Nutritional Support In Children Research Articles

Cost-utility analysis of teduglutide compared to standard care in weaning parenteral nutrition support in children with short bowel syndrome

A growing proportion of children with short bowel syndrome (SBS) remain dependent on long-term parenteral nutrition (PN). Teduglutide offers the potential for more children to decrease PN support and achieve enteral autonomy (EA), but at a significant expense. This study aims to assess the incremental costs of teduglutide plus standard of care compared to standard of care alone in weaning PN support per quality-adjusted life year (QALY) gained in children with SBS. This is a cost-utility analysis comparing teduglutide with standard of care alone in children with SBS. A microsimulation model of children with SBS on PN aged 1-17 years was constructed over a time horizon of six years, with a cycle length of one month. The study adopted the healthcare system and societal payer perspectives in Ontario, Canada. The health outcome measure was QALYs, with results expressed in terms of incremental costs and QALYs. Scenario analyses were performed to examine the effects of different time horizons, timing of teduglutide initiation, and modeling cost of teduglutide based on pediatric weight-dosing. Incremental healthcare system costs for teduglutide compared to standard of care were CAD$441,314 (95% CI, 414,006 to 441,314) and incremental QALYs were 1.80 (95% CI, 1.70 to 1.89) resulting in an incremental cost-effectiveness ratio (ICER) of CAD$285,334 (95% CI, 178,209 to 392,459) per QALY gained. Incremental societal costs were CAD$418,504 (95% CI, 409,487 to 427,522) and incremental societal QALYs were 1.91 (95% CI, 1.85 to 1.98) resulting in an ICER of CAD$261,880 (95% CI, 136,887 to 386,874) per QALY gained. Scenario analysis showed that teduglutide was cost-effective when it was started two years after intestinal resection (ICER CAD$48,741, 95% CI, 17,317 to 80,165) and when its monthly cost was adjusted using weight-based dosing, avoiding wastage of the remaining 5mg dose vial (Teduglutide dominated over SOC as the less costly and most effective strategy). Although teduglutide was not cost-effective in weaning PN support in children with SBS, starting teduglutide once natural intestinal adaptation is reduced and adjusting its monthly cost to reflect cost by volume as dictated by weight-based dosing rendered the intervention cost-effective relative to standard of care. These results indicate the potential for clinicians to re-assess optimal time for initiation of teduglutide after intestinal resection, drug manufacturers to consider the use of multi-dose or paediatric-dose vials, and the opportunity for decision-makers to re-evaluate teduglutide funding.

Total pancreatectomy with islet autotransplantation reduces opioid use and improves nutritional support in children with debilitating pancreatitis.

Chronic pancreatitis (CP) can result in opioid dependence and nutritional challenges in children. Total pancreatectomy with islet autotransplantation (TPIAT) is a viable surgical option in appropriately selected patients. We examined differences between children who met criteria for TPIAT versus those who did not and continued with non-operative management. Retrospective observational cohort study of patients evaluated for TPIAT between August 2014 and July 2020 was performed. Cohort-based analyses between TPIAT and non-TPIAT groups were performed. Analyses included 121 patients, 69 of whom underwent TPIAT. Demographics, genetic risk factors, and anatomic variants did not differ between groups. TPIAT patients were more likely to have CP (88% vs 71%; p = 0.02), had higher median number of endoscopic retrograde cholangiopancreatography procedures (2.0 vs 1.0; p = 0.0001), and had higher likelihood of opioid use (61% vs 42%; p = 0.04) and nutritional supplementation (23% vs 4%; p = 0.004), compared to non-TPIAT. At 6 months post-TPIAT, patients had lower use of any analgesic pain medications (39% vs 73%; p = 0.0002) and lower use of opioids (9% vs 39%; p = 0.0006), compared to non-TPIAT patients at 6 months after evaluation. At 6 months post-TPIAT, rate of exclusively oral nutrition increased from 77% to 86%, and total parenteral nutrition use decreased from 13% to 0% (p = 0.02). In children referred for TPIAT evaluation, there is greater burden of disease in those selected for operation, compared to patients who do not undergo operation. TPIAT achieves lower analgesic pain medication use compared to continuation with non-TPIAT management and achieves freedom from nutritional supplementation. Level of evidence: Retrospective comparative study, Level III.

Nutritional Support in Children Meeting the At-Risk for Pediatric Acute Respiratory Distress Syndrome Criteria.

To examine associations between early enteral nutrition (EN) and PICU outcomes in a cohort of children meeting the 2015 Pediatric Acute Lung Injury Consensus Conference "at-risk" for pediatric acute respiratory distress syndrome (ARF-PARDS) criteria. This was a single-center, electronic health record-based retrospective chart review. We included children less than or equal to 18 years-old admitted to our mixed medical-surgical PICU from January 2017 to December 2018 who met ARF-PARDS criteria within 48 hours of admission. Children were categorized as receiving "early" EN if feeds were initiated within 48 hours of admission. All others were categorized as "delayed" EN. Extracted data included demographics, illness characteristics including primary diagnosis and Pediatric Risk of Mortality (PRISM) III score, respiratory support and oxygenation indices, nutritional data, and PICU length of stay (LOS). The primary outcome of interest was subsequent diagnosis of PARDS. Of 201 included children, 152 (75.6%) received early EN. The most common admission diagnoses were pneumonia, bronchiolitis, and influenza. Overall, 21.4% (n = 43) of children developed PARDS. Children receiving early EN had a subsequent diagnosis of PARDS less often then children receiving delayed EN (15.1% vs 40.8%; p < 0.001), an association that persisted after adjusting for patient demographics and illness characteristics, including PRISM III and diagnosis (adjusted odds ratio, 0.24; 95% CI, 0.10-0.58; p = 0.002). Early EN was also associated with a shorter PICU LOS in univariate analysis (2.2 d [interquartile range, 1.5-3.4 d] vs 4.2 d [2.7-8.9 d]; p < 0.001). In this single-center, retrospective cohort study, compared with children with ARF-PARDS who received late EN, those who received early EN demonstrated a reduced odds of subsequent diagnosis of PARDS, and an unadjusted reduction in PICU LOS when compared with delayed EN. Prospective studies should be designed to confirm these findings.

Nutritional therapy for protein-energy malnutrition in children with sepsis

This review presents meta-analyses on nutrition in patients with critical illness using ASPEN/SCCM (2017), SSC (2012, 2021), ESPNIC (2020), and SSC (2020) pediatric sepsis guidelines. The ESPNIC (2020) guideline, based on new evidence, complements most of the existing ASPEN (2017) guidelines for critical pediatrics. Childrens SSC (2020) did not find direct evidence and sufficient data to develop strong nutritional recommendations for children with sepsis/SS. Many issues remain unresolved, requiring systematic analysis. In the literature search, only a few randomized clinical trials have focused on the assessment and correction of protein-energy malnutrition in pediatric intensive care. Over the past decade, small and large pediatric studies have recommended nutritional therapy. However, given the heterogeneity of children admitted to intensive care units in terms of age, pathology, disease severity, presence of comorbidities, and nutritional status, it is unrealistic to expect that one nutrition strategy applies to all patients requiring intensive care. Therefore, most clinicians emphasize the need for an individualized approach to nutrition support in children, taking into account the pathology, severity, initial nutritional status, and riskbenefit ratio of different nutritional therapies. An extensive search of the literature on the problem did not reveal strong nutritional recommendations for children with sepsis/SS, which dictates the need for future research on the topic and correction of protein-energy malnutrition in children with sepsis/SS.

Expert Consensus on Nutritional Support for Children with Congenital Heart Disease (2023 Edition)

Expert Consensus on Nutritional Support for Children with Congenital Heart Disease (2023 Edition)

Administration of ciprofloxacin through a nasogastric tube in pediatric oncology and stem cell transplantation patients.

Pediatric oncology and hematopoietic stem cell transplantation patients are facing many gastrointestinal side effects of chemotherapy, including nausea, vomiting, mucositis, and diarrhea. International guidelines advise early enteral tube feeding as the first option of nutritional support in children undergoing myeloablative hematopoietic stem cell transplantation. When using enteral feeding tubes for nutritional purposes as well as drug administration, some pharmaceutical, nursing, and technical issues have to be taken into account. Ciprofloxacin is a fluoroquinolone, widely used because of its broad spectrum antimicrobial activity and favorable pharmacokinetic properties. However, its co-administration with polyvalent cations (as present in enteral feeding) makes the absorption of ciprofloxacin more difficult and may alter the pharmacokinetic parameters. Literature data are conflicting on how long the enteral feeding should be discontinued for patients receiving ciprofloxacin via an enteral feeding tube, ranging from 2 h before to 6 h after the administration of ciprofloxacin. Our research question was guided by challenges and concerns of nurses about the delay time between ciprofloxacin administration and restart of the enteral feeding without compromising the nutritional intake of the children. Our guideline was adapted, nurses were instructed accordingly, and patient leaflets with correct information were created.

Nutrition support in children and adolescents with cystic fibrosis: Is there a difference between pancreatic sufficient and insufficient patients?

1. Nagy R, Gede N, Ocskay K, et al. Association of Body Mass Index With Clinical Outcomes in Patients With Cystic Fibrosis: A Systematic Review and Meta-analysis. JAMA Netw Open. 2022;5(3):e220740. doi:10.1001/jamanetworkopen.2022.0740 CrossRef Google Scholar

The nutritional support in children with spastic forms of cerebral palsy

Background. The approaches to the managing of nutrition for healthy children are not always applicable to patients with neurological disorders, since their body composition, muscle tone, level of physical activity, and energy requirements significantly differ from healthy children and, therefore, must be personalized with the mandatory involvement of a nutritionist/dietitian. The purpose is to assess nutrition in children with cerebral palsy (CP) depending on Gross Motor Function Classification System (GMFCS) level. Materials and methods. Eighty-eight 2 to 16 years nine months CP children rehabilitated at the National Medical Research Center for Children’s Health from 2019 to 2021 were included in this study. Participants were divided into two groups. The main group was patients with GMFCS levels IV-V (48 children) and the comparison group - GMFCS levels I-III (40 children). The medical and dietary history of participants was analyzed. Anthropometric parameters using the WHO AnthroPlus (2009) software were assessed in all participants, the ability to eat and drink was determined by questioning the EDACS scale (Eating and Drinking Ability Classification System). Results. The mean values of weight/age, height/age, BMI/age Z-scores were significantly below 0 (p = 0.01) in all patients (88): WAZ -1.54 ± 1.9, HAZ -1.03 ± 1.48, BAZ -1.5 [-3.11; -0.35]. Children of the main group had significantly lower Z-scores. As a result of the survey, patients of the main group were revealed to have indicators characterizing eating disorders significantly more often (p &lt; 0.001) than the comparison group. EDACS survey revealed that children of the main group were significantly more likely (58% and 10%, respectively; p &lt; 0.001) to have disorders corresponding to levels IV-V, characterized by significant safety restrictions. We have developed a nutritional assessment and management algorithm for children with cerebral palsy, admitted for rehabilitation at the neurological department. Conclusion. Children with cerebral palsy need regular nutritional assessment and management for timely and adequate nutritional support, including enteral nutrition.

Relationship between nutritional factors and clinical outcome in children with tuberculous meningitis

Objective: To investigate the relationship between nutritional risk status and clinical outcome in children with tuberculous meningitis (TBM). Methods: The clinical data (basic information, clinical symptoms and laboratory test results) of 112 patients with TBM, who were admitted to Department of Pediatric Infectious Diseases of West China Second Hospital of Sichuan University,from January 2013 to December 2020 were retrospectively analyzed. The patients were divided into the nutritional risk group and the non-nutritional risk group according to the assessment of the nutritional risk by the STRONGkids Scale. The variables of basic information, clinical symptoms and laboratory test measurements etc. were compared between the two groups by using Student t test, Rank sum test or Chi-square test. Multivariate Logistic regression analysis were used to analyze nutritional risk factors. Results: Among 112 patient with TBM, 55 were males and 57 females. There were 62 cases in the nutritional risk group and 50 cases in the non-nutritional risk group. The proportion of cases with nutritional risk was 55.4% (62/112). Patients in the nutritional risk who lived in rural areas, had symptoms of brain nerve damage, convulsions, emaciation and anorexia, with a diagnosis time of ≥21 days, and the level of cerebrospinal fluid (CSF) protein were all higher than those in the non-nutritional risk group ((50 cases (80.6%) vs. 32 cases (64.0%), 20 cases (32.3%) vs.8 cases (16.0%), 33 cases (53.2%) vs. 15 cases (30.0%), 30 cases (48.4%) vs. 2 cases (4.0%), 59 cases (95.2%) vs. 1 case (2.0%),41 cases (66.1%) vs.18 cases (36.0%), 1 406 (1 079, 2 068) vs. 929 (683, 1 208) mg/L, χ2=3.91, 3.90, 6.10, 26.72, 98.58, 10.08, Z=4.35, all P<0.05). The levels of serum albumin,hemoglobin,lymphocyte count, white blood cell count, and CSF glucose were significantly lower in patients with nutritional risk ((36±5) vs. (41±4) g/L, (110±17) vs. (122±14) g/L, 1.4 (1.0, 2.0)vs. 2.3 (1.6, 3.8)×109/L, 7.8 (6.3, 10.0)×109 vs. 10.0 (8.3, 12.8)×109/L, 1.0 (0.8, 1.6) vs. 2.1 (1.3, 2.5) mmol/L, t=-6.15, -4.22, Z=-4.86, -3.92, -4.16, all P<0.05).Increased levels of serum albumin (OR=0.812, 95%CI:0.705-0.935, P=0.004) and lymphocyte count (OR=0.609, 95%CI:0.383-0.970, P=0.037) may reduce the nutritional risk of children with TBM; while convulsions (OR=3.853, 95%CI:1.116-13.308, P=0.033) and increased level of CSF protein (OR=1.001,95%CI:1.000-1.002, P=0.015) may increase the nutritional risk of children with TBM. Similarly, the rate of complications and drug-induced liver injury was higher in the nutritional risk group (47 cases (75.8%) vs. 15 cases(30.0%), 31 cases (50.0%) vs.8 cases (16.0%), χ2=23.50, 14.10, all P<0.05). Moreover, the length of hospital stay was also longer in the nutritional risk group ((27±13) vs. (18±7) d, t=4.38, P<0.05). Conclusions: Children with TBM have a high incidence of nutritional risk. Convulsive, the level of serum albumin, the level of lymphocyte count and CSF protein may affect the nutritional risk of children with TBM. The nutritional risk group has a high incidence of complications and heavy economic burden.It is necessary to carry out nutritional screening and nutritional support for children with TBM as early as possible.

Child food insecurity in the wake of the COVID-19 pandemic: urgent need for policy evaluation and reform in Israel\u2019s school feeding programs

Even in high-income countries like Israel, children have been particularly vulnerable to the surge in food insecurity driven by quarantines, unemployment, and economic hardships of the COVID-19 pandemic. Under normal circumstances, School Feeding Programs (SFPs) can help to ensure child food security. In the wake of the pandemic, policy makers worldwide have been challenged to adapt national SFPs to provide nutritional support to children (and indirectly to their families) during extended school closures. Most national SFPs implemented contingency plans to ensure continued nutritional support for children. In Israel, where SFPs were largely suspended during long periods of mandated school closing, there was a loss of 30–50% of feeding days for the ~ 454,000 children enrolled in the program. The lack of emergency contingency planning and failure to maintain Israeli SFPs during school closures reveals longstanding structural policy flaws that hindered coordination between relevant ministries and authorities and impeded the mobilization of funds and existing programs to meet the emergent need. The school feeding law does not identify child food security as an explicit aim, there are no benchmarks for monitoring and evaluating the program to ensure that the food aid reaches the children most in need, even routinely, and the Ministry of Education had no obligation to maintain the program and to marshal data on the participants that could be acted upon in the emergency. Moreover, because Israeli SFPs are “selective”, in other words, implemented according to community risk (low-income, high poverty rate) and geographical factors, attendant stigma and financial burdens can make participation in the program less attractive to families and communities that need them the most. We argue that Israel should make urgent, long-term improvements to the SFPs as follows: First, eliminating childhood food insecurity should be made an explicit goal of legislation in the broader context of national social, health, and nutritional goals, and this includes ensuring SFPs are maintained during emergencies. Second, the government should assume responsibility for the routine assessment and data collection on food insecurity among Israeli children. Third, SFPs should be subjected to rigorous independent program evaluation. Finally, a “universal” SFP providing nutritious diets would likely improve the health of all Israeli children, across all socioeconomic backgrounds. These steps to guarantee that Israeli children have food to realize their full physical and cognitive potential would emphasize Israel’s firm commitment to support multiple dimensions of health, educational achievement, and societal values, to combat the complex and long-term consequences of the pandemic, and to prepare for the next one.

A Pilot Study of Nutrition Management in the Department of Pediatric Oncology Department of a Hospital in Kazakhstan

Maintaining optimal nutritional status is important for children with cancer because it can affect clinical outcomes. This study aimed to prospectively study clinical practices in children's cancer departments to improve the nutritional health of children and adolescents receiving cancer treatment. Currently, there are no unified and harmonized protocols for assessing the nutritional status and nutritional support of children in pediatric wards in Kazakhstan. According to WHO research, most of the children admitted to hospitals already have significant nutritional status disorders, such as exhaustion and malnutrition, lipid metabolism disorders, hypovitaminosis and anemia. 200 children with cancer aged 6 months to 17 years (n=200) were recruited. Dietary data and other relevant anthropometric and biochemical data were collected using a data collection form validated and developed by the researchers. Data processing is still in progress. They were randomly allocated either to a treatment group or a control group (age-matched and gender matched). The treatment group received nutritional advice and support and the control group received the standard treatment. A significant decrease in the intake of protein and energy with the consumed diets, which are prescribed by doctors in daily practice, was revealed, which is a risk factor for the development of severe nutritional disorders (p&gt;0.5). Patients who were assigned nutritional support in addition to the General diets during the study had higher nutrient intake. Comparing week zero with subsequent weeks of nutritional support, children in the main group showed significant improvements in the thickness of the triceps skin fold (P&lt;0.001), the circumference of the middle shoulder (P&lt;0.001), and the circumference of the arm muscles (P&lt;0.001), showing that performing nutritional support is better for the evolution of nutrition (P&lt;0.01). Proper use of nutritional support in children with cancer can prevent the development of nutritional deficiencies and associated risks. To improve nutrition management, attention should be paid to nutrition education and assessment tools for doctors and nurses.

Особенности пищевого статуса у детей с детским церебральным параличом, находящихся на питании через гастростому

Objective. To assess the nutritional status, dietary intake, and effectiveness of nutritional support in children with infantile cerebral palsy (ICP) receiving gastrostomy tube feeding. Patients and methods. The study included 46 children with spastic ICP between 2 and 18 years of age. All children belonged to GMFCS level V and were fed by gastrostomy tube. Nutritional status, energy and macronutrient intake were evaluated. Body composition was determined by caliperometry (n = 46) and bioelectrical impedance analysis (bioimpedanceometry) (n = 18). Considering the disorders revealed, specialized formulas for enteral feeding were introduced into the diet. To assess the effectiveness of diet therapy, we observed 14 children for 6–9 months. Results. Weight loss was detected in 33 (71.7%) children: 14 (30.4%) children had mild weight loss, 1 (2.2%) child had moderate weight loss and 18 (39.1%) children had severe weight loss. Growth delay was observed in 5 (10.9%) children, in 3 (6.5%) of them the degree of delay appeared more severe. Protein-energy malnutrition by 17–50% from the recommended norm was detected in all children: all children had carbohydrate deficiency and 37 (80.4%) children had protein and fat deficiency. In the observational period against the background of diet therapy there were statistically significant positive dynamics of weight and height parameters, an increase in body fat mass (2.4 [1.6; 5.3] kg and 3.3 [1.3; 4.6] kg at the beginning and at the end of observation) and phase angle values (3.9 [3.5; 4.4] and 5.0 [3.6; 5.6], respectively); a decrease in body cell mass and skeletal muscle mass was revealed. Conclusion. The diet of children with ICP should meet their individual needs and correspond to their functional abilities. Key words: infantile cerebral palsy, gastrostomy, motor activity level, weight loss, nutritional support

Питание и нутритивная поддержка детей со злокачественными новообразованиями после завершения лечения: основные аспекты

Children with malignant neoplasms are a high-risk group for developing nutritional and metabolic disorders, which are one of the key disabling factors that significantly reduce the effectiveness of medical and social rehabilitation. Dynamic monitoring, screening, and timely correction of identified problems, including nutritional ones, constitute an essential precondition for the success of rehabilitation. The basic principles of nutritional correction in pediatric oncology include the following: a personalized approach; avoidance of long intervals between meals; prescription of any restrictive diets only for reasonable indications; multidisciplinarity; sparing of the gastrointestinal tract; timely initiation of nutritional support; continuity, dynamic monitoring, and control of nutritional status. The aim of this study is to describe the main aspects of nutritional support in children with malignant neoplasms after the end of cancer treatment. Key words: children, nutritional support, oncology, nutrition, cancer

Glutamine solution in the parenteral nutrition for children with critical conditions

Nutritional support for children with critical conditions is currently considered as the most important factor in the complex of therapy, which can prevent catabolism and risk of postoperative complications. Underestimation of the nutritional factor can lead to poor outcomes, such as a decrease in immunological resistance and the occurrence of postoperative complications.&#x0D; Acute trauma in critically ill patients is characterized by metabolic and systemic responses, including an immune-inflammatory response that leads to immunosuppression and nosocomial infections. Parenteral nutrition is prescribed for patients in the intensive care unit who cannot be fed naturally to provide protein and energy substrates because of impaired homeostasis. The active use of arginine, glutamine, and omega-3 fatty acids is mainly indicated for patients with injuries and burns. Moreover, the discussion about the use of immune nutrition (arginine, glutamine, and omega-3 fatty acids) continues given the need for active use in intensive care. The article provides a review of the literature on the use of glutamine solution in parenteral nutrition for children. The article discusses modern approaches to prescribing parenteral nutrition with the additional use of glutamine solution, which has beneficial effects on the childs body increases the absorption function of the intestine, increases the thickness of the intestinal mucosa, helps maintain the morphological integrity of the intestine, and reduces intestinal permeability. Recent meta-analyses have shown the effect of glutamine-rich diets especially in patients with critical conditions. The addition of glutamine improves cellular processes and functioning of organs and systems. This leads to an improvement in immune competence, barrier function, and cessation of the inflammatory process. It is also a substrate for the formation of nitrite oxide and improves the formation of adenosine triphosphate in cells. Glutamine is an energy substrate for proliferative cells, including lymphocytes. In general, glutamine has a positive effect on many organs and systems, including the gastrointestinal systems, kidneys, lungs, heart, and liver. Immune nutrition has an anti-inflammatory effect, which helps prevent the development of acute phase response. In addition, it restores the indicators of protein metabolism in the early stages of parenteral nutrition. Therefore, the use of glutamine solution in total or complementary parenteral nutrition programs can optimize the quality of treatment for children.

Parenteral nutritional support in children in the early period after hematopoietic stem cell transplantation: specifics and clinical aspects

Hematopoietic stem cell transplantation (HSCT) as a treatment modality is associated with nutritional problems that are mainly caused by eating difficulties and gastrointestinal complications occurring at different stages of HSCT: starting from conditioning until late post-transplant period. Nutritional problems have in turn a negative impact on the outcomes of HSCT which demonstrates the importance of preventive measures and timely correction of these problems. The majority of patients who underwent HSCT experience various problems at different stages of treatment leading to a situation when enteral nutrition is impossible. This is why parenteral nutrition is of utmost importance in these patients. This review describes the main clinical factors that may influence the prescription of nutritional support to patients after HSCT as well as possible problems and negative consequences of inappropriate prescribing of parenteral nutrition.

Assessment of dietary diversity and nutritional support for children living with HIV in the IeDEA pediatric West African cohort: a non-comparative, feasibility study

BackgroundNutritional care is not optimally integrated into pediatric HIV care in sub-Saharan Africa. We assessed the 6-month effect of a nutritional support provided to children living with HIV, followed in a multicentric cohort in West Africa.MethodsIn 2014-2016, a nutritional intervention was carried out for children living with HIV, aged under 10 years, receiving antiretroviral therapy (ART) or not, in five HIV pediatric cohorts, in Benin, Togo and Côte d’Ivoire. Weight deficiency was assessed using two definitions: wasting (Weight for Height Z-score [WHZ] for children<5 years old or Body-Mass-Index for Age [BAZ] for ≥5 years) and underweight (Weight for Age Z-score [WAZ]) (WHO child growth standards). Combining these indicators, three categories of nutritional support were defined: 1/ children with severe malnutrition (WAZ and/or WHZ/BAZ <-3 Standard Deviations [SD]) were supported with Ready-To-Use Therapeutic Food (RUTF), 2/ those with moderate malnutrition (WAZ and/or WHZ/BAZ = [-3;-2[ SD) were supported with fortified blended flours produced locally in each country, 3/ those non malnourished (WAZ and WHZ/BAZ ≥-2 SD) received nutritional counselling only. Children were followed monthly over 6 months. Dietary Diversity Score (DDS) using a 24h recall was measured at the first and last visit of the intervention.ResultsOverall, 326 children were included, 48% were girls. At baseline, 66% were aged 5-10 years, 91% were on ART, and 17% were severely immunodeficient (CD4 <250 cells/mL or CD4%<15). Twenty-nine (9%) were severely malnourished, 63 (19%) moderately malnourished and 234 (72%) non-malnourished. After 6 months, 9/29 (31%) and 31/63 (48%) recovered from severe and moderate malnutrition respectively. The median DDS was 8 (IQR 7-9) in Côte d’Ivoire and Togo, 6 (IQR 6-7) in Benin. Mean DDS was 4.3/9 (sd 1.2) at first visit, with a lower score in Benin, but with no difference between first and last visit (p=0.907), nor by intervention groups (p-value=0.767).ConclusionsThis intervention had a limited effect on nutritional recovery and dietary diversity improvement. Questions remain on determining appropriate nutritional products, in terms of adherence, proper use for families and adequate energy needs coverage for children living with HIV.Trial registrationPACTR202001816232398, June 01, 2020, retrospectively registered.

Effectiveness of nutritional status correction in children with cerebral palsy

The frequency of underweight in children with cerebral palsy is about 60–70%. A benefit of nutritional support in children with cerebral palsy are underestimated. The use of nutritional support during active physical rehabilitation can have a positive effect on not only body weight, but also the component composition of the body and their rehabilitation potential.The aim of our study was to evaluate the effectiveness of nutritional support – a hypercaloric (1,5 kcal/ml) polymer formula with fibers (Pediashure 1,5 Fiber, Abbott) in children with cerebral palsy.Characteristics of children and research methods. Anthropometric indicators (body weight, height, body mass index, triceps skinfold thickness, subscapular skinfold thickness, mid-upper arm circumference, shoulder muscle circumference) and body composition were studied in 15 underweight children with cerebral palsy aged 4–10 years with the level of motor disorders GMFCSIII–IV. They were prescribed of nutritional support with a hyper caloric mixture (1,5kcal/ml) with fiber lasting 3months during active physical rehabilitation.Results. Against the background of nutritional support, there was a significant increase in body weight, height, z-score of body weight, mainly due to musculoskeletal, active cell and lean mass. In addition to correcting the nutritional status of children with cerebral palsy, an improvement in their motor abilities was noted.

Nutritional support for children and young people: nasogastric tubes.

The need to offer nutritional support to children and young people is commonplace for health professionals. This article explores the use and indication of nasogastric tubes (NGT) in children and young people, before explaining the process of inserting NGTs and the ongoing management of this method of nutritional support.

Nutritional status and nutritional therapy in pediatric and adolescent patients submitted to autologous hematopoietic stem cell transplantation

Introduction: To assess the use of nutritional support in children and adolescents submitted to autologous hematopoietic stem cell transplantation (HSCT), and analyze changes in nutritional status at hospital discharge after HSCT. Methods: A retrospective observational study was conducted on pediatric oncology patients hospitalized for autologous HSCT between 2010 and 2017. Nutritional therapy was evaluated based on the duration of enteral tube feeding (ETF) and parenteral nutrition (PN), either alone or in combination. The length of hospital stay was measured in days. Nutritional status was assessed at admission and discharge, and classified according to World Health Organization criteria. Results: The sample consisted of 68 patients, 54.4% of whom were boys. Most participants (89.7%) had solid tumors. Nutritional therapy was required in over half (52.9%) of cases, with PN being the most common indication. There was a reduction in the percentage of overweight patients and an increase in the percentage of underweight patients at discharge relative to admission. Conclusions: The use of nutritional therapy is highly prevalent in this population, and HSCT has a negative impact on nutritional status at discharge.

The effects of nutritional support baskets on growth parameters of under five years old children with malnutrition and low socio-economic status.

Although malnutrition is globally widespread among children, there is no consensus on the most effective intervention for improving a child's growth. The present study is designed to investigate the effects of nutritional support basketson growth indices of malnourished children. This is a field trial conducted on 3667 malnourished children (0-60 months) for 9months, between 2017 and 2018, in Fars province of Iran. Weight-for-age, height-for-age, weight-for-height and body mass index-for age indices were assessed before and after the intervention with nutritional support baskets, which contains 600 kcal/day. The baseline prevalence of moderate/severeunderweight, stunting and wasting were 31.5%, 33.3% and 28.9%, respectively. After the intervention, the prevalence non-significantly reduced to 25.5%, 31.7% and 20.35%, respectively (p > 0.05). The intervention is associated with a non-significant reduction in the prevalence of underweight and wasting in 0-23 months children, and a non-significant reduction in the prevalence of underweight, stunting and wasting in 24-60 months children. Furthermore, the intervention is associated with a non-significant reduction in the prevalence of underweight, stunting and wasting in girls, and a non-significant reduction in the prevalence of underweight and wasting in boys. Nutrition support was effective in improving malnutrition indices of children; however, the results were non-significant. Further studies with longer period and control group areneeded to support the effectiveness of nutrition support in children.