Nutritional Status of Children with Cerebral Palsy-Findings from Prospective Hospital-Based Surveillance in Vietnam Indicate a Need for Action.

BACKGROUND: Lack of evidence on the burden and risk factors for malnutrition among children with cerebral palsy (CP) in Vietnam limits evidence-based interventions. We aimed to define the nutritional status of children with CP in Vietnam. MATERIALS AND METHODS: The study utilized data from active prospective hospital-based surveillance modelled on the Pediatric Active Enhanced Disease Surveillance system. Children (0-18 years) with CP attending the National Children's Hospital Hanoi, Vietnam between June-November 2017 were included. Data on demographic, clinical and rehabilitation status were collected following detailed neurodevelopmental assessment. Anthropometric measurements were taken. Nutritional status was determined using the World Health Organization guideline. RESULTS: Of 765 children (the mean (SD) age was 2.6 (2.5) years; 35.8% were female), 28.9% (n = 213) were underweight and 29.0% (n = 214) stunted. The odds of underweight were significantly higher among children aged >5 years and/or having a monthly family income of <50 USD. Underweight and/or stunting was high among children with quadriplegia (81%, n = 60 and 84.5%, n = 87) and/or Gross Motor Functional Classification System (GMFCS) level IV-V (62.5%, n = 45 and 67.0%, n = 67). Nearly one-third of intellectually impaired and more than half of hearing-impaired children were underweight and/or stunted. CONCLUSIONS: Poor economic status and increased motor severity increased vulnerability to malnutrition. Our findings will inform nutritional rehabilitation programs among these vulnerable children.

Linear growth faltering and the role of weight attainment: Prospective analysis of young children recovering from severe wasting in Niger.

Efforts to reduce the impact of stunting have been largely independent of interventions to reduce the impact of wasting, despite the observation that the conditions can coexist in the same child and increase risk of death. To optimize the management of malnourished children-who can be wasted, stunted, or both-the relationship between stunting and wasting should be elaborated. We aimed to describe the relationship between concurrent weight and height gain during and after rehabilitation from severe wasting. We conducted a secondary analysis of a randomized trial for the outpatient treatment of severe wasting, including 1,542 children who recovered and were followed for 12 weeks. We described the overlap of stunting and severe wasting and the change in stunting over time. We showed the relationship between concurrent weight and height gain using adjusted generalized estimating equations and calculated the mean rate of change in weight-for-height z score (WHZ) and height-for-age z score (HAZ) during and after rehabilitation. At baseline, 79% (n = 1,223/1,542) and 49% (n = 757/1,542) of children were stunted and severely stunted, respectively. Prevalence increased over time among children <24 months. During rehabilitation when weight was not yet fully recovered, we found rapid WHZ gain but limited HAZ gain. Following successful rehabilitation, WHZ gain slowed. The rate of HAZ gain was negative after rehabilitation but increased relative to the period during treatment. The potential relationship between weight and height gain calls for increased coverage of wasting treatment to not only prevent child mortality but also reduce linear growth faltering.

Nutritional rehabilitation of children < 6 mo with severe acute malnutrition.

The authors studied the outcome of 108 infants < 6 mo with severe acute malnutrition (SAM) admitted in the Nutritional Rehabilitation Centres (NRC) at a teaching hospital. The most common symptom that the children presented with, was acute diarrhoea (35.2 %) followed by failure to gain weight (26.9 %). Seventy five (69.4 %) infants were cured after nutritional rehabilitation and 29 (26.8 %) were non responders. Fifty two (48 %) infants showed good weight gain after proper counseling or supplementary suckling technique alone.

Treatment of severe acute malnutrition in infants aged <6 months in Niger.

OBJECTIVE: To report a nutritional rehabilitation program in Niger for the management of severe acute malnutrition in infants aged <6 months. STUDY DESIGN: This is a presentation of a case series (n = 632) of young infants who were admitted to a nutrition rehabilitation program in 2010-2011. The main characteristics of the inpatient treatment protocol where the use of diluted F-100 milk via a supplementary suckling technique until exclusive breastfeeding was reinitialized, coaching of mothers on infant feeding, and intensive antibiotic therapy as indicated during the stabilization phase. Semistructured interviews were conducted with 103 mothers. RESULTS: Rates of recovery, mortality, and default were 85% (537 of 632), 6% (37 of 632), and 9% (55 of 632), respectively. The majority of infants had an infectious disease at study entry (81%), particularly acute watery diarrhea and respiratory tract infections. Infection on admission was a predictor of death during treatment (OR, 3.9; 95% CI, 1.6-9.2). Anorexia at entry was a risk factor for treatment failure (OR, 4.4; 95% CI, 1.71-11.1). Interviews revealed a very low rate of exclusive breastfeeding (3%), with delayed initiation in 68% of cases. Traditional beliefs, perceived insufficiency of breast milk, and psychological problems played important roles in feeding choices. CONCLUSION: Severe acute malnutrition in infants aged <6 months can be successfully treated by managing cases as inpatients with an adapted protocol, intensive clinical supervision, and intensive drug treatment if indicated. Whether similar outcomes are achievable in community-based programs remains to be verified. Effective interventions for improving breastfeeding practices are needed.

Infant malnutrition is associated with persisting attention deficits in middle adulthood.

Infantile malnutrition is known to be associated with cognitive and behavioral impairment during childhood and adolescence. Data pertaining to longer-term effects on behavioral outcomes in adulthood are limited. In this study, we report associations between infantile malnutrition and attention problems in adults at midlife. Attention problems were assessed by the Conners Adult ADHD Rating Scales (CAARS) and the Conners Continuous Performance Test (CPT) in 145 Barbadian adults (aged 37-43 y) who had been followed longitudinally since childhood. Previously malnourished participants (n = 80) had experienced moderate to severe protein-energy malnutrition in the first year of life and were successfully rehabilitated thereafter. They were compared with healthy adults (n = 65) who were former classmates of the index cases and who had been matched for age, sex, and handedness in childhood. Multiple regression analyses showed persisting effects of childhood malnutrition on both the CAARS and the CPT, independent of effects of household standard of living assessed in childhood. The malnutrition effect on the CAARS ratings was independent of IQ, whereas this effect was attenuated for the CPT after adjustment for IQ. Teacher-reported attention problems in childhood predicted attention problems in adulthood, indicating continuity over the life span. Infantile malnutrition may have long-term effects on attentional processes nearly 40 y after the episode, even with excellent long-term nutritional rehabilitation and independent of socioeconomic conditions in childhood and adolescence. This finding has major public health implications for populations exposed to early childhood malnutrition.

Home visits by neighborhood Mentor Mothers provide timely recovery from childhood malnutrition in South Africa: results from a randomized controlled trial.

BACKGROUND: Child and infant malnourishment is a significant and growing problem in the developing world. Malnourished children are at high risk for negative health outcomes over their lifespans. Philani, a paraprofessional home visiting program, was developed to improve childhood nourishment. The objective of this study is to evaluate whether the Philani program can rehabilitate malnourished children in a timely manner. METHODS: Mentor Mothers were trained to conduct home visits. Mentor Mothers went from house to house in assigned neighborhoods, weighed children age 5 and younger, and recruited mother-child dyads where there was an underweight child. Participating dyads were assigned in a 2:1 random sequence to the Philani intervention condition (n = 536) or a control condition (n = 252). Mentor Mothers visited dyads in the intervention condition for one year, supporting mothers' problem-solving around nutrition. All children were weighed by Mentor Mothers at baseline and three, six, nine and twelve month follow-ups. RESULTS: By three months, children in the intervention condition were five times more likely to rehabilitate (reach a healthy weight for their ages) than children in the control condition. Throughout the course of the study, 43% (n = 233 of 536) of children in the intervention condition were rehabilitated while 31% (n = 78 of 252) of children in the control condition were rehabilitated. CONCLUSIONS: Paraprofessional Mentor Mothers are an effective strategy for delivering home visiting programs by providing the knowledge and support necessary to change the behavior of families at risk.

CD95 expression in white blood cells of malnourished infants during hospitalization and catch-up growth.

Malnutrition continues to be a major health burden in developing countries. Flow cytometric estimation of the apoptotic marker CD95 in peripheral neutrophils, lymphocytes and monocytes was done for 18 infants with non-oedematous protein energy malnutrition (PEM) and 12 oedematous ones, on hospital admission and after supervised nutritional rehabilitation, and compared with 12 matched controls. CD95 counts in the 3 types of white blood cells were significantly higher in PEM infants and showed improvement after nutritional rehabilitation yet not reaching the control values. Enhanced apoptosis in the leukocytes of peripheral blood of PEM patients may be a marker of increased infection and immune disturbances. This derangement reverses upon proper nutritional rehabilitation.

Nutritional recovery in HIV-infected and HIV-uninfected children with severe acute malnutrition.

OBJECTIVE: Few studies have reported on nutritional recovery, survival and growth among severely malnourished children with HIV. This study explores nutritional recovery in HIV-infected and HIV-uninfected children during inpatient nutrition rehabilitation and 4 months of follow-up. DESIGN: Prospective cohort study. SETTING: Lilongwe district, Malawi. MAIN OUTCOME MEASURES: Weight gain, anthropometrics. RESULTS: In our sample of 454 children with severe acute malnutrition (SAM), 17.4% (n = 79) of children were HIV infected. None of the children were on antiretroviral therapy upon admission. Among the HIV-infected children, 35.4% (28/79) died, compared with 10.4% (39/375) in HIV-uninfected children (p<0.001). All children who survived achieved nutritional recovery (>85% weight for height and no oedema), regardless of HIV status. HIV-infected children had similar weight gain to HIV-uninfected children (8.9 vs 8.0 g/kg/d, not significant (NS)). Mean increases in z-scores for both subscapular (2.72 vs 2.69, NS) and triceps (1.26 vs 1.48, NS) skinfolds were similar between HIV-infected and HIV-uninfected children, respectively, during nutrition rehabilitation. 362 children were followed for 4 months, at which time mean weight for height z-score was similar in HIV-infected and HIV-uninfected children (-0.85 vs -0.64, NS). CONCLUSIONS: HIV-infected children with SAM have higher mortality rates than HIV-uninfected children. Among those who survive, however, nutritional recovery is similar in HIV-infected and HIV-uninfected children.

[Infant-juvenile malnutrition in Fo-Boure (Benin): Anthropometric data and management of malnourished children]. / Malnutrition infantojuvénile à Fo-Bouré (Bénin): données anthropométriques et prise en charge des enfants malnutris.

UNLABELLED: Acute malnutrition or emaciation in childhood is defined by a low ratio weight/height. In Benin, 8% of the children are concerned. In the north of Benin, the situation is alarming. The aim of this survey is to specify: (1) the characteristics of infantile malnutrition in rural area in the north of Benin and (2) the management of the malnourished children. SUBJECTS AND METHODS: A descriptive survey was conducted in a paediatric dispensary. Anthropometric data of children from 0 to 60 months were collected. The children with severe malnutrition were admitted to a nutritional rehabilitation centre. The methods were those recommended by the World Health Organization and were adapted to the local resources. RESULTS: The anthropometric data of 239 children were analyzed. The prevalence of emaciation was 33%. Thirty-eight children were admitted to the centre. Twenty-nine of the children recovered. DISCUSSION: This survey confirms the precarious situation in the north of Benin, which may be explained by socio-economic and climatic factors. It can be prevented partly by better food availability, but also by an education on mothers. The strategies must be updated according to their effectiveness in terms of public health and their local acceptability. CONCLUSION: The prevalence of malnutrition in Fo-Bouré is beyond the value used by WHO to define the zones where the nutritional situation requires nutritional rehabilitation centres.

Sleep-wake cycle disturbances in protein-energy malnutrition: effect of nutritional rehabilitation.

A standard sleep questionnaire was given to the parents of 26 infants with protein-energy malnutrition who underwent polysomnographic evaluation. These investigations were repeated approximately 2 months after enrolment in a nutritional rehabilitation programme based on World Health Organization guidelines. Anthropometric values and serum serotonin levels were also measured. After nutritional rehabilitation there was a significantly higher percentage of non-rapid eye movement (REM) sleep; 2nd REM time, and latency times for sleep and REM sleep increased. Percentages of REM sleep and serum serotonin levels decreased significantly. Protein-energy malnutrition seems to affect the sleep-wake cycle; disturbed serotonin levels may be among the factors responsible.

[Management of severe acute malnutrition in an urban nutritional rehabilitation center in Burkina Faso]. / Prise en charge de la malnutrition aiguë sévère dans un centre de réhabilitation et d'éducation nutritionnelle urbain au Burkina Faso.

BACKGROUND: Management of acute severe malnutrition greatly contributes to the reduction of childhood mortality rate. In developing countries, where malnutrition is common, number of acute severe malnutrition cases exceeds inpatient treatment capacity. Recent success of community-based therapeutic care put back on agenda the management of acute severe malnutrition. We analysed key issues of inpatient management of severe malnutrition to suggest appropriate global approach. METHODS: Data of 1322 malnourished children, admitted in an urban nutritional rehabilitation center, in Burkina Faso, from 1999 to 2003 were analyzed. The nutritional status was assessed using anthropometrics indexes. Association between mortality and variables was measured by relative risks. Kaplan-Meier survival curves and Cox model were used. RESULTS: From the 1322 hospitalized children, 8.5% dropped out. Daily weight gain was 10.18 (+/-7.05) g/kg/d. Among hospitalized malnourished children, 16% died. Patients were at high risk of early death, as 80% of deaths occurred during the first week. The risk of dying was highest among the severely malnourished: weight-for-height<-4 standard deviation (SD), RR=2.55 P<0,001; low MUAC-for-age, RR=2.05 P<0.001. Kaplan-Meier survival curves and Cox model showed that the variables most strongly associated with mortality were weight-for-height and MUAC-for-age. Among children discharged from the nutritional rehabilitation centre, 10.9% had weight-for-height<-3 SD. CONCLUSION: The nutrition rehabilitation centre is confronted with extremely ill children with high risk of death. There is need to support those units for appropriate management of acute severe malnutrition. It is also important to implement community-based therapeutic care for management of children still malnourished at discharge from nutritional rehabilitation centre. These programs will contribute to reduce mortality rate and number of severely malnourished children attending inpatient nutrition rehabilitation centers, by prevention and early management.

Comparison of the efficacy of a solid ready-to-use food and a liquid, milk-based diet for the rehabilitation of severely malnourished children: a randomized trial.

BACKGROUND: The World Health Organization recommends a liquid, milk-based diet (F100) during the rehabilitation phase of the treatment of severe malnutrition. A dry, solid, ready-to-use food (RTUF) that can be eaten without adding water has been proposed to eliminate the risk of bacterial contamination from added water. The efficacies of RTUF and F100 have not been compared. OBJECTIVE: The objective was to compare the efficacy of RTUF and F100 in promoting weight gain in malnourished children. DESIGN: In an open-labeled, randomized trial, 70 severely malnourished Senegalese children aged 6-36 mo were randomly allocated to receive 3 meals containing either F100 (n = 35) or RTUF (n = 35) in addition to the local diet. The data from 30 children in each group were analyzed. RESULTS: The mean (+/- SD) daily energy intake in the RTUF group was 808 +/- 280 (95% CI: 703.8, 912.9) kJ x kg body wt(-1) x d(-1), and that in the F100 group was 573 +/- 201 (95% CI: 497.9, 648.7) kJ. kg body wt(-1) x d(-1) (P < 0.001). The average weight gains in the RTUF and F100 groups were 15.6 (95% CI: 13.4, 17.8) and 10.1 (95% CI: 8.7, 11.4) g x kg body wt(-1) x d(-1), respectively (P < 0.001). The difference in weight gain was greater in the most wasted children (P < 0.05). The average duration of rehabilitation was 17.3 (95% CI: 15.6, 19.0) d in the F100 group and was 13.4 (95% CI: 12.1, 14.7) d in the RTUF group (P < 0.001). CONCLUSIONS: This study indicated that RTUF can be used efficiently for the rehabilitation of severely malnourished children.

Impact of nutritional rehabilitation on enzymatic antioxidant levels in protein energy malnutrition.

To assess the role of enzymatic antioxidants in the pathogenesis of protein energy malnutrition (PEM) and the effect of nutritional rehabilitation, we studied 30 infants with PEM (mean age 10.63 +/- 4.39 months: 10 marasmic; 8 with kwashiorkor; 12 with marasmic kwashiorkor) and 15 controls. All underwent clinical examination and laboratory investigations, including superoxide dismutase (SOD) and glutathione peroxidase (GPx) estimation before and after nutrition rehabilitation. SOD and GPx were significantly lower in all malnourished infants compared to controls, and significantly increased after nutritional rehabilitation. These significant correlations suggest that antioxidants could be introduced during PEM nutritional rehabilitation to decrease morbidity and mortality.

[The effect of nutritional management on the mortality of malnourished children, uninfected and infected with the human immunodeficiency virus]. / Impact d'une prise en charge nutritionnelle sur la mortalité d'enfants malnutris infectés ou non par le virus de l'immunodéficience humaine.

Weight loss is a major complication in children infected with HIV. Very few studies have focused on the nutritional management of malnourished HIV-positive children, particularly in developing countries, although there have been some studies in adults. Therefore, the aim of this retrospective study was to evaluate, as a function of HIV status, the effect of a nutritional rehabilitation program on the mortality of malnourished children in an Ivory Coast nursery. We studied 193 malnourished children over the age of 15 months from January 1 1994 to December 31 1996; 41 % of these children (80 of 193) were HIV-positive. The nutritional rehabilitation program was introduced in 1995. It had a beneficial effect in HIV-negative children because the setback rate (the number of deaths and transfers x 1,000/the number of child-months at risk) decreased significantly over the three years of the study (1994: 130; 1995: 113; 1996: 26; p < 0.05). The rate in HIV-positive children did fall slightly, but this decrease was not statistically significant. These results demonstrate the difficulties involved in the nutritional management of malnourished HIV-positive children. However, recent studies have suggested that nutritional rehabilitation (by mouth) combined with total vitamin and mineral supplementation may be more effective. Given the frequency of malnutrition in HIV-positive children, clinical studies aimed at improving the nutritional management of these children should be a priority in developing countries.

Long-term prospects of malnourished children after rehabilitation at the Nutrition Rehabilitation Centre of St Mary's Hospital, Mumias, Kenya.

The growth and survival of children was studied after rehabilitation for malnutrition at the Nutrition Rehabilitation Centre (NRC) of St Mary's Hospital on average 1.5 year after discharge. The findings are intended partly to provide descriptive information on later progress in the community of these children and also to identify specific risk factors. Of 50 children eligible for follow-up, 39 (78 per cent) could be traced. Overall mortality was 36 per cent, 28 per cent were found to be underweight, and 36 per cent were in good condition with satisfactory catch up in weight. Mortality was determined by age, duration of stay in hospital and centre, and nutritional status. Most literature on the subject implies that the long-term effectiveness of the NRC is affected by limiting factors at home and in the centre itself. Our data suggest that the poor results are mainly due to improper use of the NRC. The NRC was called in too early by the hospital and children were discharged too soon from the NRC. As evidenced by the frequent presence of infectious symptoms, the severity of nutritional status, inadequate weight gain, and short duration of stay in the hospital and the NRC.

Rehabilitation of grade III protein energy malnutrition on out patients basis.

Malnutrition is an important yet preventable and curable cause of morbidity and mortality. One hundred and thirty-five children suffering from grade III Protein Energy Malnutrition (PEM) from a poor urban population of Karachi city were enrolled for rehabilitation by health education and growth monitoring as out patient. Of these, 89% showed satisfactory recovery during a mean follow-up period of 3.2 months. Mainstay of this study was simple health messages adapted according to local cultural practices in native language. This simple strategy can go a long way in prevention and treatment of PEM in all the developing countries.

Home based nutrition rehabilitation (RND)

RND is a community approach that ensures the management of malnourished children in their own environment; by the people in their immediate surroundings. In Kpovie village in the Pahau commune (sous-prefecture of Ouidah) CREDESA nutrition project succeeded in rehabilitating a child suffering from severe kwashiorkor whose family had given up hope. This patient was nursed at home with the use of local food items

[Behavioral development and nerve conduction velocity during recovery from malnutrition]. / Evolución conductual y velocidad de la conducción nerviosa durante la recuperación de la desnutrición.

OBJECTIVES: To research if the improvement in psychomotor development observed during the treatment of malnutrition, is related to favorable changes in the speed of nerve conduction and in the excretion of hydroxy-indole acetic acid (indole). DESIGNED OF THE STUDY: Prospective, of a descriptive type, includes the follow-up of children during the first month of treatment. APPLICATION: To better know the impact which malnutrition has on mental development. PATIENTS: Nine children, ranging from three to 15 months of age, gravely undernourished. INTERVENTION: The neurological development, the speed of nerve conduction and the excretion of indole were evaluated at 10 day intervals. MEASUREMENTS AND RESULTS: Using the Gesell technique in order to evaluate the development, the measurement of conduction through the medial and external popliteal sciatic nerves and indole excreted in 24 hours, a quantitative increase of all of these variables was seen in 24 hours. At the beginning the conduction speed was slow (less than 30 m/s) and the excretion of indole was very low (0.28 mg/24 h). After the tenth day these measurements returned to normal, although the development coefficient was found to still below at the end of the study (63.9 +/- 21.0). CONCLUSIONS: Simultaneous to the neurological deficit, there is a reduced speed of conduction, which returns to normal after the tenth day without a positive correlation with motor functions and development. Neither does the disponibility of serotonin (judged by the excretion of indole) correlate with the speed of conduction.