Improvement of Nutritional Status in Cholestatic Children with Supplemental Nocturnal Enteral Nutrition

Moreno, L.; Gottrand, Frédéric; Hoden, S.; Turck, Dominique; Loeuille, Guy A.; Farriaux, J. P.

doi:10.1097/00005176-199102000-00013

Cited by 38 publications

(28 citation statements)

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“…As principais características antropométricas de pacientes com doença hepática crônica e, principalmente, daqueles com colestase crônica já foram assunto de importantes estudos 4,20 . Muitas críticas são atribuídas aos dados obtidos, uma vez que a relação peso/estatura desses pacientes não é um dado muito confiável, mesmo quando o edema e a ascite não estão evidentes.…”

Section: Resultsunclassified

Nutritional evaluation of children with cholestatic diseases

Cardoso¹,

Porta²,

Vieira³

1997

J Pediatr (Rio J)

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Objetivo: Caracterizar o grau de desnutrição e a utilidade dos índices antropométricos em crianças com doença crônica do fígado.Métodos: Foram examinados 11 pacientes, com idades variando de 5 a 105 meses. A definição do estado nutricional se fez através da determinação dos escores Z de peso para a idade (P/I) e estatura para a idade (E/I). Também se avaliou o estado nutricional através do critério de Waterlow: comparação do peso do paciente com o peso ideal para a estatura (P*), e estatura do paciente em relação à estatura ideal para a idade (E*). A estimativa dos depósitos de gordura foi feita através da medida da prega cutânea tricipital (PCT), e aquela do teor protéico do organismo, através da circunferência muscular do braço (CMB). A avaliação da ingestão alimentar, tanto qualitativa como quantitativamente, foi feita pelo método do recordatório de 24 horas.Resultados: Os escores Z médios de peso/idade (-1,18) e de estatura/idade (-1,26) foram inferiores a um desvio padrão da média, enquanto o escore Z médio de peso /estatura (0.8) situou-se numa faixa normal. A avaliação pelo método de Waterlow mostra uma média normal de P* e um pouco abaixo do normal de E*. Apenas 3 pacientes tinham medida de PCT maior que o percentil 15, e 5 deles tinham as medidas de CMB maior que esse mesmo percentil. A ingestão alimentar do ponto de vista qualitativo foi adequada em apenas 4 dos pacientes. Quanto à distribuição calórica dos nutrientes, em todos ela foi inadequada.Conclusões: A determinação dos escores Z permite caracterizar esse grupo de pacientes como desnutridos crônicos, com uma média de escore Z de P/E dentro da faixa do normal. O diagnóstico nutricional feito através do método de Waterlow aponta para a necessidade de se ter cautela na sua interpretação, uma vez que esses pacientes geralmente têm visceromegalia. O escore Z médio da prega cutânea tricipital foi o parâmetro que melhor refletiu o comprometimento nutricional dos pacientes. Do ponto de vista alimentar, considerando-se o fator de risco da patologia, tanto qualitativa como quantitativamente, a ingestão mostrou-se inadequada. J. pediatr. (Rio J.). 1997; 73(1):43-50:antropometria, avaliação nutricional, doença crônica do fígado, colestase. AbstractObjective: To characterize the type of malnutrition and to determine the usefulness of anthropometric indices in children with chronic liver disease (CLD) Methods: 11 children (aged 5 -105 mo) with CLD underwent anthropometric evaluation when they were clinically stable. The nutritional evaluation was made by the determination of Weight/ Age (W/A), Height/Age (H/A) and Weight/Height (W/E) Z scores. The nutritional evaluation by Waterlow's method was also made. The fat and protein body deposits were estimated by triceps skinfold and midarm muscular circumference measurements. The analysis of the 24-hour recall was used to evaluate the quality and pattern of the feeding. Results:The mean weight / age (W/A = -1.18) and height / age (H/A = -1.26) Z scores were depressed under 1 SD, whereas mean weight / height (W/H) Z...

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Section: Resultsunclassified

Nutritional evaluation of children with cholestatic diseases

Cardoso¹,

Porta²,

Vieira³

1997

J Pediatr (Rio J)

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“…Although the first step is to increase the caloric density of the formula (for infants, this is seldom sufficient alone), nighttime drip feedings through either a nasogastric or nasojejunal tube may be successful in some children who can tolerate the additional volume of feedings without increasing either ascites or emesis. [9][10][11] However, supplemental enteral feedings still may not suffice, and the best option is often parenteral nutrition. The parenteral route allows for tight control of fluid and sodium, as well as delivered calories, and also allows for efficient vitamin supplementation.…”

Section: Pretransplantation Managementmentioning

confidence: 99%

“…Long-term antihypertensive medication may be required. 87 (9) Both cyclosporine and tacrolimus affect renal tubular function; potassium retention and magnesium and bicarbonate wasting are the most common problems. These electrolytes must be routinely assessed, and supplementation of both bicarbonate and magnesium may be required, even years after transplantation.…”

Section: Monitoring For Long-term Complications Of Immunosuppressionmentioning

confidence: 99%

Management of the pediatric liver transplant patient

McDiarmid

2001

Liver Transplantation

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Key Points 1. In pretransplant management, the prevention and treatment of malnutrition is essential for pediatric patients as malnutrition is associated with both increased pre-and posttransplant mortality. 2. Technical complications, particularly hepatic artery thrombosis, after pediatric liver transplantation are relatively common given the small size of the majority of the recipients. Early recognition is essential to reduce the associated increased risk for both patient and graft loss. 3. Immunosuppression regimens in children should aim to begin weaning of steroids within the first year after transplant because of their detrimental impact on growth. 4. Long-term immunosuppression strategies must focus on avoiding the risks of long-term immunosuppression, particularly nephrotoxicity, neurotoxicity, de novo malignancy, and late infections. 5. EBV-associated PTLD is a special problem for young pediatric liver recipients. Strategies for prevention and preemptive management are essential. 6. Noncompliance in teens is a particular problem and is associated not only with graft dysfunction, but also with graft loss and patient death. Recognizing teens at risk and providing intervention strategies require a multi-disciplinary approach. (Liver Transpl 2001;7:S77-S86.)

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“…However, salt restriction below 2 g/d is not palatable for many children, and caloric intake is further reduced to unacceptable levels. Nighttime enteral feeding via a nasogastric tube is necessary in some patients to achieve adequate growth [2]. Fat-soluble vitamin deficiency is common among children with chronic liver disease.…”

Section: Malnutritionmentioning

confidence: 99%

End-stage liver disease in children

Squires

2001

Curr Treat Options Gastro

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The treatment of children with end-stage liver disease involves the coordinated management of nutritional deficiencies, ascites, pruritus, encephalopathy, and portal hypertension. The implementation of management strategies depends upon a parent or guardian to administer the plan in the context of a child at different stages of developmental, physiologic, emotional, and physical maturity. Fat-soluble vitamins (A, D, E, and K) and micronutrient levels should be monitored routinely and supplemented if deficient. In some patients, supplemental nutrition to provide additional energy and protein is needed to ensure optimal growth and development. Ascites often respond to spironolactone and sodium restriction, but may require the addition of a loop diuretic or even abdominal paracentesis. Pruritus significantly impairs the quality of life of patients and is typically treated with ursodeoxycholic acid, rifampin, or an antihistamine. Partial biliary diversion, or liver transplant in some instances, is necessary for patients with self-mutilating pruritus that results from intrahepatic cholestasis. Hepatic encephalopathy is poorly defined in infants and small children. Elevated serum ammonia serves as a surrogate marker for encephalopathy, which is treated with dietary protein restriction and lactulose. The usefulness of medical prophylaxis for esophageal varices has been noted in adults, though such studies have not been performed in children. If variceal bleeding becomes problematic, treatment with endoscopic variceal banding or sclerotherapy is indicated. A surgical shunt to reduce portal pressure is needed in some cases. Orthotopic liver transplant ultimately may be necessary to overcome the unrelenting consequences of end-stage liver disease.

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Improvement of Nutritional Status in Cholestatic Children with Supplemental Nocturnal Enteral Nutrition

Cited by 38 publications

References 0 publications

Nutritional evaluation of children with cholestatic diseases

Nutritional evaluation of children with cholestatic diseases

Management of the pediatric liver transplant patient

End-stage liver disease in children

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