.5 x 10(-3) mm2, P < 0.005.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- H Trachtman
- Department of Pediatrics (Division of Nephrology), Schneider Children's Hospital of Long Island Jewish Medical Center, Long Island Campus for the Albert Einstein College of Medicine, New Hyde Park, New York
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45
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Hinchliffe SA, Howard CV, Lynch MR, Sargent PH, Judd BA, van Velzen D. Renal developmental arrest in sudden infant death syndrome. PEDIATRIC PATHOLOGY 1993; 13:333-43. [PMID: 8516228 DOI: 10.3109/15513819309048221] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Investigations linking sudden infant death syndrome (SIDS) and type II intrauterine growth retardation (IUGR) have thus far failed due in part to technical limitations. Recently developed stereological methods for the unbiased estimation of total nephron number in the human kidney are capable of detecting deviations from normal values of greater than 10%. We compared the total number of nephrons in the kidneys of 24 SIDS victims with those from 16 controls with the same age range. Mean nephron number was significantly (P < 0.001) reduced in ex-IUGR SIDS cases (birthweight under the 10th centile, n = 9, mean number 635,000, range 327,000-1,010,000) in comparison with controls (903,000, 740,000-1,060,000). A similarly significant (P < 0.01) reduction in the "normal birthweight" SIDS group (birthweight over 10th centile, n = 15, 690,000, 361,000-1,040,000) was found. This hitherto unreported renal developmental arrest may be only one manifestation of a general, somatic developmental defect, reflecting adverse intrauterine conditions; other organ systems, similarly critical to homeostasis may be comparably affected. The findings, although not proposed as direct cause of SIDS, may represent a potential explanation for the recognized association of IUGR and SIDS, and provide--we believe--the first quantitative evidence of intrauterine growth retardation in, at least a number of, children of average birthweight.
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Affiliation(s)
- S A Hinchliffe
- Department of Fetal and Infant Pathology, University of Liverpool, Royal Liverpool Children's Hospital Alder Hey, United Kingdom
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46
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Abstract
Infants born with congenital renal insufficiency generally grow poorly during the first years of life and incur a height deficit that is rarely regained. Actual energy and protein requirements have not been determined for these children. In 12 infants with creatinine clearances less than 70 ml/min per 1.73 m2, growth and nutrient intakes were monitored during the first 2 years of life. Forced feeding regimens after 3 months of age, including gastrostomy in 3 patients, were necessary to maintain energy intakes near 100% of the recommended dietary allowance (RDA). Protein intakes averaged in excess of 140% RDA. Linear growth did not correlate with either energy or protein intakes, suggesting that neither was a limiting factor to growth. Length velocity standard deviation score (LV-SDS) did not correlate with degree of renal insufficiency at any age, but average LV-SDS did relate significantly and inversely to C-terminal parathyroid hormone (PTH) levels. Growth parameters, including LV-SDS and weight velocity SDS (WV-SDS) were lowest at 6 months of age. Weight and length SDS followed with a maximum decline at 12 months of age. While weight for length SDS remained normal and WV-SDS showed recovery during the 2nd year, LV-SDS remained negative. Length SDS stabilized near--2 SDS. In summary, these data suggest that the major height deficit in infants with renal insufficiency is incurred during the first 6 months of life. Ponderal indices suggested that very early nutritional deficits may have been a primary contributor to subsequent height deficits.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- C L Abitbol
- Department of Pediatrics, University of Miami/Jackson Memorial Medical Center, Florida
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47
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Kist-van Holthe tot Echten JE, Nauta J, Hop WC, de Jong MC, Reitsma-Bierens WC, Ploos van Amstel SL, van Acker KJ, Noordzij CM, Wolff ED. Protein restriction in chronic renal failure. Arch Dis Child 1993; 68:371-5. [PMID: 8466240 PMCID: PMC1793870 DOI: 10.1136/adc.68.3.371] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
The aim of the study was to investigate the effect of a protein restricted diet on renal function and growth of children with chronic renal failure. In a multicentre prospective study 56 children (aged 2-18 years) with chronic renal failure were randomly assigned to the protein restricted (0.8-1.1 g/kg/day) or the control group. All children were followed up by the same paediatrician and dietitian. After a follow up period of three years there was no significant difference in glomerular filtration rate between children on a protein restricted diet and children of the control group. There was no significant difference in weight with respect to height and height SD score between the protein restricted and the control group. Compliance with the protein restricted diet, as indicated by the prospective diet diaries and the serum urea:creatinine ratio, was good. This study shows that children with chronic renal failure do not benefit from a protein restricted diet.
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48
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Tamminga RY, Zweens M, Kamps W, Drayer N. Longitudinal study of bone age in acute lymphoblastic leukaemia. MEDICAL AND PEDIATRIC ONCOLOGY 1993; 21:14-8. [PMID: 8426572 DOI: 10.1002/mpo.2950210104] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Bone age was assessed in children with acute lymphoblastic leukaemia (ALL) using the Tanner-Whitehouse II method. X-rays of the left hand (wrist) were made at diagnosis and annually until 5 years after diagnosis. A total of 164 X-rays from 40 patients was available. During treatment bone age development as well as height growth was retarded in relation to calendar age. A catch-up of bone age and height was observed in the 2 years after cessation of treatment. No significant differences could be found between patients with and without cranial irradiation as central nervous system treatment. Therefore cranial irradiation alone is not responsible for the growth retardation of children with ALL; the causative role of cytostatic drug therapy and/or corticosteroids has to be investigated.
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Affiliation(s)
- R Y Tamminga
- Department of Pediatrics, University Hospital, University of Groningen, The Netherlands
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49
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Hokken-Koelega AC, Stijnen T, de Muinck Keizer-Schrama SM, Wit JM, Wolff ED, de Jong MC, Donckerwolcke RA, Abbad NC, Bot A, Blum WF. Placebo-controlled, double-blind, cross-over trial of growth hormone treatment in prepubertal children with chronic renal failure. Lancet 1991; 338:585-90. [PMID: 1715501 DOI: 10.1016/0140-6736(91)90604-n] [Citation(s) in RCA: 141] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Stunted growth is a serious problem for children with chronic renal failure (CRF) despite normal endogenous growth hormone secretion and normal or elevated plasma concentrations of insulin-like growth factors (IGF) I and II. Biosynthetic growth hormone (GH) was given to 20 prepubertal children (eleven boys, nine girls; mean age 9.5 years, range 4-16) with CRF and severe growth retardation in a placebo-controlled, double-blind, cross-over trial. 6 months of subcutaneous injection of GH (4 IU/m2 per day) was either preceded or followed by 6 months of placebo injection. The patients had a full examination every 3 months. Sixteen children completed the study. Height velocity improved significantly with GH therapy (p less than 0.0001) and placebo (p less than 0.04), but the GH-induced height-velocity increase exceeded that of placebo by 2.9 cm per 6 months. There was a positive relationship between prestudy height velocity and height-velocity increase. Bone maturation was not affected. GH caused a significant increase in IGF-I and a moderate increase in IGF-II plasma concentrations. The pretreatment elevation of IGF-binding protein-1 decreased by almost 50% during GH therapy, while IGF-binding protein-3 increased significantly in concentration, although this increase was significantly smaller than the GH-induced increase in IGF-I. Fructosamine, lipid, and parathyroid concentrations remained constant. Renal function deterioration did not accelerate. Impressive height-velocity increase can be achieved with GH therapy in children with CRF and growth retardation without changes in renal function. Bone maturation appears unaffected suggesting improved final height. Treatment is best started before growth retardation becomes considerable.
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Affiliation(s)
- A C Hokken-Koelega
- Division of Endocrinology, Sophia Children's Hospital, Rotterdam, The Netherlands
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50
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Rees L, Rigden SP, Chantler C. The influence of steroid therapy and recombinant human erythropoietin on the growth of children with renal disease. Pediatr Nephrol 1991; 5:556-8. [PMID: 1911137 DOI: 10.1007/bf01453701] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Long-term steroid therapy has a depressant effect on hypothalamo-pituitary pulsatile secretion of growth hormone (GH), and this results in an attenuated pubertal growth spurt. Oxandrolone and recombinant human GH improve growth rates in children taking long-term steroid therapy for renal disease, but there are potential side effects. Treatment with recombinant human erythropoietin improved the growth of three prepubertal, but not three pubertal haemodialysis patients.
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Affiliation(s)
- L Rees
- Department of Paediatrics, United Medical School, Guy's Hospital, London, UK
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