Estado nutricional de crianças com paralisia cerebral / Nutritional status of children with cerebral palsy

OBJETIVO: Avaliar o estado nutricional de 114 crianças com paralisia cerebral, entre 2 e 12,9 anos de idade. MÉTODO: Estudo transversal incluindo crianças atendidas nos ambulatórios de gastropediatria, ortopedia e neuropediatria de um hospital terciário universitário. Os indicadores nutricionais antropométricos estudados foram: peso, altura, índice de massa corporal, área muscular e de gordura do braço. RESULTADOS: A frequência de comprometimento nutricional (Escore-Z <-2), de acordo com os indicadores antropométricos para a idade e a média com o desvio-padrão, foram: 50,9 por cento para peso, com média de -2,19 (DP=2,48), 38,6 por cento para altura, média: -1,66 (DP=1,50), 45,6 por cento para índice de massa corporal, média: -1,74 (DP=2,75), 29,8 por cento para área muscular do braço, média: -1,03 (DP=1,73) e 35,1 por cento para área de gordura do braço, média: -1,15 (DP=1,41). CONCLUSÃO: A desnutrição foi frequente em crianças com paralisia cerebral. As crianças com paralisia cerebral do tipo tetraparético apresentaram os indicadores antropométricos mais comprometidos: peso e índice de massa corporal, com 72,4 por cento e 73,1 por cento das crianças com Escore-Z <-2 respectivamente.

OBJECTIVE: The aim of this study was to evaluate the nutritional status of 114 children aged 2 to 12.9 years with cerebral palsy. METHODS: This cross-sectional study included children treated at the gastropediatric, orthopedic and neuropediatric outpatient clinics of a tertiary university hospital. The studied anthropometric indicators were: weight, height, body mass index and mid-upper arm fat and muscle area. RESULTS: The rate of malnutrition (Z-score <-2) according to the anthropometric indicators for age, mean and standard deviation (SD) were: 50.9 percent for weight, with a mean of -2.19 (SD=2.48), 38.6 percent for height, mean: -1.66 (SD=1.50), 45.6 percent for body mass index, mean: -1.74 (SD=2.75), 29.8 percent for mid-upper arm muscle area, mean: -1.03 (SD=1.73) and 35.1 percent for mid-upper arm fat area, mean: -1.15 (SD=1.41). CONCLUSION: Malnutrition was common in children with cerebral palsy. The anthropometric indicators were worse in children with tetraparetic cerebral palsy: 72.4 percent and 73.1 percent of the children had Z-scores <-2 for weight and body mass index, respectively.

Gallbladder motility in children with chronic constipation.

OBJECTIVE: The aim of this study was to evaluate gallbladder motility in constipated children. PATIENTS AND METHODS: A cross-sectional study was conducted on pediatric patients with refractory constipation examined in a pediatric gastroenterology unit of a teaching hospital between January 2005 and August 2006. All of the patients seen during the period were included (age range, 2-16 years). The control group, matched for sex and age, was selected among patients seen at the same basic health units where patients were seen before being referred to pediatric gastroenterologists. A gallbladder contractility index was calculated based on fasting and postprandial gallbladder areas, using an ultrasonographic method. Ultrasonography studies were performed prospectively and blindly by the same physician. Measurements obtained in patients were compared with those obtained in controls. RESULTS: A total of 132 constipated children and the same number of healthy controls were included in the study. Median and mean fasting gallbladder areas were similar in patients and controls. Postprandial gallbladder areas were larger in the patient group, mean +/- SD = 594.8 +/- 206.4 mm, median, 562.5 mm, than in the control group, mean +/- SD = 541.1 +/- 156.1 mm, median, 530.5 mm; P = .031. Logistic regression showed that the risk of a contractility index <25% was 5.2 times greater in patients (odds ratio [OR] 5.2; 95% confidence interval [CI] 2.5-10.81) than in controls. Age was found to be a protective factor (OR 0.79; 95% CI 0.71-0.88). CONCLUSIONS: Gallbladder motility disorder was identified in a group of children with severe constipation. This finding may contribute to the understanding of functional constipation in children.

Growth evaluation in infants with neonatal cholestasis.

BACKGROUND: [corrected] Chronic liver diseases in childhood often cause undernutrition and growth failure. To our knowledge, growth parameters in infants with neonatal cholestasis are not available AIM: To evaluate the nutritional status and growth pattern in infants with intrahepatic cholestasis and extrahepatic cholestasis. PATIENTS AND METHODS: One hundred forty-four patients with neonatal cholestasis were followed up at the Pediatric Gastroenterology Service of the Teaching Hospital, State University of Campinas, Campinas, SP, Brazil, in a 23-year period, from 1980 to 2003. The records of these patients were reviewed and patients were classified into two groups, according to their anatomical diagnosis: patients with intrahepatic cholestasis - group 1, and patients with extrahepatic cholestasis - group 2. Records of weight and height measurements were collected at 4 age stages of growth, in the first year of life: 1) from the time of the first medical visit to the age of 4 months (T1); 2) from the 5th to the 7th month (T2); 3) from the 8th to the 10th month (T3); and 4) from the 11th to the 13th month (T4). The weight-by-age and height-by-age Z-scores were calculated for each patient at each stage. In order for the patient to be included in the study it was necessary to have the weight and/or height measurements at the 4 stages. Analyses of variance and Tukey's tests were used for statistical analysis. Repeated measurement analyses of variance of the weight-by-age Z-score were performed in a 60-patient sample, including 29 patients from group 1 and 31 patients from group 2. The height-by-age data of 33 patients were recorded, 15 from group 1 and 18 from group 2 RESULTS: The mean weight-by-age Z-scores of group 1 patients at the 4 age stages were: T1=-1.54; T2=-1.40; T3=-0.94; T4=-0.78. There was a significant difference between T2 X T3 and T1 X T4. The weight-by-age Z-scores for group 2 patients were :T1=-1.04; T2=-1.67; T3=-1.93 and T4=-1.77, with a significant difference between T1 X T2 and T1 X T4. The mean weight-by-age Z-scores also showed a significant difference between group 1 and group 2 at stages T3 and T4. The mean height-by-age Z-scores at the four stages in group 1 were: T1=-1.27; T2=-1.16; T3=-0.92 and T4=-0.22, with a significant difference between T3XT4 and T1XT4. The scores for group 2 patients were: T1=-0.93; T2=-1.89; T3=-2.26 and T4=-2.03, with a significant difference between T1XT2 and T1XT4. The mean height-by-age Z-scores also showed a significant difference between group 1 and group 2 at T3 and T4 CONCLUSION: The weight and height differences between the groups became significant from the 3rd measurement onward, with the most substantial deficit found in the extrahepatic group. In this group, there is evidence that the onset of weight and height deficit occurs between the first and second evaluation stages.

Chagasic megaesophagus and megacolon diagnosed in childhood and probably caused by vertical transmission

Reports on children presenting symptoms compatible with the chronic phase of Chagas disease are sporadic. We report a case of a 7-year-old boy who had megaesophagus and megacolon, both of them a consequence of the trypanosomiasis. The etiology was established by means of laboratory and histological features. Based on epidemiological data, the authors concluded that vertical transmission was the most probable route of acquisition. This diagnosis should be considered in children presenting similar complaints, even those living away from endemic areas