Biomedical subjects
Publications and source records attributed to D Turck.
This paper presents practical guidelines for nutrition and feeding of infants and toddlers including vitamin D, vitamin K and fluoride supplementations and preventive measures at risk for food allergy based on family history.
INTRODUCTION: Iodine deficiency is responsible for a higher mortality and morbidity in neonates and infants. It has not yet disappeared in European countries, especially in Southern and Eastern Europe. OBJECTIVES: The present study aimed at evaluating the status of iodine nutrition of infants living in the North department (France) and at studying risk factors for iodine deficiency. METHODS: The study was conducted in primary health care centres in 160 healthy infants aged ten days to six years (mean +/- SD: 17.7 +/- 2.5 months). Data included: familial thyroid disease history, type of feeding at inclusion, timing of introduction of complementary foods, nutritional status (weight, height, head and arm circumference), as well as maternal education level and family socio-economical status. Iodine status was assessed by urinary iodine excretion. RESULTS: Urinary iodine concentration ranged from 4 to 1042 microg/l (median +/- SD: 195,5 +/- 21,6 microg/l). Thirty-eight (24%) of 160 children were iodine deficient (urinary iodine < 100 microg/l): mild iodine deficiency (50-99 microg/l: 17%), moderate iodine deficiency (20-49 microg/l: 5%), severe iodine deficiency (<20 microg/l: 2%). No relationship was found between iodine status and age, sex, geographic origin of the children, as well as social and occupational group of the parents. Breast-feeding did not prevent from iodine deficiency. Iodine status did not differ between the cow's milk fed group and the group that was not fed cow's milk. Formula feeding was associated with iodine deficiency (p = 0,02). CONCLUSIONS: Prevalence of severe iodine deficiency was very low in this population. However, iodine status was not optimal.
INTRODUCTION: Choking phobia has been rarely described in the literature and its prevalence has not yet been determined. Because of its clinical picture (female predominance, avoidance or refusal of certain foodstuffs, secondary weight loss, associated obsessive-compulsive symptoms), it is often misdiagnosed as anorexia nervosa. CASE REPORT: The authors describe the case of an 11-year-old girl, hospitalised for anorexia, who actually had choking phobia. Following a long history of anxiety disorders (including separation anxiety, social phobia, obsessive-compulsive disorder), the choking phobia had been triggered by a traumatic choking episode occurred in her grandfather. The disorder was successfully treated by cognitive-behavioural techniques associated with an antidepressant therapy. CONCLUSION: This typical case questions the relationships between choking phobia and the other anxiety disorders of childhood and adolescence. According to data from the literature, the authors conclude that choking phobia may be regarded as a non developmental specific phobia, whose occurrence is facilitated by the presence of pre-existing anxiety disorders. The disorder is usually improved by cognitive-behavioural treatment.
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France has decided to add to the national neonatal screening program (Phenylketonuria, Hypothyroidism, Congenital Adrenal Hyperplasia, Sickle cell disease) the screening of cystic fibrosis (CF). The screening of CF will be implemented in all regions of France by the end of 2002 and will cover all newborn (near 800,000/year). Based on the recommendation of the French Screening Foundation, the project has been approved by the Health Ministry and will be financed by the social security. CF neonatal screening is now technically feasible and reliable. The proposed methodology includes: immunoreactive trypsin (IRT) dosage on all newborns at day 3 (by radioimmunology "Cis Bio" or immunofluorescence "Delfia") followed by genotype CFTR analysis if IRT level is above 60 micrograms/L. Screening for 29 mutations is planned. If genotype is negative, control of IRT at day 21 will be obtained. Several requirements are included in the program: a protocol of care for the newly diagnosed CF in a specialised CF center; information to all parents of newborns; results of CFTR genotype has to be given during a clinical visit, even if negative. This screening program should allow to screen 98% of the cystic fibrosis patients before the age of 1 month. In order to ensure perfect efficacy, the CF screening program will be evaluated and modified if necessary.
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Recent European studies have shown that growth retardation is com-mon in people with phenylketonuria (PKU) during the first years of life while they receive a low-phenylalanine (Phe) diet. The aims of the present study were to assess the growth of our PKU patients and to search for nutritional and hormonal explanations for the growth delay. Twenty PKU patients aged 8 months to 7 years entered the study. The design was cross-sectional, a longitudinal study having already been performed in our centre. The following data were recorded: weight/height (W/H), height/age (H/A), and weight/age (W/A) Z-scores; fat-free mass (measured from bioelectrical impedometry (FFM1), and skinfold thickness (FFMA). Thyroid hormones, insulin-like growth factor I (IGF1), insulin-like growth factor binding protein (IGFBP3), selenium, zinc, and Phe blood levels were measured. Dietary intake was also recorded over 4 days. PKU patients were moderately but significantly shorter (H/A Z-score varied from -2.12 to 1.61; mean -0.49) and lighter (W/A Z-score varied from -2.58 to 1.49; mean -0.71) than the French reference population. Body composition was not different from that of controls matched for age and sex. IGF1, IGFBP3, and thyroid hormone levels were within normal range. All children received more than two-thirds of the recommended daily allowances for energy (91% +/- 18%) and for proteins (146% +/- 26%). The mean daily intake of our patients was sufficient in selenium, but markedly deficient in zinc (2.4 +/- 2.2 mg/day). No correlation was found between zinc daily intake or zinc plasma levels and growth retardation. Moreover, no relation was found between the plasma Phe concentrations, protein or caloric intake and the presence of growth retardation. Our results show that growth retardation in PKU patients is not related to hormonal or caloric deficiencies. Further studies are needed to investigate the effect of various nutrient supplementation regimens (especially zinc) on the growth of PKU patients.
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OBJECTIVE: To report our experience of enteral feeding via gastrostomy in children with severe chronic neonatal lung disease, failure to thrive, and oral aversive behavior after initial hospitalization. POPULATION: Thirteen patients were studied. All children had chronic lung disease of neonatal onset and were severely malnourished. They received enteral nutrition via a gastrostomy at a median age of 13 months (range: 8-35). RESULTS: Z-scores for weight-for-height increased significantly, from -3.4 to -1.9 after four months of enteral nutrition. Caloric intake increased significantly from 100% to 140% of the recommended daily allowance for age. Pulmonary status remained stable for all patients and oxygenation was normal. There was an aggravation of oral aversive behavior in 7 of the 13 children, especially those children who were ventilated and hospitalized for a long time (median duration: 195 days). The median follow-up of patients after gastrostomy was 30 months (range: 8-54) and only six patients could be weaned from enteral nutrition. CONCLUSION: Enteral nutrition via gastrostomy is efficient, and provides the means to improve caloric intake and nutritional status. Gastrostomy is a safe and convenient technique that should be considered early in the course of treatment for infants presenting with malnutrition related to neonatal pulmonary disease.
INTRODUCTION: Exercise testing is useful in the respiratory evaluation of patients with cystic fibrosis. The shuttle walk test (SWT) is a progressive, externally paced, exercise test requiring the subject to walk/run back and forth between two fixed points. The aim is to assess the reproductibility of the SWT in paediatric patients with cystic fibrosis. METHODS: This prospective study recruited 31 children with stable disease. The patients performed two SWT one day (SWT 1 and 2) and two others (SWT 3 and 4) within 15 days. Only SWT 2 and 4 were assessed for reproducibility. RESULTS: 61% were boys, median age (range): 12.9 (7-18.9) years, median Shwachman score (range): 80 (65-100), median values for FEV1 and FVC (range): 92 (55-154) and 92 (64-140)% predicted, respectively. Median distance for SWT 2-4 (range): 910 (580-1020) and 925 (540-1020) metres. Reproducibility for SWT distance and physical activity measured by an accelerometer is very good (intra-class correlation coefficient=0.90 and 0.92, respectively). SWT distance correlated with physical activity (p=3.10(-4)) and weight (p=0.03). SWT distance was independent of the following parameters: height, weight-for-age Z-score, FEV1, FVC, Shwachman score, colonisation with Pseudomonas aeruginosa. CONCLUSIONS: The SWT is reproducible in paediatric patients with cystic fibrosis and provides assessment of respiratory performance that complements spirometric measures of lung function.
This paper written by the Comité de nutrition de la Société française de pédiatrie is specially devoted to the nutritional treatment of infant and child acute diarrhea, i.e. oral rehydration with salts solution and feeding. It complements an article on drug therapy of child acute diarrhea written by the Groupe francophone d'hépatologie, gastroentérologie et nutrition pédiatriques, and published in this same issue of the Archives de pédiatrie.
AIM: Esophageal manometry has been increasingly used in children allowing better description of esophageal primary disorders as partial achalasia. The aim of this retrospective study was to describe clinical manifestations of partial achalasia, to look for their specificities and to follow clinical and manometric evolution in response to treatment. PATIENTS AND METHODS: Eighteen patients (mean age four years: range one month-13.5 years) presenting with partial achalasia were examined from 1990 to 1998. The symptomatology leading to esophageal manometry was: dysphagia (n = 9), gastroesophageal reflux (n = 6), swallowing disorder (n = 3). pH-metry (n = 8), esophageal endoscopy (n = 11) and barium transit (n = 12) were also performed. RESULTS: Twelve children were treated with nifedipine, (dysphagia n = 6, gastroesophageal reflux n = 5, swallowing disorder n = 1). At follow-up, a good clinical response was observed in six children while no effect or transient improvement were observed in two and four children respectively. Two of them presented spontaneous clinical resolution of symptoms after nifedipine was stopped but four children needed Heller procedure. Six of 18 patients (dysphagia n = 3, gastroesophageal reflux n = 2, swallowing disorder n = 1) developed achalasia or recurrent symptoms which required Heller surgery. At the first examination, no clinical or manometric features could differentiate these six patients from the remainders who presented a favorable outcome. CONCLUSION: Esophageal primary disorders as partial achalasia in children are observed in various clinical conditions. The possible development of achalasia and persistence of symptoms in some children justify both attentive clinical and manometric follow-up.
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UNLABELLED: Detection of a gastroesophageal reflux in the aetiology of recurrent respiratory diseases is the main indication of continuous gastroesophageal pH-metry in children. The aim of the study was to measure the diagnostic value of a daytime esophageal pH monitoring in children with recurrent respiratory diseases. METHODS: One hundred seventeen continuous esophageal pH monitoring of 5 +/- 3 year-old children presenting recurrent respiratory diseases have been reviewed. For each record, an analysis of the total record period, then the diurnal record, then the nocturnal record period was performed. The reflux index, the number of reflux per hour, and the number of long lasting reflux (> 5 min) per hour were compared between different periods (total, diurnal, and nocturnal). RESULTS: For the reflux index, the sensibility, the specificity, the positive predictive value and the negative predictive value of the awake period in comparison with the continuous 24 h record, considering the same standards for both periods, were 97%, 46%, 72% and 92% respectively. The ROC graph analysis showed that the cut-off adaptation for the reflux index and for the number of reflux per hour, did not allow to improve the day pH-metry performance, since sensibility and specificity moved respectively from 66% to 56% for reflux index, and from 75% to 56% for the number of reflux per hour. CONCLUSION: In children explored for recurrent respiratory diseases, the night record has a bad diagnostic value and a negative diurnal record is strongly predictive of absence of pathological gastroesophageal reflux in these children. Because of the absence of paediatric specific standards for this disorder, it is not possible to reduce the recording time to the diurnal period.
UNLABELLED: The aim of this study was to evaluate the safety and efficacy of intravenous iron saccharate administration in iron-deficient anemic children, under long-term parenteral nutrition, who are unable to tolerate oral iron supplementation or are unresponsive to oral supplementation because of gastrointestinal dysfunction or iron malabsorption. METHODS: Twenty-two infants and children aged 5 months-17 years (median: 38 months) receiving long-term parenteral nutrition and presenting with iron deficiency anemia were included. Total iron to be infused was determined by the formula: total iron (mg) = 0.6 x W (100 - Hb x 100/12) (W: weight, Hb: hemoglobin). Intravenous iron saccharate was given at the hospital. Each patient received a test dose of 25 mg of iron saccharate prior to the initiation of the infusion. Hemoglobin values, reticulocytes count, serum iron, and serum ferritin were determined before iron administration (day 1), as well as 15 and 45 days after iron administration. RESULTS: Tolerance of intravenous iron saccharate was good except in one patient who developed transient exanthema and hypotension after completion of the last iron saccharate infusion. Intravenous iron led to a significative increase in hemoglobin concentration of 2.2 g/dl within 45 days (range: 0.4-4.3 g/dl). CONCLUSION: Intravenous iron supplementation with iron saccharate is an efficient procedure, replenishing iron body stores and significantly increasing the hemoglobin concentration. The possible occurrence of allergic reactions emphasizes the need for close medical supervision.
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Total energy expenditure (EE) can be assessed in children by the heart-rate (HR) monitoring technique calibrated against open-circuit indirect calorimetry (IC). In this technique, sleeping EE is usually estimated as the lowest value of a 30 min resting EE measurement x 0 x 90 to give an average for the total sleeping period. However, sleeping is a dynamic process in which sleeping EE is modulated by the effect of factors such as body movement and different sleep stages. The aim of the present study was to determine a new method to improve the sleeping EE measurement by taking into account body movements during sleep. Twenty-four non-obese children participated in the present study. All subjects passed through a calibration period. HR and EE measured by IC were simultaneously collected during resting, the postprandial period, and during different levels of activity. Different methods for computing sleeping EE (resting with different breakpoints ('flex point' HR with linear regression or 'inflection point' (IP) HR with the third order polynomial regression equation (P3)) were compared with EE measured for least 2.0 h in eight sleeping children. The best method of calculation was then tested in sixteen children undergoing HR monitoring and with a body movement detector. In a subset of eight children undergoing simultaneous sleeping EE measurement by IC and HR, the use of the equation resting when HR IP during the sleeping period gave the lowest difference (1 (sd 5.4) %) compared with other methods (linear or polynomial regressions). The new formula was tested in an independent subset of sixteen other children. The difference between sleeping EE computed with the formula resting and sleeping EE computed with resting when HR IP during sleeping periods was significant (13 (sd 5.9) %) only for active sleeping subjects (n 6 of 16 subjects). The correlation between the difference in the results from the two methods of calculation and body movements was close (r 0.63, P<0.005, Spearman test) as well as computed sleeping EE (Spearman test, r 0.679, P<0.001), indicating that this new method is reliable for computing sleeping EE with HR monitoring if children are moving during sleep and improves the total EE assessment.
Determining total energy expenditure (EE) in children under free-living conditions has become of increasingly clinical interest. The aim of this study was to compare three different methods to assess EE triaxial accelerometry (TriTrac-R3D; Professional Products, Division of Reining International, Madison, WI, USA), activity diary and heart-rate (HR) monitoring combined with indirect calorimetry (IC). Twenty non-obese children and adolescents, aged 5.5 to 16.0 years, participated in this study. Results from the three methods were collected simultaneously under free-living conditions during the same 24 h schoolday period. Neither activity diary (5904 (sd 1756) kJ) nor the TriTrac-R3D (6389 (sd 979) kJ) showed statistical differences in 24 h total EE compared with HR monitoring (5965 (sd 1911) kJ). When considering different physical activity (PA) periods, compared with HR monitoring, activity diary underestimates total EE during sedentary periods (P<0.001) and overestimates total EE and PA-EE during PA periods (P<0.001) because of the high energy cost equivalence of activity levels. The TriTrac-R3D, compared with HR monitoring, shows good agreement for assessing PA-EE during PA periods (mean difference +0.25 (sd 1.9) kJ/min; 95 % CI for the bias -0.08, 0.58), but underestimates PA-EE and it does not show good precision during sedentary periods (-0.87 (sd 1.4) kJ/min, P<0.001). Correlation between the vector magnitude generated by the TriTrac-R3D accelerometer and EE of activities derived from HR monitoring is high. When compared with the HR method, the TriTrac-R3D and activity diary are not systematically accurate and must be carefully used for the assessment of children's EE depending on the purpose of each study.