Malnourished Infants Research Articles

The World Stops for the Hungry

The threat of intellectual impairment in malnourished infants has been a political petard breaking down resistance to maternal and child welfare feeding programs. That the case has frequently been overstated in the heat of political debate and rhetoric of presidential messages is forgivable in light of the social progress which has ensued. Until recently, it has been politically fashionable to dogmatically equate malnutrition in childhood with physical and mental retardation. It is true that severe undernutrition during the latter stages of pregnancy and the first few months of life will jeopardize mental and physical development. In an older child, however, nutritional deprivation may create only a maturational lag; ie, with time, the child may overcome the handicap. Malnutrition as a deterrent to social progress should not be taken lightly. Malnutrition can be involved directly or indirectly in the initiation and perpetuation of a disheartened, listless segment of a population, thus

Metabolic and Hormonal Responses to Glucose and Glucagon in Patients with Infantile Malnutrition

Extract: The interrelations of plasma levels of glucose, free fatty acids (FFA), α-amino nitrogen (α-aaN), insulin, and growth hormone (GH) were studied in 26 malnourished infants shortly after admission to the hospital and again several weeks later when they had recovered. In the sick children (SC) fasting levels of FFA and GH were high, and insulin and α-aaN were low; with recovery FFA, α-aaN and insulin levels became normal, and GH levels fell. No change occurred in glucose levels. Ten infants were given glucose (0.5 g/kg body weight) intravenously on the 1st or 2nd day after admission and again 6–12 weeks later. Glucose tolerance was impaired in the sick group and, although improved, was not normal when the children had recovered from the nutritional insult. Insulin secretion was stimulated by glucose in those that had recovered (RC), but not in the SC. No significant change occurred in either FFA or α-aaN levels in these groups. Nine infants received glucagon (0.1 mg/kg body weight) intravenously on the 2nd to 6th day after admission and again 6–12 weeks later. Glucagon caused a rise in glucose levels that were greater in RC than in SC but did not cause a significant change in insulin levels in either group. Free fatty acid levels were higher in SC throughout the test, but in both groups FFA levels responded similarly to glucagon administration, falling 10 and 60 min after the injection. Changes in GH levels in plasma after glucose or glucagon administration were compared with the changes caused by five venepunctures in RC. Venepunctures and glucose caused similar rises in GH levels, but glucagon caused a greater rise than either. It was concluded that the stress of repeated venepunctures caused a rise in GH levels in plasma in all three tests, but that, independent of this, glucagon stimulated GH secretion. Speculation: Insulin secretion is impaired in infantile malnutrition and does not improve at the same rate as clinical recovery occurs, suggesting that normal β cell function is not essential for rapid growth. The role of growth hormone in malnutrition is not clear, but it appears to be involved more in the metabolic adaptation to malnutrition than in the control of growth.

Dietary protein quality in infants and children. VI. Isolated soy protein milk.

Milks based on isolated soy protein enriched with dl-methionine are rapidly coming into common use in pediatric practice. The biological value of its protein has been measured at critical levels in the initial therapy of malnourished infants and children and during convalescence. Absorption and retention of nitrogen, as well as growth rates, were equivalent to those from modified cow's milk. Normal serum albumin levels were achieved and maintained, as were levels of fasting plasma amino acids, both indicative of dietary protein adequacy. These results confirm the enormous potential of isolated soy protein in human nutrition, particularly in the diet of those intolerant of milk proteins or lactose.

Diphenoxylate Hydrochloride Therapy in the Diarrhoea of Malnourished Infants

In a double-blind study on 45 malnourished infants with moderately severe non-specific diarrhoea, diphenoxylate hydrochloride proved to be an effective antidiarrhoeal agent when the diarrhoea was acute, but not as effective when the diarrhoea was chronic.

Generalized herpes simplex in malnourished children.

Five cases of fatal generalized herpes simplex infection in malnourished children are described. This is almost certainly a much more common disease in underdeveloped communities than is at present appreciated. Only a greater awareness of the disease, coupled with full use of histological and cultural methods of diagnosis, will lead to knowledge of its true frequency.A case of neonatal infection, the first recorded in an African, is also described. Reasons are suggested as to why this disease should be seen in malnourished infants in Africa but only very rarely in neonates.

Pattern of adverse events following immunization in nourished and malnourished infants in Kano, North-Western Nigeria

Background: Adverse events following immunization (AEFI) occur in both nourished and malnourished babies but are often mislabeled as manifestations or complications of background condition or disease especially among malnourished infants. Aim/Objective: To study the pattern of AEFIs in nourished and malnourished infants in Kano. Materials and Methods: Descriptive cross-sectional design was used to study 372 eligible infants aged 0–11 months old. All infants immunized in the first quarter of 2014 that had up to date immunization card qualified for the study. Data were analyzed using SPSS version 16.0. Results: The mean age of the infants was 3.5 ± 3.1 months, with male being 53.5%, and well nourished being 88.4%. Prevalence of AEFI was 33.1% (nourished), 48.8% (malnourished), and 34.9% overall. Fever occurred in 79.8% nourished and 95.2% malnourished infants. Localized pains and/or swelling occurred in 29.3% nourished and 47.6% malnourished, but abscess or ulceration around vaccination site occurred only in the nourished infants and was significantly associated with the 1st immunization visit. Most AEFI were experienced around the 1st three immunization visits. Majority of the AEFI, experienced, nourished (58.7%), and malnourished (52.4%), occurred within 1–11 h and was mild to moderate in severity in 99.1% and 100% of the respective groups. Conclusion and Recommendation: Focused research on vaccine formulation and safety, and recurrent training of immunization workers on vaccine administration, and early and prompt treatment of AEFI are paramount.

Antenatal malnutrition: Its relationship to subsequent infant and child development

Congenitally malnourished animals have shown more severe changes than those whose malnutrition was begun after birth. Critical periods of development in the brains of animals and human seem well-established. Malnutrition between the tenth and thirtieth weeks of gestation may result in permanent changes in reflexes with the later-developing ones disappearing first. Clinical and electroencephalographic evidence shows that brain function in children is affected by states of malnutrition; this dysfunction may persist following correction of the deficit. Vitamins have been shown to be of developmental importance. Maternal undernutrition or lack of weight gain has been associated with small-for-dates infants who subsequently have a poor developmental prognosis. In a study on malnourished infants from homes where malnourishment among the parents before and during pregnancy was most likely revealed: 1) abnormalities of EEG (presence of theta waves low voltage alpha-waves) 2) low IQ 3) a pattern similar to brain-injured children with a deficit of visual motor ability and pattern perception. The timing severity and duration of malnutrition markedly influence the quality extent and degree of reversibility of observed deficits. Persistence of malnutrition across generations appears to worsen outcome and prognosis at least in animal studies.

Infantile malnutrition. Changes in body composition during rehabilitation.

Extract: Total body water (TBW), intracellular (ICW) and extracellular (ECW) spaces, muscle mass and supporting tissue were measured in nine malnourished infants, 5–30 months of age, shortly after hospitalization, and then following 4–9 months of rehabilation. Initially all infants had server growth deficits, heights age being 4–64% (average 40%) and weight age 0–40% (average 15.6%) of chronologic age TBW ranged from 63.5 to 89.3% of body weight and ECW ranged from 38.6 to 50.6% of TBW, suggesting marked losses of cell mass and body fat with conservation of supporting tissues. Excretory levels of creatinine and hydroxproline ranged from 31 to 86 mg/24 h and from 10.3 to 28.5 mg/24 h, respectively. During rehabilitation all patients exhibited accelerated growth, height age becoming 28.6–69.1% (averange 58.8%) of chronologic age; most of the children become moderately obese. With the exception of one infant, who did not gain weight well hydroxyproline increased 45–360% over the intial values. TBW became 54.7–65% of body weight and ECW 41.8–55.9% of TBW. Proportionally smaller increase in metabolically active protoplasm, respresented by ICW, were exprienced in four infants under 11 months (average 25%, than in four of five infants over 11 months of age (average 67.5%); however; these four infants demonstrated proportionately greater gains in ECW (77 versus 36%). Determinations of blood sugar, growth hormone and insulin responses to arginine were made in five of these patients and in three additional infants. On admission, the levels of growth hormone in these infants were found to be elevated (11.5–18 ng/ml) and did not respond, to arginine injection; determination of blood sugar also showed elevated levels (119–182 mg/100 ml). One to three months later the response was usually normal. Insulin responses, initially and after partial rehabilitaion, were almost invariably blunted, with only one child, at 50 days, showing a rise to 45 ng/ml. It is apparent that growth during, recovery from malnutrition is neither a uniform process nor is it simply reinitiation of normal growth. Speculation: The apparently normal production of growth hormone and the impaired insulin, which was persistently demonstrated by these infants, along wiht the poor growth in cell mass of those under 11 months of age, suggest that gains in cell mass in the younger infant may be primarily dependent on insulin and not on growth hormone. Cartilage and other supporting tissues may continue to respond to growth hormone, despite fairly severe malnutririon.

Metabolic rates during recovery from protein-calorie malnutrition: the need for a new concept of specific dynamic action.

OPINION is still divided as to whether the metabolic rate of malnourished infants is increased or decreased, or whether, indeed, it remains the same1–17. The conflicting evidence probably arises from lack of suitable standards of reference and differing interpretations of the basal state. In addition, the term malnutrition or under-nutrition has been applied to a variety of clinical conditions from primordial dwarfism to simple fasting. The confusion, however, is small in comparison with that surrounding the phenomenon of specific dynamic action. The present study has the disadvantage of having to deal with both of these difficult issues.

Head circumference and cellular growth of the brain in normal and marasmic children

The relationship between increasing head circumference and cellular growth of thebrain was examined in normal children and in children who died of severe malnutrition during the first year of life. Weight and protein content of the brain increase hyperbolically when compared with head circumference, but linearly when compared with the theoretical cranial volume calculated from head circumference. In contrast, increase in total brain DNA content is linearly related directly to changes in head circumference. In marasmic infants who died as a result of their severe malnutrition, brain weight and protein were reduced proportionally to head circumference. DNA content (cell number) was reduced as much as, and in 3 cases more than, head circumference. These data strongly support the validity of using changes in head circumference as a measure of postnatal brain growth in normal and malnourished infants.

Relationship between muscle potassium andtotal body potassium in infants with malnutrition

Specimens of muscle were obtained with a biopsy needle from 23 Jamaican children who were recovering from malnutrition. The samples were analyzed for water, fat, nitrogen, and potassium; total body potassium was also measured. Muscle water is increased, but potassium concentration declines in malnutrition. A significant relationship exists between the depletions of muscle potassium and of total body potassium in malnourished infants. Analysis of muscle biopsy samples may lead to a better understanding of the response of tissue to protein depletion at the cellular level.

Sugar intolerance in malnourished infants and children.

Of 100 malnourished Indian infants and children 50 showed a stool pH below 6. Carbohydrate-loading tests demonstrated intolerance to lactose in 39, to sucrose in 25, and to maltose in 15. D-Xylose absorption was reduced in 16. Steatorrhoea was detected in 7 of 18 children tested. Nutritional recovery reversed the abnormalities in all except four, in whom a primary enzymic deficiency was considered on the basis of persistent lactose intolerance and a positive family history.

CALORIE REQUIREMENTS OF CHILDREN RECOVERING FROM PROTEIN-CALORIE MALNUTRITION

Weight gains in forty-seven malnourished infants have been studied in relation to the type of diet given during the recovery phase. Twenty-three (group P) were given substantially more calories than the rest (group O). Group P gained weight at a significantly greater rate (10·6 as against 7·65 g. per kg. per day). The response was particularly striking in marasmic infants, who grew more rapidly than those admitted to hospital with kwashiorkor. The rapid weight gains were achieved with relatively modest protein intakes (about 4 g. per kg. per day). This finding will be important in countries where malnutrition is a serious problem and where it is easier to provide calories than protein.

Experimental studies on nicotine absorption during pregnancy: IV. The postmature neonate

This report deals with 55 pregnant rats assigned randomly, 5 each, to 11 study groups. Three groups were untreated controls delivered either spontaneously on the twenty-second day of gestation (term), or by cesarean section on the twenty-first and twenty-second day. Four groups were rendered postmature by prolonging gestation with chorionic gonadotropin and were delivered by section on days 21, 22, 23, and 24. Four other experimental groups producing postmature young were delivered by section on these same days after having been treated chronically with nicotine throughout pregnancy. While gestation had been equally prolonged in the two experimental groups, hormone-induced postmaturity yielded young with many of the characteristics that have been ascribed to the postmaturity syndrome in man. However, nicotine-exposed young were underweight, virtually fetal in appearance, had narrower transverse head diameters, shorter vibrissae, shorter claws or none at all, and ossification in the long bones had not progressed as far as it had in term young of equal weights. Both groups of experimental animals would have delayed delivery even longer had sectioning not intervened. The nicotine-treated off spring could have passed for premature and were somewhat comparable to the peculiar, small, malnourished infants with prolonged gestations described recently in the human literature.

Benefit of early vs. late feeding of intrauterine fetally malnourished (IUM) infants

Benefit of early vs. late feeding of intrauterine fetally malnourished (IUM) infants

Improvement of Impaired Carbohydrate Metabolism by Chromium(III) in Malnourished Infants

Twelve malnourished infants with impaired glucose tolerances, six from Jordan and six from Nigeria, were treated with 250 µg of Cr(III) as CrCl3-6H2O. Within 18 hr after the Cr(III) administration, the glucose removal rates of the Jordanian infants improved significantly from an average of 0.6 to 2.9%/min and those of the Nigerian infants improved significantly from an average of 1.2 to 2.9%/min. When a group of five infants with impaired glucose tolerances from both areas was given an initial and a second tolerance test, but without Cr(III) treatment between the tests, the glucose removal rates did not improve significantly. In Jordan a clear-cut correlation between the geographical residence of the family and an impaired glucose tolerance in the infant was observed. All 10 refugee infants from the Jordanian hill area had impaired glucose removal rates, with an average of 0.7%/min, as compared to refugee infants from the Jordan Valley who were all normal, averaging 3.8%/min. The food supply for both groups was from a common source (United Nations). These normal glucose tolerances appeared to be related to the threefold higher chromium content of the family drinking water in the Jordan Valley area.

Acute bacterial infection in kwashiorkor and marasmus.

God cast down on them great tribulation, famine, and pesti lence: the people perished. So Hesiod (c. 700 B.c.) described the association between famine and pestilence, and they have been firmly coupled in men's minds at least since that time. McCance (1951) has reviewed the historical association. Children with kwashiorkor or nutritional marasmus often have acute bacterial infections. This has been established mainly by post-mortem surveys. Campbell (1956) found at necropsy microscopical evidence of pyaemic abscesses or bronchopneumo in the lungs of 31 out of 40 malnourished children in Cape Town, and another six had evidence of renal infection. Renal lesions, many of them infective, were also found in two-thirds of a Jamaican series (Stirling, 1962), and Brown (1965) found a 45% incidence ofbronchopneumonia among malnourished infants in a survey of all paediatric necropsies performed over a 12-year period in Mulago Hpspital, Kampala. In Cape Town two clical studies with bacterio logical support attributed many of the deaths to infection of the gut and to generalized septica (Smythe, 1958; Smythe ani Campbell, 1959). Usually, interest has been centred on one or more particular syste, and few attempts have been made to define the geeral pattern of bacterial infection. Since it has been generally assumed that acute bacterial infec tion is common and serious, antibiotics have often been advised in the treatment of all cases of kwashiorkor and marasmus ; but there is little agreement on the most suitable regimen. Peni cillin is widely used (Bhr, Viteri, and Scrimshaw, 1957; Piburn, 1960; de Silva, 1964), sometimes with streptomycin (Dean and Swanne, 1963) or sulphadiazine (Hansen, 1961). Tetracycline is favoured in Jamaica (Garrow, Picou, and Water low, 1962), and Dean (1965) often used chloramphenical. The studies in Cape Town (Smythe, 1958) led to the use of a com bination of chloramphenicol, neomycin, and nystatin, sometimes followed by penicillin and streptomycin and later by yoghurt. During most of 1966 all children admitted to the Medical Research Council Infantile Malniutrition Research Unit, Kam pala, received a five-day course of penicillin. Despite this, pyrexias often of unknown origin were common, tetracycline had frequently to be given later to control chest infections, and a few of the children showed signs of bacteraemic shock (Whar ton, 1966). Finally, the records of the unit showed that, despite all these antibiotics, bronchopneumonia was commonly found at necropsy (Dean, 1965). These clinical difficulties and the lack of agreement on therapy led us to study the pattern of acute bacterial infection in mal nourished children in Kampala.

Relationship between total body and muscle respiratory rates in infants with malnutrition.

Montgomery1 and Monckeberg2 have observed altered levels of oxygen consumption by malnourished infants before and during therapy of nutritional deficits. There are indirect indications of changes in tissue oxygen metabolism in malnourished children. Glucose tolerance tests reveal delayed clearance of intravenous glucose loads3–4. It has been found that the malnourished infant has a reduced ability to utilize acetate, glucose and pyruvate when these were administered as 14C isotopes5.

Hypoglycaemia in infantile malnutrition.

SummaryThe incidence, the clinical significance and the factors predisposing to hypoglycaemia were studied in 84 malnourished infants. Predisposing factors were young age, intestinal infections, extreme wasting of the body, the deficit in weight exceeding 25 % as compared to normal infants of the same length, and even brief periods of fasting. Older oedematous infants, if not extremely marasmic, were not hypoglyc‐aemic. Malabsorption of carbohydrate does not play a leading role in eliciting hypoglycaemia, since severe hypoglycae‐mia was also observed in cases in whom the ability to split disaccharides was preserved.The prominent clinical symptoms at blood sugar levels between 25 and 0 mg/ 100 ml were pallor and apnoeic spells, while convulsions were exceptional. There was a prompt response to intravenous glucose, and recurring attacks were generally prevented by frequent feeding and by the administration of corticoids. Some cases exhibiting very low blood sugar levels remained asymptomatic. Fasting blood sugar levels were found to be of great prognostic significance.

Nitrogen balance and energy metabolism in malnourished infants

Nitrogen balance and energy metabolism in malnourished infants