Effect of medium chain triglycerides enriched formula on growth of biliary atresia patients after Kasai portoenterostomy.

BACKGROUND AND STUDY AIMS: Biliary atresia (BA) is the most common cause of neonatal cholestasis, negatively affecting nutritional status, growth, and development. It is the most frequent paediatric indication for liver transplantation. The Kasai portoenterostomy (KPE) operation is an effective procedure with favourable outcomes when performed before two months of age. The present study aimed to assess the nutritional status of patients with biliary atresia who underwent the Kasai operation and to evaluate the effectiveness of nutritional counselling using medium-chain triglyceride (MCT) formulas and proper supplementation on their nutritional status, growth, and vitamin D levels. PATIENTS AND METHODS: This prospective observational study included 36 infants with biliary atresia who underwent Kasai portoenterostomy. All patients underwent clinical assessment, anthropometric evaluation, nutritional counselling, and an evaluation of vitamin D levels. Only compliant patients (22/36) were followed up after 3 and 6 months of nutritional counselling. RESULTS: Z-scores for weight, triceps skinfold thickness, and mid-upper arm circumference improved significantly after three months, and the height velocity Z-score improved after six months of nutritional counselling using an MCT-containing formula and supplementations. Patients who showed an improvement in cholestasis had better responses. The initial assessment revealed low serum levels of 25-hydroxyvitamin D in 77.8 %, which increased significantly (p = 0.012). CONCLUSION: Dietary intervention and supplementation with MCT and micronutrients can improve the nutritional status of children with BA following KPE.

Patterns of respiratory tract infections in children under 5 years of age in a low-middle-income country.

BACKGROUND: Respiratory tract infections (RTIs) are among the most commonly encountered major public health problems, with a higher prevalence of lower RTIs among children and more generally the poor. The present study aimed to describe the pattern of respiratory tract infections in Egyptian children aged under 5 years and explore possible associations between socio-demographics and nutritional status and types of RTIs. METHODS: Over 6 months beginning in September 2018 (including one winter season), a cross-sectional, observational, epidemiological study was conducted on a sample of patients with upper and lower RTIs diagnosed clinically and/or radiologically in the outpatient clinics at Cairo University Children's Hospital in Egypt. An interview questionnaire was employed to collect socio-demographic and nutritional data. Heights/lengths and weights were measured and analyzed using the World Health Organization's (WHO) Anthro Plus [Computer Program]. Patients with pneumonia (n = 28) were compared to 97 healthy children of the same age and sex. RESULTS: The total number of children diagnosed with upper and lower respiratory infections was 611. Malnutrition was present in 12.4% of all children with upper and lower RTIs. Lower RTI and malnutrition were substantially more prevalent among children aged under 2 years (p = 0.048 and p < 0.001, respectively). The strongest predictor of lower RTI was a younger age (OR 0.797, CI 0.713-0.89, p < 0.001). CONCLUSION: At our center, approximately one-third of infections in under-fives were lower RTI. Malnutrition was one of the significant risk factors for lower RTI in children below 2 years. The nutritional status of infants and young children should be improved by encouraging exclusive breastfeeding during the first 6 months of life and strengthening the healthcare and nutritional counseling available for vulnerable children, particularly in rural regions.

Impaired Pancreatic ß-Cell Function in Critically Ill Children.

Critical illness hyperglycemia (CIH) is common in the pediatric intensive care unit (PICU). Increased glucose production, insulin resistance (IR), and pancreatic ß-cell dysfunction are responsible mechanisms. We aimed to investigate ß-cell function in the PICU and to uncover its relation to clinical and laboratory variables and ICU mortality. We prospectively recruited 91 children. Pancreatic ß-cell function was assessed by using a homeostasis model assessment (HOMA)-ß. Patients with ß-cell function <40.0% had significantly higher Pediatric Risk of Mortality III (PRISM III) scores, higher rates of a positive C-reactive protein (CRP), lower IR, and a longer hospital stay. The patients with 40-80% ß-cell function had the highest IR. Intermediate IR was found when the ß-cell function was >80%. ICU survivors had better ß-cell function than ICU non-survivors. A multivariate logistic regression analysis revealed that higher PRISM III score and HOMA-ß <80.0% were significant predictors of mortality. In conclusion, ß-cell dysfunction is prevalent among PICU patients and influences patient morbidity and mortality.

Stretched penile length and anogenital distance in Egyptian boys aged one month to five years.

BACKGROUND: In children with isolated unilateral undescended testis mechanical anomalies are commonly implicated and a diagnosis of simple hypospadius implies that the rest of the external genitalia are normal. Patients with disorders of sexual development, by contrast, have other associated genital anomalies including micropenis and should be referred to the endocrinologist for hormonal assessment before surgical correction of undescended testis or hypospadius. Early diagnosis of abnormal penile size is important but proper assessment begins with defining the normal population-specific age-appropriate reference range. Anogenital distance (AGD) reflects prenatal and early postnatal testosterone levels. OBJECTIVE: The aim of our study was to establish mean reference values and percentile curves for strtetched penile length (SPL) and AGD in healthy Egyptian males from the age of one month to five years and to determine the mean monthly increase in SPL and AGDs from 1 to 13 months of age (a reflection of mini-puberty). STUDY DESIGN: This was a descriptive cross-sectional study conducted in Cairo University and Mataria Hosptals, Egypt to determine SPL and AGD in 2972 Egyptian males aged from one month to five years from October 2016-December 2018. In addition, we measured length/height, weight and body mass index. RESULTS: SPL increased gradually from a mean ± SD of 3.55 ± 0.51 cm in the first year of life to 5.52 ± 0.67 cm by five years of age with a growth from 1 to 12 months of life of 0.6 cm. SPL showed smaller values in infants 6-9 months old compared to younger infants. AGD increased from 7.48 ± 1.47 cm in the first year of life to 12.83 ± 0.58 cm by 5 years of age with a growth from 1 to 12 months of 4.34 cm. SPL and AGD Z-scores correlated positively with each other and with age (months), and Z-scores of height/length, weight and BMI (p < 0.001). DISCUSSION: The rapid increases in SPL and AGD observed in our study group in the first few months of life reflect the effects of mini-puberty. The fact that SPL and AGD correlated positively with other anthropometric measurements suggests that SPL and AGD may be controlled by nutritional and/or hormonal factors. We suggest that waning testosterone levels marking the end of minipuberty might explain smaller values for SPL in our group of 6-9 month old infants compared with younger infants. LIMITATION: We have not included children under one month old. CONCLUSION: It is important for each country to develop its own national percentile curves for all growth parameters. This will allow the physician to identify normal differences in the population and to pick up disorders at an age when intervention may yield better results We have developed percentile curves for SPL and AGD that can be used as references for Egyptian male infants and young children.

Birth Weight, Insulin Resistance, and Blood Pressure in Late Preterm Infants.

OBJECTIVES: This study aims to compare insulin sensitivity, lipid profile, and blood pressure in late preterm infants born at appropriate for gestational age (AGA) and small for gestational age (SGA). STUDY DESIGN: We conducted a prospective, observational study on AGA and SGA late preterm infants. Blood pressure, fasting blood glucose, insulin, insulin-like growth factor 1 (IGF-1), insulin resistance, and lipid profile were measured on the 1st day and in the 2nd week of life. RESULTS: Overall 81 infants (41 AGA and 40 SGA) were included in the study. At the time of enrollment, there was no difference in blood pressure, insulin resistance, and lipid profile. At follow-up SGA patients had significantly decreased diastolic blood pressure (48 ± 11 mm Hg vs. 42 ± 11 mm Hg, p = 0.04), and decreased IGF-1 (139 ng/mL [119-153] vs. 124 ng/mL [115-138], p = 0.05). No linear association was found between the insulin resistance and either birth weight percentile, day of life, or average 1st week daily caloric intake. CONCLUSION: As compared with AGA, SGA late preterm infants had lower diastolic blood pressure and lower IGF-1 during the 2nd week of life, but similar insulin resistance and lipid profile. We speculate that although metabolic derangements in SGA infants could have occurred at a much earlier age in fetal life, their manifestations may not be present in the immediate postnatal life.