Nutritional Basis of Growth Failure in Children and Adolescents with Crohn's Disease

Kelts, Drew; Grand, Richard J.; Shen, Grace Yen; Watkins, John B.; Werlin, Steven L.; Boehme, Carol

doi:10.1016/s0016-5085(79)80171-7

Cited by 214 publications

(50 citation statements)

References 30 publications

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“…In malnourished children, this rate of heme-protein uptake is likelv to be altered, and iron utilization will be poor. [11][12][13][14][15][16][17][18][19][20][21] Adverse reactions to parenteral iron are well reported, but data available suggest a low order of frequency.…”

Section: Discussionmentioning

confidence: 99%

Iron‐Deficiency Anemia in Childhood Inflammatory Bowel Disease: Treatment with Intravenous Iron‐Dextran

Halpin

Bertino

Rothstein

et al. 1982

J Parenter Enteral Nutr

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A prospective protocol for iron replacement was used in six children with severe inflammatory bowel disease who had iron-deficiency anemia. All were given a single totaldose infusion of iron-dextran after a taper of the parenteral nutrition solution. Each had hematologic and biochemical correction of their iron-deficiency anemia. As outlined, intravenous iron-dextran appears to be a safe, efficacious, and practical method of iron repletion in children with inflammatory bowel disease who require prolonged parenteral nutrition and bowel rest.Iron-deficiency anemia is a common finding in both adults and children with severe inflammatory bowel disease (led).1. '' This deficiency is exaggerated in the child with Crohn's disease and chronic ulcerative colitis. Ongoing heme-protein losses from inflamed bowel, poor nutritional intake, and the increased mineral needs of the growing child often lead to profound deficiencies of iron. In severe inflammatory bowel disease accompanied by anorexia, vomiting and weight loss, parenteral nutrition (PN) has been employed for short-and intermediateterm nutritional support.'3 Yet, present recommendations preclude the inclusion of iron in parenteral nutrition solutions.'The use of intramuscular iron-dextran has been an effective means of iron repletion in those children unable to ingest iron salts. However, in the sick child with IBD, lack of adequate muscle bulk and pain at the site of multiple injections complicate replacement therapy. The use of intravenous iron-dextran (IVID) would appear to circumvent these problems. Considerable experience with the use of IVID has been gained in adults, and it appears to be a safe and efficacious means of iron repletion.5-' Despite beliefs of excess toxicity, the use of IVID in children has not been associated with problems, although most studies have been performed in developing countries.'-&dquo;) The present prospective protocol was designed to assess the safety and efficacy of IVID in children with iron-deficiency anemia. MATERIALS AND METHODSSix children (age 6-15 yr, four girls, two boys) with newly diagnosed Crohn's disease (3) and chronic ulcerative colitis (3) were begun on PN solution to achieve a minimum of 60 kcal/kg/day.&dquo; Caloric support was designed to achieve ideal standard weight-for-admission height. Clinical and laboratory profiles are listed in Tables I and II. As a group, children were greater than 15% below ideal weight-for-height ratio. All children with inflammatory bowel disease had activity indices which placed them into the moderate to severe category. Historical clinical and laboratory parameters used to calculate the &dquo;disease activity index&dquo; are listed in Table III. 12 After evaluation and diagnosis, all children were begun on prednisone (1.5 mg/kg/day). Nutritional status was monitored weekly, and IVID was given after normalization of serum proteins. All children had normal values of serum folate, vitamin B12, and vitamin E prior to IVID infusion. No child had received a blood transfusion before therap...

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Section: Discussionmentioning

confidence: 99%

Iron‐Deficiency Anemia in Childhood Inflammatory Bowel Disease: Treatment with Intravenous Iron‐Dextran

Halpin

Bertino

Rothstein

et al. 1982

J Parenter Enteral Nutr

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“…Several early studies reported that dietary intake is chronically insufficient in the majority of severely growth-retarded children with CD. 56,57 Animal studies showed that anorexia may result from an adverse interaction of circulating IL-1 with 1 or more of the central nervous system feeding pathways. 58 A number of approaches have been taken for the therapy for growth failure in IBD in children.…”

Section: Lesson 6: Growth Failure Is Common In Children With Ibd Espmentioning

confidence: 99%

Pediatric Inflammatory Bowel Disease: What Children Can Teach Adults

Hait

Bousvaros

Grand

2005

Inflammatory Bowel Diseases

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“…Current evidence supports the hypothesis that malnutrition is the primary cause of growth retardation in IBD. A low daily intake of energy was found in studies from Chicago and Boston (6,7). Protein-losing enteropathy is detected in most chil-* For definition of this and other unfamiliar terms, please see His symptoms started at the age of 8.7 years.…”

Section: Etiology Of Growth Retardation In Ibdmentioning

confidence: 99%

Mechanisms of growth retardation, drug therapy, and nutritional support in pediatric inflammatory bowel disease: A workshop sponsored by the North American and eUropean societies for pediatric gastroenterology and nutrition

Ferry¹,

Büller²,

Hildebrand³

et al. 2007

Inflamm Bowel Dis

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Growth retardation is common in children with inflammatory bowel disease (IBD). The most sensitive measure of impaired growth, growth velocity, is abnormal in 65% of children with Crohn's disease. With treatment, growth velocity may return to normal, but catch‐up growth is often incomplete and ultimate height lower than predicted In some patients delayed puberty may compensate for poor growth earlier in life, and there is good evidence that even after menarche, significant growth can occur. Surgery may have a favorable impact on growth in the short term, but final height often remains reduced. The mechanism for growth failure in IBD is thought to be related to both prolonged periods of suboptimal nutritional intake and persistent inflammation. Growth throughout childhood is dependent on growth hormone and insulin‐like growth factors (IGF). At puberty, androgens and estrogens also play a significant role in normal growth. Both malnutrition and inflammatory bowel disease result in low levels of IGF‐1. With recovery, levels return to normal. Although little work has been done to measure the effects of chronic maintenance drug therapy on growth, it is known that children taking alternate‐day prednisone grow normally and can exhibit catch‐up growth. Nutritional therapy with tube feeding of elemental diets also improves nutrition and decreases inflammation. Children with either small‐bowel Crohn's or Crohn's ileocolitis respond to tube feedings of both elemental or semielemental diets.

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Nutritional Basis of Growth Failure in Children and Adolescents with Crohn's Disease

Cited by 214 publications

References 30 publications

Iron‐Deficiency Anemia in Childhood Inflammatory Bowel Disease: Treatment with Intravenous Iron‐Dextran

Iron‐Deficiency Anemia in Childhood Inflammatory Bowel Disease: Treatment with Intravenous Iron‐Dextran

Pediatric Inflammatory Bowel Disease: What Children Can Teach Adults

Mechanisms of growth retardation, drug therapy, and nutritional support in pediatric inflammatory bowel disease: A workshop sponsored by the North American and eUropean societies for pediatric gastroenterology and nutrition

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