Study of serum insulin-like growth factor-I, prealbumin and procollagen type III peptide in children with protein energy malnutrition

This study was done to estimate the value of determination of serum concentrations of albumin, prealbumin, insulin-like growth factor-I [IGF-I] and procollagen 111 peptide [PIIINP] as early predictors of protein energy malnutrition [PEM] in children as well as to demonstrate the effect of nutritional rehabilitation therapy on these parameters. This work was carried out on 60 infants and children suffering from PEM. Their age ranged from 6 months to 3 years. They were classified into four groups according to Welcome classification of PEM; group I included 15 underweight infants and children, group I/ included 15 infants and children with marasmus, group III included 15 infants and children with kwashiorkor and group IV included 15 infants and children with marasmus-kwashiorkor. Another 30 normal healthy infants and children of matching age and sex served as a control group. All patients and control groups were subjected to a careful history taking, thorough clinical examination, anthropometric measurements including; weight, length, head circumference, mid-upper arm circumference [MUAC] and skin fold thickness [SFT] as well as laboratory investigations including complete blood picture, serum albumin, serum prealbumin, serum IGF-I, and serum PIIINP. All these laboratory investigations were repeated after 6 weeks of nutritional rehabilitation therapy in the form of a diet providing 4 gm proteins/kg/day and 150 cal./kg/day

Before nutritional rehabilitation: weight, MUAC and SFT were significantly decreased in comparing all the studied PEM groups and control one with a significant decrease in length and head circumference only in marasmus and marasmus-kwashiorkor groups. Albumin, prealbumin, IGF-I and PlllNP were significantly low in all the studied PEM groups compared to control one with more significant decrease in kwashiorkor group. Correlation study using weight for age percentage of median [WAM] as a fixed parameter showed a highly significant correlation with IGF-I more than with PlllNP and prealbumin

After nutritional rehabilitation: weight, MUAC and SFT were significantly increased in PEM groups as compared to that before nutritional rehabilitation. Albumin, prealbumin, IGF-I and PlllNP were significantly increased in PEM groups as compared with their values before nutritional rehabilitation. Correlation study using WAM as a fixed parameter showed a highly significant correlation with PlllNP more than with IGF-I and prealbumin

Conclusion: IGF-I is an early sensitive predictor of malnutrition status before nutritional rehabilitation therapy as compared to albumin, prealbumin and PIIINP. On the other-hand, PlllNP can be used as a sensitive prognostic marker that evaluates the short-term response to nutritional rehabilitation in malnourished children more than other nutritional parameters

Use of serum procalcitonin as a marker of bacterial infection in infants presenting with acute diarrhea

Bacterial infection may be a causative factor in some cases of infantile diarrhea, and can cause sepsis with acute organ dysfunction, which is considered a major threat to life. There is a need for an effective and accurate biochemical marker to support or exclude the diagnosis of bacterial infection as routine laboratory tests lack both sensitivity and specificity in correctly identifying which patients should receive antibiotics, and most confirmatory microbiological test results are not available for 24 hours. The present study aimed to determine plasma PCT level in infants with acute diarrhea to evaluate its tote as a marker of bacterial infection and hence to detect cases that may benefit from early institution of antimicrobial drugs. This study was carried out in the gastroenterology unit, and the intensive care wilt of Pediatric department, Tanta faculty of medicine, and started at January 2002, and ended by July 2002. It was conducted on 53 infants [35 ware males and 18 females], and their ages ranged from 6-24 months. The following investigations were made immediately alter admission: 1- Complete blood count, 2- Blood urine, and stool bacterial aerobic and anaerobic cultures [culture of ear discharge was done in cases with otitis media], 3-Cerebrospinal fluid [CSF] examination and culture were done in cases with positive blood cultures, 4- Serum C- reactive protein [CRP] and plasma concentration of procalcitonin [PCT], and 5- Chest X-ray. The patients warn classified into 2 groups, those who have negative microbiological cultures, 31 cases [group I], and others with positive cultures, 22 cases [group II]. It was found that in infants proved to have bacterial infection with positive cultures had significantly elevated serum PCT and CRP mole than the infants who had negative bacterial cultures [1.41 +/- 0.64, and 48.18 +/- 17.8 versus 0.53 +/- 0.23 and 5.6 7 +/- 2.47 respectively, p < 0.001]. Group II had significantly higher total leukocytic count [TLC] and lower platelet count than group I [13.5 +/- 3.58, and 161.41 +/- 79.56 versus 5.41 +/- 1.082 and 247.35 +/- 79.033 respectively]. We found that no significant difference between cases with and without bacteremia as regard to TCL, CRP, and PCT, but platelet count was significantly lower in cases of bacteremia than in others with no bacteremia [t=3.72 and p =0.001]. Serum PCT levels were found to be correlated significantly with the duration of diarrhea in infants proved to have bacterial growth on different cultures, but not with TLC, platelet count, or CRP. We concluded and recommended that:1] PCT is a useful indicator of bacterial infection among cases presenting with acute infantile diarrhea in which bacteria may be the causative underlying factor or complicating such cases, so it can help in selecting cases that need lipid administration of antibacterial agents. 2] PCT should be added to the required laboratory investigations as CRP, TLC, and platelet count in all cases of acute infantile diarrhea suspected to have bacterial etiology or in those who are critically ill, because most microbiological tests need time and couldn't help in emergency situations

Fecal alpha-1-antitrypsin and gastrointestinal blood loss in infants on different types of milk feeding

The effect of some types of milk feeding on gastrointestinal tract was studied in 60 healthy infants aged 7 days to 18 months [20 breast-fed, 20 formula-fed and 20 whole cow's milk-fed infants], using alpha alpha4 - antitrypsin as an indicator of plasma protein loss through the intestinal mucosa, and the guaiac test as a sensitive test for detection of occult blood loss. The whole cow's milk-fed infants showed higher levels of fecal alpha4- antitrypsin and more positive tests for occult blood loss especially in those infants below the age of 6 months [P< 0.05]. The same group also showed decreased hemoglobin concentrations, and lower serum iron compared with breast-fed infants group, but the difference was non-significant [P> 0.05]. The above two parameters were decreased in all groups after the age of 6 months. Age and feeding differences in the concentration of fecal alpha1- antitrypsin, may reflect subtle changes in gastro-intestinal tract function in early infancy