Decreased neutrophil oxidative burst activity in children with failure to thrive - a pilot study.

Failure to thrive (FTT) is a broad term that is used to document an abnormal pattern of weight gain over time. There is no single definition for FTT, but all proposed definitions use anthropometric parameters such as weight gain or weight for length. The term FTT has been falling out of favor, and the term weight/growth faltering is becoming more common to describe this clinical entity. The underlying problem in FTT is inadequate usable calories. The primary mechanisms leading to FTT are impaired absorption, increased metabolic demands, and inadequate caloric intake. Inadequate caloric intake is the most common of these mechanisms, although FTT is often a combination of the three. The diagnostic evaluation of FTT must take into account the multifactorial nature of this clinical sign. A comprehensive history is essential for diagnosis and should include specific questions about the child’s living situation and feeding habits. The physical examination must include accurate weight and length measurements. Clinicians should look for signs of abuse or neglect, dysmorphic features, abnormal skin or nail findings, digital clubbing, or other signs of chronic disease. Laboratory investigations are rarely revealing in FTT but should be considered if there is a high index of suspicion for underlying disease. Treatment in FTT favors a multidisciplinary approach. The primary goal of treatment is restoration of normal growth velocity. Children with FTT are at increased risk for growth and cognitive problems in later childhood, although the clinical significance of these findings is not well understood. The mainstay of treatment is increasing calories in the diet. Enteral feeding, orally or via a tube, is always preferred over parenteral feeding due to a better safety profile, ease of feeding, and lower cost. Parenteral nutrition is an acceptable way to meet caloric needs in infants and children when enteral nutrition is not possible. Children with FTT and malnutrition should be monitored closely for refeeding syndrome, which results from fluid and electrolyte shifts in malnourished children. In general, FTT can be treated on an outpatient basis with close follow-up. Indications for hospitalization include severe malnutrition/dehydration and concern for child endangerment. This review contains 7 figures, 8 tables and 26 references Key words: enteral feeding, failure to thrive, growth charts, nutrition, parenteral nutrition, poor weight gain, tube feeding, weight loss

Failure to thrive (FTT) is a broad term that is used to document an abnormal pattern of weight gain over time. There is no single definition for FTT, but all proposed definitions use anthropometric parameters such as weight gain or weight for length. The term FTT has been falling out of favor, and the term weight/growth faltering is becoming more common to describe this clinical entity. The underlying problem in FTT is inadequate usable calories. The primary mechanisms leading to FTT are impaired absorption, increased metabolic demands, and inadequate caloric intake. Inadequate caloric intake is the most common of these mechanisms, although FTT is often a combination of the three. The diagnostic evaluation of FTT must take into account the multifactorial nature of this clinical sign. A comprehensive history is essential for diagnosis and should include specific questions about the child’s living situation and feeding habits. The physical examination must include accurate weight and length measurements. Clinicians should look for signs of abuse or neglect, dysmorphic features, abnormal skin or nail findings, digital clubbing, or other signs of chronic disease. Laboratory investigations are rarely revealing in FTT but should be considered if there is a high index of suspicion for underlying disease. Treatment in FTT favors a multidisciplinary approach. The primary goal of treatment is restoration of normal growth velocity. Children with FTT are at increased risk for growth and cognitive problems in later childhood, although the clinical significance of these findings is not well understood. The mainstay of treatment is increasing calories in the diet. Enteral feeding, orally or via a tube, is always preferred over parenteral feeding due to a better safety profile, ease of feeding, and lower cost. Parenteral nutrition is an acceptable way to meet caloric needs in infants and children when enteral nutrition is not possible. Children with FTT and malnutrition should be monitored closely for refeeding syndrome, which results from fluid and electrolyte shifts in malnourished children. In general, FTT can be treated on an outpatient basis with close follow-up. Indications for hospitalization include severe malnutrition/dehydration and concern for child endangerment. Key words: enteral feeding, failure to thrive, growth charts, nutrition, parenteral nutrition, poor weight gain, tube feeding, weight loss

Is it X-Linked or autosomal recessive chronic granulomatous disease?

To evaluate the effect of plasma transfusion on phagocytosis and oxidative burst activity of peripheral blood neutrophils from healthy and septic equine neonates with sub-optimal passive transfer of maternal immunity. Nine healthy and seven septic foals with suboptimal passive transfer of maternal immunity (serum IgG < 8 g/L) presented to participating veterinary hospitals for plasma transfusion, and seven healthy foals less than 7 days of age and with circulating IgG concentrations > or = 8 g/L. Foals with serum IgG concentrations < 8 g/L were assessed as healthy or septic. Sepsis was recognised by positive bacterial cultures and/or sepsis scores of > or = 11. All foals received between 1 and 3 L of plasma to boost circulating IgG concentrations to > or = 8 g/L. Serum IgG concentrations were determined before and following transfusion by glutaraldehyde coagulation test and confirmed by single radial immunodiffusion assays. Neutrophil phagocytosis and oxidative burst activity were determined before plasma transfusion and at 0 h, 12 h, 24 h, 48 h and 5 d following treatment. Neutrophil function from seven healthy foals less than 7 d of age and with circulating IgG concentrations of > or = 8 g/L was similarly evaluated on a single occasion. Plasma treatment significantly increased circulating IgG concentrations for healthy and septic foals. Oxidative burst activity of neutrophils from septic foals was significantly increased 5 days following treatment, relative to 0 h post treatment. Other differences were not significant but suggested a transient decrease in phagocytosis by neutrophils from healthy foals and increased phagocytosis by neutrophils from septic foals immediately following transfusion. Oxidative burst activity of neutrophils from septic foals tended to be less than that of healthy foals at all sampling times. Serum IgG concentrations were not correlated with neutrophil phagocytosis, but were correlated with oxidative burst activity. Plasma transfusion did not improve neutrophil function of healthy foals, suggesting that such treatment may be of equivocal benefit for healthy neonates. Conversely, improved neutrophil function was observed following treatment of septic foals, suggesting that plasma transfusion was beneficial for these foals. Oxidative burst activity of neutrophils from septic foals was lower than that of neutrophils from healthy foals and was significantly improved 5 days post treatment, when compared with values obtained immediately following treatment.

Early childhood diarrhoea is a major cause of infant morbidity and mortality in developing countries. Recurrent and persistent diarrhoea affect growth and cognition in children as young as 6 years. To evaluate the effect of early childhood cryptosporidial and giardial diarrhoea on growth and development in children in a semi-urban slum in India. This is the first report of such assessment at 3 years of age. This study was undertaken on 116 children who were part of an ongoing birth cohort study (n=452) of rotaviral and cryptosporidial diarrhoea between June and December 2005. Social quotients (SQ) assessed by the Vineland Social Maturity Scale, intelligence quotients (IQ) assessed by the Seguin Form Board Test, physical growth parameters and sociodemographic data in 84 children with a history of cryptosporidial or giardial diarrhoea were compared with those of 32 without diarrhoea. Children with a past history of giardial diarrhoea showed a trend towards lower SQ (p=0.09) and had significantly lower IQ (p=0.04) and increased wasting (p=0.04). Cryptosporidial diarrhoea was not associated with poor IQ, SQ or physical growth. This study demonstrates the long-term effect of protozoan diarrhoea, especially that caused by giardia, on both intelligence and physical growth in Indian children as early as 3 years of age and re-inforces the need for early detection and prevention of early childhood protozoan diarrhoea.

Since past 6 million years, humans and their ancestors have been walking on this biosphere. As the humans developed so does the environment, and along with them myriad diseases, disorders as well different medical conditions also flourished. Covid-19 is one of the recent and well know example of the pandemic viral diseases. Every year thousands of humans succumbed to death who were suffering from different diseases or disorders. But comparatively, the death rate of the affected persons from diseases or disorders is more than those who are suffering from some medical conditions. One of that is Failure to Thrive which is mostly referred as FTT. In general practice, FTT is commonly used for any child who fails to gain weight or height according to standard medical growth charts. FTT occurs when a child is either not receiving adequate calories or is unable to properly utilize the calories that are given, resulting in failure to grow or gain weight over a period. About 3% - 5% of children admitted to hospitals suffers from this condition. The FTT is of two types, one is “organic” and other one is “non-organic”. Organic FTT refers to growth failure caused by an acute or chronic medical illness that interferes with regular food intake, absorption, or digestion of food, or by a higher calorie need to keep up with or aid growth. Whereas most babies with FTT do not have a specific underlying disease or medical condition to account for their growth failure. This is referred to as Non-organic FTT. Up to 80% of all children with FTT have non-organic type FTT. Non-organic FTT most commonly occurs when there is inadequate food intake or there is a lack of environmental stimuli. Lack of food intake owing to the issues with feeding procedures, or an insufficient supply of breast milk are all examples of non-organic FTT. The best indication of nutritional status is weight. Obtaining your child's height is also vital; however, a single height measurement is less useful for the diagnosis of FTT than numerous height measures taken over time. Linear growth may be impacted in malnourished children, although this typically reflects a protracted period of low nutrition. Majority of children with non-organic FTT exhibit growth failure in their first year of life and seek medical attention around the age of six months. The time of presentation in children with organic FTT is more varied and depends on the child's underlying medical condition. Treatment The treatment of failure to thrive is determined by the child's age, the related symptoms, and the underlying cause of the poor growth. The general objective of therapy is to offer appropriate calories and any additional assistance required to encourage child's growth. If the kid is experiencing organic failure to thrive, extra therapy may be required to treat the underlying medical issue. Intestinal problems, for instance, might result in inadequate dietary absorption and failure to flourish. In that case, a particular diet may be required. Failure to thrive can occur in twins or triplets simply because multiple births are more difficult to care for and are more demanding to the feed. Premature births are more likely to have FTT because many of the physiological and biochemical processes are still immature at the birth. Lung or heart illness, particularly in very young babies, can make feedings difficult, resulting in low calorie intake and failure to grow.

Objective: To investigate and analyze the status of physical growth and its change in children under 7 years of age in 9 cities of China, and to provide scientific data for renewing and developing the new growth reference of Chinese children. Methods: Data of healthy children under 7 years of age were collected by stratified cluster sampling method in Beijing, Harbin, Xi'an, Shanghai, Nanjing, Wuhan, Guangzhou, Fuzhou and Kunming during the period from June to November in 2015. They were divided into 22 age groups. The sample size of boys or girls, urban or suburban was 150-200 in each age group in each city, and the total sample size in the 9 cities was 161 774. Weight, length/height, head circumference, sitting height, chest circumference and waist circumference were measured by the trained investigators using standard methods. There were strict quality control measures during investigation process. The t test was used to compare the difference of physical growth between two groups and one-way ANOVA was used to compare the difference of physical growth among three groups. Results: (1) The level of physical growth of children under 7 years were different between boys and girls, urban and suburban, as well as different regions of China in 2015. The urban-suburban difference was more significant in children older than 8 months, that is, the weight and height of urban children were greater than those of suburban children (0.01-0.48 kg and 0.1-1.1 cm respectively). (2) Weight and height of children in the 9 cities, whether urban or suburban areas, had been greater than WHO growth standards, for example, the Z-scores of height values of urban and suburban children were 0.43 ±0.99 (t=130.551, P<0.05) and 0.30 ±1.01 (t=87.407, P<0.05) higher than the WHO standards. (3) The physical growth of children in the 9 cities was improved in varying degrees during the past 10 years. For example, the changes of weight and height in urban children under 3 years were not significant, while there was significant improvement among children older than 3 years and the increasing trend became apparent along with the increasing of age (0.05-1.18 kg in weight and 0.5-1.8 cm in height). The urban-suburban difference of physical growth in each age group of boys and girls narrowed significantly during the past 10 years, which was clearly shown from the narrowing urban-suburban differences of weight and height in boys aged 5.5-<6.0 years (1.58 kg in 2005 vs. 0.44 kg in 2015 and 2.8 cm in 2005 vs. 0.9 cm in 2015) . (4) From the increments of each decade during 1975-2015, a rapid increments of physical growth during 1975-2005 were found, while the increments after 2005 had slowed comparing with that of the previous period in urban areas, for example, the increments of height in boys aged 5.5-<6.0 years were 1.5, 2.1, 2.7, 0.7 cm respectively in the 1(st), 2(nd), 3(rd) and 4(th) decade (1975-1985, 1985-1995, 1995-2005, 2005-2015) . In suburban areas, the trends of the previous 3 decades were similar with that of urban children, while the increments of the 4(th) decade were still bigger though they were slightly smaller than those of the 3(rd) decade, for example, the increments of height in boys aged 5.5-<6.0 years were 2.4, 2.3, 3.2, 2.6 cm in the 1(st), 2(nd), 3(rd) and 4(th) decade respectively. Conclusions: Physical growth of children under 7 years of age showed a slow positive secular trend during the last decade after a rapid increase. The increments of suburban children's physical growth were greater than those of urban children. The physical growth of children under 7 years in 9 Chinese cities exceeded the WHO standards.

Failure to thrive (FTT) is a common and potentially serious growth problem identified in the first three years of life, affecting 5% to 10% of children seen in the primary care setting (Schwartz, 2000). It accounts for 5% to 10% of referrals to (Daniel et al., 2008) and 1% of hospital admissions in tertiary care centers (Berwick et al., 1982). Although FTT is relatively common, there seems to be no consensus regarding its definition (Raynor & Rudolf, 2000). The term is most often used to describe persistently inadequate linear growth and/or weight gain within the first three years of life (Schwartz, 2000). FTT is a sign or finding rather than a diagnosis since it simply represents an abnormal growth pattern in young children. The underlying condition causing FTT might be difficult to determine, requiring a thorough history and physical examination with special attention to dietary and psychosocial factors. It requires close monitoring by the primary physician. Poor growth or poor weight gain in children may be due to a variety of medical or psychosocial problems. Therefore, monitoring growth is an invaluable tool for primary care physicians and should be done vigilantly at every well-child visit. Growth charts are useful in comparing a child to appropriate standards for age, sex and ethnic background. If any abnormality in the growth pattern is detected, necessary measures should be undertaken to ensure appropriate evaluation for and treatment of any underlying condition. Long-term FTT without significant underlying organic etiology has been shown to negatively impact neurodevelopmental outcome (Hufton et al., 1977). Studies have shown that five to eight years after a FTT diagnosis these children show disorders of personality trait, have decreased educational attainment and demonstrate lower IQ’s despite having average anthropometric parameters at the time of evaluation (Hufton, et al., 1977). Therefore, early diagnosis and intervention are believed to be key factors in improving outcome in children with FTT (Casey et al., 1994). In the absence of effective treatment, children with FTT may develop irreversible cognitive and behavioral disorders that seem to correlate with the severity and duration of the FTT. However, other studies have reached the opposite conclusion. In a review and analysis of thirteen studies, there seemed to be no significant difference in the IQ of patients with failure to thrive compared to the general population (Wright et al., 1998). This discrepancy in outcome is probably due to the lack of large, randomized, controlled studies in children with FTT.

Children of today are the citizens of tomorrow. Childhood is the period of rapid change in developmental, social, emotional, cognitive and linguistic abilities of the child. The mother continues to be the main person who cares for children. Employment of women has created number of problems for the development of children. A comparative study was conducted to assess the physical growth in children of working and non- working mothers in a selected community, Ludhiana, Punjab with objectives: To assess the physical growth in children of working and non- working mothers, To compare the physical growth in children of working and non-working mothers, To assess and compare the relationship of physical growth in children of working and non-working mothers with selected demographic variables and to prepare pamphlets. A non-experimental, comparative study was conducted in selected community of Ludhiana. The target population was children (3–5 years) of working and non- working mothers. 60 children were selected by purposive sampling technique. Data was collected by using self structured proforma. Data was analyzed by using descriptive and inferential statistics and presented through tables and figures. Findings revealed that majority of children of Non- working mothers had normal physical growth as compared to children of working mothers. While comparing the physical growth in children of working and non-working mothers three parameters of physical growth that is weight for age, height for age and mid arm circumference were found statistically significant and body mass index was found statistically non significant. In demographic variables mother's age, child's gender, birth order, and Type of Family had an impact on Weight for age, birth order had some impact on height for age. Family income had an effect on mid arm circumference and mother's age had impact on body mass index of children.

Diencephalic syndrome (DS) is a rare syndrome with failure to thrive (FTT) as the primary manifestation, which is often associated with astrocytoma or glioma and rarely caused by germinoma. To our knowledge, there are no reports of female patients presenting with DS secondary to germinoma. we report a case (an 11-year-old girl) of diencephalic syndrome presenting with FTT. She was diagnosed with severe malnutrition in the local hospital two years before admission and still did not show normal development after long-term nutritional support. Finally, after ruling out increased metabolism, inadequate caloric intake, and nutrient absorption, intracranial MRI showed a space-occupying lesion in the suprasellar cisterna-hypothalamus area. After excluding other causes of FTT, a biopsy was performed for pathological examination and demonstrated a germinoma. An excellent therapeutic effect was achieved during the three-month follow-up after radiotherapy. This case reminds us that intracranial tumors should be considered an indispensable etiology for patients with suspicious FTT, and early diagnosis and intervention may achieve a good prognosis.

Failure to thrive (FTT) is an inadequate growth in young children. It can increase the risk of overweight or obesity later in life. Patients with renal tubulopathies can present FTT due to solute losses in the urine. We aimed to test our hypothesis that children with tubulopathies have an increased risk of overweight and obesity due to rebound following FTT that could complicate these conditions. We enrolled 26 patients with tubulopathies and evaluated for the first time within the first 12 months of life (mean age: 4.8 months ± 2.6 SDS). FTT was evident in 17 out of 26 patients (65.4%). The mean age at the last follow-up was 14.1 years ± 5.5 SDS. The mean age at overweight/obesity onset was 9.0 years ± 3.6 SDS. The prevalence of overweight/obesity was 73.1% (19/26). Among the patients with FTT, 15 (88.2%) developed overweight/obesity compared to 4 out of the 9 patients (44.4%) without FFT (p = 0.028). The presence of FTT determined an OR for obesity/overweight of 9.4 (95% CI: 1.3-67.6; p = 0.026). FTT continued to be significantly associated with obesity/overweight also after adjustment for preterm birth and birth weight <10th percentile (OR = 23.3; 95% CI: 1.95-279.4; p = 0.01). In conclusion, in our series, patients with tubulopathies presented an increased risk of overweight/obesity due to the FTT that can complicate these conditions.

Phagocytic and Oxidative Burst Activity of Neutrophils in Patients With Spinal Cord Injury

To evaluate the phagocytic activity and neutrophil oxidative burst in liver cirrhosis. In 45 patients with advanced postalcoholic liver cirrhosis (aged 45+/-14 years) and in 25 healthy volunteers (aged 38+/-5 years), the percentage of phagocytizing cells after in vitro incubation with E. coli (Phagotest Kit), phagocytic activity (mean intensity of fluorescence, MIF) and the percentage of neutrophil oxidative burst (Bursttest Kit), and the level of free oxygen radical production (MIF of Rodamine 123) were analyzed by flow cytometry. The levels of soluble sICAM-1, sVCAM-1, sP-selectin, sE-selectin, sL-selectin, and TNF-alpha were determined in blood serum. The percentage of E. coli phagocytizing neutrophils in liver cirrhosis patients was comparable to that in healthy subjects. MIF of neutrophil -- ingested E. coli was higher in patients with liver cirrhosis. The oxidative burst in E. coli phagocytizing neutrophils generated less amount of active oxygen compounds in liver cirrhosis patients (MIF of R123: 24.7+/-7.1 and 29.7+/-6.6 in healthy, P<0.01). Phorbol myristate acetate (PMA) -- stimulated neutrophilsproduced less reactive oxidants in liver cirrhosis patients than in healthy subjects (MIF of R123: 42.7+/-14.6 vs 50.2+/-13.3, P<0.01). A negative correlation was observed between oxidative burst MIF of PMA-stimulated neutrophils and ALT and AST levels (r -0.35, P<0.05; r-0.4, P<0.03). sVCAM-1, sICAM-1, sE-selectin concentrations correlated negatively with the oxygen free radical production (MIF of R123) in neutrophils after PMA stimulation in liver cirrhosis patients (r-0.45, P<0.05; r-0.41, P<0.05; r-0.39, P<0.05, respectively). Neutrophil metabolic activity diminishes together with the intensification of liver failure. The metabolic potential of phagocytizing neutrophils is significantly lower in liver cirrhosis patients, which can be one of the causes of immune mechanism damage. The evaluation of oxygen metabolism of E. coli-stimulated neutrophils reveals that the amount of released oxygen metabolites is smaller in liver cirrhosis patients than in healthy subjects.

Failure to thrive (FTT) is a term commonly used to characterize slower-than-expected weight gain. While inadequate caloric intake is the predominant cause, failure to thrive is a manifestation of undernutrition often resulting from the interplay of multiple etiologies. This case highlights the diagnosis and management of an infant who presented with recurrent large-volume emesis and poor weight gain secondary to esophageal compression from an aberrant right subclavian artery (ARSA).

Introduction: Hyper IgM (HIGM) syndrome is a rare kind of primary Immunodeficiency disease (PID) characterized by normal to the increased serum IgM and very low or undetectable IgG, IgA, and IgE. Broad spectrum of clinical manifestations and laboratory findings are observed in the HIGM patients including hematologic problem and malignancy. This study was conducted to assess demographic data, clinical manifestation, and immunological findings in the HIGM patients. Methods: Lab findings and clinical presentations data of 79 Iranian patients diagnosed with HIgM syndrome were collected. All the patients were classified into two different groups including the patients with hematological problems and those without hematological problems. Results: Hematologic problems were observed in 34 patients (43%, 23 males and 11 females). The most common hematologic problems types were anemia and leukemia (33 and 25%, respectively). Also, 19 patients (24.1%) had a family history of PID. Significant data that were higher in the patients with hematologic problems, were the oral ulcer (p=0.037), failure to thrive (p=0.022), recurrent diarrhoea (p=0.021), chronic diarrhoea (p=0.022), urinary tract infections (p=0.037), anemia (p=0.000), neutropenia (p=0.000), thrombocytopenia (p=0.001), gastrointestinal problem (p=0.011), neurologic problem (p=0.000), multiple site problem (p=0.000), platelet count (p=0.005), and IgG level (p=0.048).Conclusion: The association between HIgM syndrome and hematologic problems could lead to severe clinical disorders. Therefore, it is necessary for immunologists to be aware of these situations.