Prevalence of undernutrition in Japanese pediatric patients on admission: Comparison of tertiary, acute-care, and rehabilitation hospitals.

BACKGROUND AND OBJECTIVES: There exist many studies in Western countries dealing with pediatric nutritional assessment on admission, but those in Asian countries are comparatively limited. This study aimed at clarifying the prevalence of undernutrition in 3 Japanese pediatric hospitals, especially focusing on their different characteristics. METHODS AND STUDY DESIGN: Study participants included 313 patients aged 1-17 years admitted to a tertiary hospital (175 patients), an acute-care hospital (99 patients), or a rehabilitation hospital (39 patients). On admission, body height, weight, and serum albumin were measured. BMI was calculated by dividing the weight (kg) by the square of height (m). Patients exhibited undernutrition on account of BMI z-score <-2, weight-for-height (W/H) <90%, height-for-age (H/A) <95%, or albumin <3.5 g/dL. RESULTS: The overall prevalence of undernutrition was 53.0%. Among 4 nutritional measures, the prevalence was highest in H/A (33.9%), followed by W/H (26.8%), BMI z-score (17.6%) and albumin (12.8%). A rehabilitation hospital exhibited significantly higher prevalence than that in a tertiary- or acute-care hospital. By the classification of International Statistical Classification of Diseases and Related Health Problems-10, neurological diseases and congenital anomalies showed higher prevalence among the disease categories which had the number of enrolled patients more than twenty. CONCLUSIONS: This study indicates that hospital characteristics and inpatient disease categories are important in the admission evaluation of the likelihood of undernutrition. These observations require consideration by hospital physicians in paediatric nutritional diagnosis and management.

Domperidone with ORT in the treatment of pediatric acute gastroenteritis in Japan: a multicenter, randomized controlled trial.

Domperidone is an antiemetic that is often prescribed for children with acute gastroenteritis in Japan. In this study, the authors assessed the efficacy of domperidone prescription in combination with oral rehydration treatment (ORT) in the treatment of vomiting during acute gastroenteritis in children during the early period. They performed a prospective multicenter randomized trial in Japan. Patients received either ORT or ORT and domperidone prescription. The primary outcome was the proportion of patients who had vomiting during the first 2 hours after randomization. A total of 56 children were eligible; 24 received ORT alone, and 32 received ORT and prescribed domperidone suppository. Results showed that 27.3% of children in the ORT group vomited as compared with 20.7% of children in the ORT and domperidone group (P = .41). In this study, it appears that domperidone in combination with ORT in the treatment of acute gastroenteritis does not reduce vomiting in the early period.

Varied clinical course of aplastic crisis in hereditary spherocytosis.

This study is the first to report a familial case involving differing clinical courses of aplastic crisis triggered by parvovirus B19 in two patients with HS, although similar eosin-5-maleimide-binding test and sodium dodecylsulfate-polyacrylamide gel electrophoresis results had been obtained for both. One patient had short-term mild symptoms, whereas the other patient developed severe anemia that required blood transfusion, experienced fever for 13 days, and did not have any rash. The severity of aplastic crisis is reported to be correlated with the severity of the underlying hemolytic anemia; the present findings show that the severity of infection should also be considered as an important predictive factor of the severity of aplastic crisis.

Association of age and family history with supplement use in pediatric patients with allergy.

This study was conducted to determine the frequency and characteristics of supplement use in pediatric patients with allergic disorders in Japan. A total of 229 patients with various allergic disorders aged between 0 and 15 years were enrolled. Supplements were defined as preparations that provided nutritional content in the form of a tablet, capsule, powder, liquid, or jelly. The parents of each subject were asked to complete a questionnaire on their child's use of supplements over the previous year. Demographic information, parents' perceived view of the child's health status over the previous month, and family history of both allergic disorders, and supplement use were collected. Four hundred eight age- and sex-matched healthy children served as the controls. Twenty-nine (12.7%) patients had used supplements. This frequency was not significantly different from that in the control group (15.0%). The types of supplements most commonly used were vitamins, followed by minerals, probiotics, and chlorella. Univariate analysis revealed that older age and a positive family history of supplement use were associated with patients' supplement use. The types of allergic disorders, health status from the point of view of the parents, and a family history of allergic disorders did not show any significant association. To our knowledge, this is the first cross-sectional study to demonstrate the frequency and the factors affecting supplement use in pediatric patients with allergic disorders.

Characterization of chronic idiopathic thrombocytopenic purpura in Japanese children: a retrospective multi-center study.

The objectives of this study are to clarify (1) the difference in demographic and clinical variables at initial presentation between acute and chronic idiopathic thrombocytopenic purpura (ITP), and (2) the prognostic factors of patients with chronic ITP. We conducted a retrospective analysis of 247 children with newly diagnosed ITP between April 1991 and March 2006 who visited one of the 12 hospitals belonging to the Kyoto University Pediatric Hematologic Study Group. 180 and 67 cases were classified as the acute type and as the chronic type, respectively. Older age, higher initial platelet count, positive medical history or concomitant medical diagnosis, the absence of preceding infection or vaccination, and the absence of an increase in immunoglobulin were risk factors for the chronicity. The prognostic factors in chronic ITP were evaluated in 53 patients after excluding patients receiving splenectomy or having insufficient follow-up data. The overall time required for 50% resolution in patients with chronic ITP was approximately 5.6 years. Age at presentation of less than 3 years and higher platelet counts at the time of chronic ITP diagnosis were good prognostic factors. On the other hand, gender, initial platelet counts, and preceding infection or vaccination were not associated with the prognosis.

[Complications in the central nervous system during chemotherapy for childhood acute lymphoblastic leukemia: JACLS ALL-02 study].

We evaluated central nervous system (CNS) complications treated under the ALL-02 protocol of the Japan Association of Childhood Leukemia Study (JACLS) from April 2002 to March 2005. According to NCI Toxicity Criteria, 17 events of grade 3 and 4 CNS complications were reported in 15 out of 541 patients. Out of these CNS complications, leukoencephalopathy was seen in 5 patients; seizure in 5; cerebrovascular disease in 3; conscious disturbance in 2; and hypertensive encephalopathy and reversible posterior leukoencephalopathy syndrome in one patient each. The complications were intensively observed during induction therapy and the last of the early phase chemotherapy. The protocol treatment was stopped or modified in most patients after CNS complications. MRI imaging demonstrated no improvement in one patient with leukoencephalopathy who developed an isolated CNS relapse, while other patients were alive and remain in their first complete remission without any neurological sequelae. Further studies will be required to analyze risk factors for CNS complications during chemotherapy not accompanied by irradiation and to establish alternative treatments after the appearance of such CNS complications.

Infant acute lymphoblastic leukemia with MLL gene rearrangements: outcome following intensive chemotherapy and hematopoietic stem cell transplantation.

Forty-four infants with acute lymphoblastic leukemia (ALL) characterized by MLL gene rearrangements were treated on a protocol of intensive chemotherapy followed by hematopoietic stem cell transplantation (HSCT) between November 1998 and June 2002. The remission induction rate was 91.0%, and the 3-year overall survival and event-free survival (EFS) rates, with 95% confidence intervals, were 58.2% (43.5%-72.9%) and 43.6% (28.5%-58.7%), respectively. Univariate analysis of EFS by presenting features indicated a poorer outcome in patients younger than 6 months of age with high white blood cell counts (>/= 100 x 10(9)/L; EFS rate, 9.4% versus 55.1% for all others, P = .0036) and in those with central nervous system invasion (EFS rate, 10.0% versus 56.9% for all others, P = .0073). The 3-year posttransplantation EFS rate for the 29 patients who underwent HSCT in first remission was 64.4% (46.4%-82.4%). In this subgroup, only the timing of HSCT (first remission versus others) was a significant risk factor by multivariate analysis (P < .0001). These results suggest that early introduction of HSCT, possibly with a less toxic conditioning regimen, may improve the prognosis for infants with MLL(+) ALL. Identification of subgroups or patients who respond well to intensified chemotherapy alone should have a high priority in future investigations.