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Damasco-Ávila E, Velasco-Hidalgo L, Zapata-Tarrés M, Cárdenas-Cardos R, Rivera-Luna R. Feeding difficulties and eating disorders in pediatric patients with cancer. Bol Med Hosp Infant Mex 2019; 76:113-119. [PMID: 31116711 DOI: 10.24875/bmhim.19000072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Feeding difficulties and disorders are a common problem in the pediatric population, which involve a series of deficient behaviors about nutrition processes that can adversely affect psychomotor, psychosocial, and physical development of children. This study aimed to describe the frequency of feeding difficulties or disorders in pediatric patients with cancer. Methods A prospective study which included 125 children from 1-19 years treated at the Department of Oncology of the Instituto Nacional de Pediatría, Mexico City, was conducted. The diagnosis of eating disorders and feeding difficulties was determined during the first 48 h since admission, and the age of the patient influenced the type of disorder and feeding difficulties. Results Children older than 11 years presented more frequently an intense resistance of feeding because of discomfort pain (fear of feeding) than younger children (11.4 ± 4.7 vs. 7.4 ± 4.9, p ≤ 0.001). The most frequent alteration associated with malnutrition was loss of appetite (odds ratio [OR]: 8.8, confidence interval [CI] 95% 2.9-26.9, p<0.001), followed by fear of feeding (OR: 3.14, CI 95% 1.24-7.9, p=0.015), and the organic causes showed the highest risk for malnutrition (OR: 3.1, CI 95% 0.98-9.7, p=0.054). Conclusions Over 90% of the studied population demonstrated at least one eating disorder or feeding difficulty. The principal effect is inadequate nutritional intake due to limited appetite and fear of feeding, which can result in undernutrition. For this reason, the identification of alterations in nutrition processes should be part of the comprehensive assessment of cancer patients.
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Affiliation(s)
| | | | | | | | - Roberto Rivera-Luna
- Subdirección de Hematología/Oncología Instituto Nacional de Pediatría, Mexico City, Mexico
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Villena R, Zubieta M, Hurtado C, Salgado C, Silva G, Fernández J, Villarroel M, Fernández M, Brahm J, O'Ryan M, Santolaya ME. [Seroconversion in response to a reinforced primary hepatitis B vaccination in children with cancer]. ACTA ACUST UNITED AC 2015; 86:236-43. [PMID: 26298296 DOI: 10.1016/j.rchipe.2015.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Accepted: 04/13/2015] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Immune response against vaccine antigens may be impaired in children with cancer. The aim of this study was to evaluate the seroconversion response against hepatitis B vaccination (HBV) at the time of chemotherapy onset and/or remission in children with cancer. PATIENTS AND METHOD Prospective, two-centre, controlled, non-randomised study conducted on children recently diagnosed with cancer, paired with healthy subjects. Cases received HBV at time 0, 1 and 6 months with DNA recombinant HBV at a dose of 20 and 40 μg if < or > than 10 years of age, respectively, at the time of diagnosis for solids tumours and after the remission in case of haematological tumours. Controls received the same schedule, but at of 10 and 20 μg doses, respectively. HBs antibodies were measured in serum samples obtained at 2, 8 and 12 months post-vaccination. Protective titres were defined as > 10 mIU/ml at 8th month of follow up. RESULTS A total of 78 children with cancer and 25 healthy controls were analysed at month 8th of follow up. Seroconversion rates in the cancer group reached 26.9%, with no differences by age, gender or type of tumour (P = .13, .29, and .44, respectively). Control group seroconversion was 100% at the 8th month, with P < .0001 compared with the cancer group. At month 12 of follow up, just 31.9% of children with cancer achieved anti-HBs antibodies > 10 mIU/ml. CONCLUSIONS Vaccination against hepatitis B with three doses of DNA recombinant vaccine at an increased concentration, administrated at the time of onset of chemotherapy and/or remission provided an insufficient immune response in a majority of children with cancer. More immunogenic vaccines should be evaluated in this special population, such as a third generation, with more immunogenic adjuvants, enhanced schedules at 0, 1, 2, 6 month, evaluation of antibody titres at month 8 and 12h to evaluate the need for further booster doses.
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Affiliation(s)
- Rodolfo Villena
- Facultad de Medicina, Universidad de Chile, Santiago, Chile; Hospital de niños Dr. Exequiel González Cortés, Santiago, Chile.
| | - Marcela Zubieta
- Hospital de niños Dr. Exequiel González Cortés, Santiago, Chile; Programa Infantil Nacional de Drogas Antineoplásicas (PINDA), Santiago, Chile; Fundación Nuestros Hijos, Santiago, Chile
| | - Carmen Hurtado
- Facultad de Medicina, Universidad de Chile, Santiago, Chile; Laboratorio de Gastroenterología, Hospital Clínico Universidad de Chile, Santiago, Chile
| | - Carmen Salgado
- Facultad de Medicina, Universidad de Chile, Santiago, Chile; Hospital de niños Dr. Exequiel González Cortés, Santiago, Chile; Programa Infantil Nacional de Drogas Antineoplásicas (PINDA), Santiago, Chile
| | - Gladys Silva
- Hospital de niños Dr. Exequiel González Cortés, Santiago, Chile
| | | | - Milena Villarroel
- Facultad de Medicina, Universidad de Chile, Santiago, Chile; Programa Infantil Nacional de Drogas Antineoplásicas (PINDA), Santiago, Chile; Hospital de niños Dr. Luis Calvo Mackenna, Santiago, Chile
| | | | - Javier Brahm
- Facultad de Medicina, Universidad de Chile, Santiago, Chile; Laboratorio de Gastroenterología, Hospital Clínico Universidad de Chile, Santiago, Chile
| | - Miguel O'Ryan
- Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - María Elena Santolaya
- Facultad de Medicina, Universidad de Chile, Santiago, Chile; Programa Infantil Nacional de Drogas Antineoplásicas (PINDA), Santiago, Chile; Hospital de niños Dr. Luis Calvo Mackenna, Santiago, Chile
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