Resting energy expenditure in children with cerebral palsy: Accuracy of available prediction formulae and development of a population-specific formula.

BACKGROUND AND AIMS: Energy requirements are difficult to estimate in children with cerebral palsy (CP). Resting energy expenditure (REE), necessary for personalized nutritional intervention, is most commonly estimated using prediction formulae because the reference method, i.e. indirect calorimetry (IC), is not available in all Nutrition Units. The main aim of the present study was to evaluate the accuracy of the most commonly used REE prediction formulae in children with CP. The secondary aim was to develop a new population-specific formula for the estimation of REE in children with CP. METHODS: REE was measured by IC in 54 children and adolescents with spastic quadriplegic cerebral palsy (SQCP) and estimated from the five most commonly used prediction formulae, i.e. the World Health Organization (WHO), Harris-Benedict, Schofield weight, Schofield weight & height, and Oxford formulae. RESULTS: The mean (standard deviation, SD) difference between the estimated and measured REE was 64 (238) kcal/day for the WHO formula, 79 (226) kcal/day for the Schofield weight formula, 79 (223) kcal/day for the Schofield weight and height formula, 55 (226) kcal/day for the Oxford formula, 37 (224) kcal/day for the Harris-Benedict formula and 0 (213) kcal/day for the purposely developed population-specific formula. Owing to the large SD of the bias, none of these formulae can be reliably applied at the individual level to estimate REE. CONCLUSIONS: The most commonly used REE prediction formulas are inaccurate at both the population and individual level in children with SQCP. A purposely developed population-specific formula, despite being accurate at the population level, does not perform better than the most commonly used REE formulae at the individual level.

Gut and mesenteric lymph node involvement in pediatric patients infected with human immunodeficiency virus.

BACKGROUND: The gastrointestinal tract is a primary target for human immunodeficiency virus (HIV). HIV infection causes a depletion of CD4+ T-lymphocytes in gut-associated lymphoid tissue and affects gastrointestinal mucosal integrity and permeability. The gastrointestinal tract has also been suggested as the main reservoir of HIV despite highly active antiretroviral therapy (HAART). We performed a prospective case-control study to assess gut involvement in HIV-infected patients, either naïve or on HAART, using noninvasive methods such as bowel ultrasound and fecal calprotectin. METHODS: Thirty HIV-infected children and youth underwent the following tests: CD4+ T-cell count and HIV viral load, fecal calprotectin, and bowel ultrasound, with the latter evaluating bowel wall thickness and mesenteric lymph nodes. Fecal calprotectin and bowel ultrasound were also assessed in 30 healthy controls matched for age and sex. Fecal calprotectin was measured using a quantitative immunochromatographic point-of-care test, and concentrations ranging from 0 to 200 µg/g were considered to be normal reference values in children. RESULTS: Fecal calprotectin was normal in 29 HIV-infected patients and was not significantly different from controls (mean values 63.8±42.5 µg/g and 68.3±40.5 µg/g, respectively; P=0.419), and did not correlate with HIV viral load, CD4+ T-cell absolute count and percentage, or HAART treatment. No significant changes were found on bowel ultrasound except for enlarged mesenteric lymph nodes, which were observed in seven HIV-infected patients (23.3%) and two controls (6.6%). This finding was significantly correlated with high HIV viral load (P=0.001) and low CD4+ T-cell percentage (P=0.004). CONCLUSION: HIV-infected children did not have significant biochemical or ultrasonographic signs of bowel inflammation. A few patients showed enlarged mesenteric lymph nodes, which correlated with uncontrolled HIV infection.

Unexpected vertical transmission of HIV infection.

Mother-to-child transmission of HIV infection occurred in a child born from an HIV-infected mother with HIV-RNA undetectable during pregnancy. She was suffering from gastroenteritis in the last 3 weeks of gestation.

Serotype distribution and antimicrobial susceptibilities of nasopharyngeal isolates of Streptococcus pneumoniae from healthy children in the 13-valent pneumococcal conjugate vaccine era.

Few epidemiological data are available since the introduction of 13-valent pneumococcal vaccine (PCV13) in 2010. We conducted a cross-sectional study to estimate the prevalence of Streptococcus pneumoniae (SP) nasopharyngeal carriage in healthy Italian infants and young children and to evaluate the impact of PCV13 on pneumococcal colonization. In the trimester September-December 2011 nasopharyngeal swabs were collected from healthy children aged 3-59 months presenting for routine well careat 16 primary care pediatricians in Milan. SP carriage isolates were serotyped and tested for antimicrobial resistance using EUCAST breakpoints. Among 1250 enrolled children, 618 had received at least 1 dose of PCV13, 292 at least 1 dose of PCV7, 94 a combination of the two vaccines and 246 were not vaccinated. The prevalence of SP carriage was 27% (95% confidence interval [CI] 25-30). At multivariable analysis, age≥25 months (prevalence ratio [PR]=0.74) and use of antibiotics in the previous 3 months (PR=0.67) were associated with lower SP carriage prevalence. Having siblings (PR=1.79 for 1 sibling and PR=2.23 for ≥2 siblings), day-care attendance (PR=2.27) and respiratory tract infections in the previous 3 months (PR=1.39) were associated with higher SP carriage prevalence. The immunization status for SP was not associated with SP carriage at univariable or at multivariable analysis. The most common carriage isolates were 6C, 19A and 23A. The prevalence of the six additional PCV13 serotypes carriage in children appropriately vaccinated with PCV13 was lower than in children appropriately vaccinated with PCV7 (0 vs. 0.060); the greater reduction in prevalence of carriage was observed for serotype 19A (0 vs. 0.041). Serotype 6C was the most common drug-resistant serotype (17.2%). Further epidemiological studies are needed to assess changes in circulating SP serotypes following the large-scale introduction of PCV13.

Tenofovir-induced renal tubular dysfunction in vertically HIV-infected patients associated with polymorphisms in ABCC2, ABCC4 and ABCC10 genes.

Tenofovir disoproxyl fumarate is a known cause of kidney tubular dysfunction in HIV-infected patients. Recent studies reported significant association between specific allelic variants in ABCC2, ABCC4 and/or ABCC10 genes and the development of kidney tubular dysfunction in HIV-infected adults. We describe the first 2 cases of vertically HIV-infected patients affected by kidney tubular dysfunction associated with polymorphisms in the ABCC genes.