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Fundoplication
Published in Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg, Operative Pediatric Surgery, 2020
Douglas C. Barnhart, Robert A. Cina
Children with neurological impairment have frequent foregut symptoms which can include retching after feedings, poor tolerance of gastric feedings, and frequent emesis. Failure to thrive is also common in these patients. These symptoms may be due to gastroesophageal reflux but can also be due to other causes such as delayed gastric emptying, esophageal dysmotility, and centrally mediated hypertonicity. Decision-making regarding fundoplication is particularly challenging in these patients due to the multiple causes of these symptoms and the increased risk of postoperative recurrent gastroesophageal reflux in these children.
Nutrition
Published in Jagdish M. Gupta, John Beveridge, MCQs in Paediatrics, 2020
Jagdish M. Gupta, John Beveridge
Unless obvious, organic causes of failure to thrive are uncommon. Even in developed countries the most common cause of failure to thrive is lack of calories; this is not necessarily due to inadequate availability of food, hence documentation of caloric intake is important. If the cause is organic it will not respond to feeding alone.
Mevalonic aciduria
Published in William L. Nyhan, Georg F. Hoffmann, Aida I. Al-Aqeel, Bruce A. Barshop, Atlas of Inherited Metabolic Diseases, 2020
Our first patient [1] presented with severe failure to thrive, diarrhea, and hepatosplenomegaly, a picture that led to referral to gastroenterologists. At 19 months, his weight, height, and head circumference were 4–8 SD below the mean for age. He had little or no subcutaneous fat (Figures 85.4 and 85.5). He died at 21 months [6]. Failure to thrive was present in nearly all the early reported patients: it was described as severe in two [1, 16], moderate in five, and mild in two [6]. The two most severely affected had gastrointestinal symptoms suggesting intolerance to cows’ milk. Hepatosplenomegaly was notable in five patients.
Nutritional interventions and outcomes of children with short bowel syndrome in a tertiary hospital setting in South Africa
Published in South African Journal of Clinical Nutrition, 2023
BD Saayman, AJW Millar, E van Niekerk
Infants with SBS may have challenges in maintaining appropriate growth due to malabsorption, bearing in mind the increased dietary requirements for growth and brain development during the first two years of life.16 Close monitoring of all anthropometric parameters should continue after enteral autonomy has been reached as patients who show appropriate weight and length gains reflect adequate intestinal adaptation and absorption. Failure to thrive may be seen as an indicator to restart specialised nutritional support such as enteral supplementation and/or partial PN if required.8 Better growth trends are observed during the period of full PN support as the effects of malabsorption are minimised. Poorer growth trends have been reported and are generally expected when enteral nutrition is introduced and the dependence on PN support is decreased, especially when PN support is aggressively weaned. It is thus essential that any decision to wean from PN should take into consideration the adequacy of a patient’s growth and the severity of any PN-related complications that may be present17,18
Maternal depression and infant social withdrawal as predictors of behaviour and development in vertically HIV-infected children at 3.5 years
Published in Paediatrics and International Child Health, 2021
Jani Nöthling, Barbara Laughton, Soraya Seedat
The maternal and infant demographic and clinical characteristics are shown in Tables 1 and 2, respectively, along with the results of the univariate analyses investigating the relationship between these variables and behaviour and development at 42 months. The percentage of mothers who scored above the clinical cut-off for depression on the CES-D at 10–12 months was 71.6%. Just under a third (31.1%) of infants showed clinically significant withdrawal at 10–12 months. Infants had a mean absolute CD4 count of 1850.4 and a mean CD4 percentage of 35.9 at 10–12 months. HIV-associated encephalopathy was diagnosed in 10.8% of children, 13.5% had failure to thrive and 5.4% were diagnosed with HIV wasting syndrome between 10 and 42 months. The mean score for behavioural problems was 44.1 with 20% scoring above the cut-off for clinically significant symptoms. The mean general Griffiths quotient for development was 83.2 at 42 months. Maternal depression (p < 0.05) and infant withdrawal (p = 0.02) at 10–12 months was associated with development at 42 months. Failure to thrive diagnosed between 10 and 42 months was also associated with development at 42 months (p < 0.05).
Advances in understanding of Netherton syndrome and therapeutic implications
Published in Expert Opinion on Orphan Drugs, 2020
Evgeniya Petrova, Alain Hovnanian
Newborns affected with NS classically present with congenital IE (generalized redness and scaling of the skin), with variable intensity and extension. Hair, eyebrows and eyelashes can be absent at birth and grow slowly or are present and subsequently become abnormal. The neonatal period is a critical period with high morbidity and life-threatening complications including hypernatraemic dehydration due to a severe skin barrier defect, hypothermia, recurrent skin, respiratory tract and systemic infections and gastrointestinal symptoms including abdominal pain, vomiting and diarrhea. Failure to thrive is frequent and has multiple causes such as increased catabolic rate, chronic inflammation, malabsorption, food allergies and recurrent infections. As a result, growth retardation and short stature are almost constant features. Rare associated findings have been reported including acute pancreatitis, acute bilateral renal vein thrombosis and persistent pulmonary hypertension Figure 2.