Artículos de revistas
Growth Evaluation In Infants With Neonatal Cholestasis
Registro en:
Arquivos De Gastroenterologia. , v. 43, n. 4, p. 305 - 309, 2006.
42803
10.1590/S0004-28032006000400012
2-s2.0-34147108598
Autor
Prado C.C.
Nogueira R.J.N.
Barros-Filho A.D.A.
Da Costa-Pinto E.A.L.
Hessel G.
Institución
Resumen
Background - Chronic liver diseases in childhood often cause undernutrition and growth failure. To our knowledge, growth parameters in infants with neonatal cholestasis are not available. Aim - To evaluate the nutritional status and growth pattern in infants with intrahepatic cholestasis and extrahepatic cholestasis. Patients and methods - One hundred forty-four patients with neonatal cholestasis were followed up at the Pediatric Gastroenterology Service of the Teaching Hospital, State University of Campinas, Campinas, SP, Brazil, in a 23-year period, from 1980 to 2003. The records of these patients were reviewed and patients were classified into two groups, according to their anatomical diagnosis: patients with intrahepatic cholestasis - group 1, and patients with extrahepatic cholestasis - group 2. Records of weight and height measurements were collected at 4 age stages of growth, in the first year of life: 1) from the time of the first medical visit to the age of 4 months (T1); 2) from the 5th to the 7th month (T2); 3) from the 8th to the 10th month (T3); and 4) from the 11th to the 13th month (T4). The weight-by-age and height-by-age Z-scores were calculated for each patient at each stage. In order for the patient to be included in the study it was necessary to have the weight and/or height measurements at the 4 stages. Analyses of variance and Tukey's tests were used for statistical analysis. Repeated measurement analyses of variance of the weight-by-age Z-score were performed in a 60-patient sample, including 29 patients from group 1 and 31 patients from group 2. The height-by-age data of 33 patients were recorded, 15 from group 1 and 18 from group 2. Results - The mean weight-by-age Z-scores of group 1 patients at the 4 age stages were: T1=-1.54; T2=-1.40; T3=-0.94; T4=-0.78. There was a significant difference between T2 X T3 and T1 X T4. The weight-by-age Z-scores for group 2 patients were :T1=-1.04; T2=-1.67; T3=-1.93 and T4=-1.77, with a significant difference between T1 X T2 and T1 X T4. The mean weight-by-age Z-scores also showed a significant difference between group 1 and group 2 at stages T3 and T4. The mean height-by-age Z-scores at the four stages in group 1 were: T1=-1.27; T2=-1.16; T3=-0.92 and T4=-0.22, with a significant difference between T3XT4 and T1XT4. The scores for group 2 patients were: T1=-0.93; T2=-1.89; T3=-2.26 and T4=-2.03, with a significant difference between T1XT2 and T1XT4. The mean height-by-age Z-scores also showed a significant difference between group 1 and group 2 at T3 and T4. Conclusion - The weight and height differences between the groups became significant from the 3rd measurement onward, with the most substantial deficit found in the extrahepatic group. In this group, there is evidence that the onset of weight and height deficit occurs between the first and second evaluation stages. 43 4 305 309 Alagille, D., Cholestasis in the first three months of life (1979) Prog Liver Dis, 6, pp. 471-485 Alagille, D., Prolonged obstructive jaundice including calculous and noncalculous gall bladder condition Pediatric clinical gastroenterology, (C1995), pp. 603-652. , Roy CC, Silverman A, Alagille D, editors, 4th ed. St. Louis: Mosby; Beath, S., Pearmain, G., Kelly, D., McMaster, P., Mayer, A., Buckels, J., Liver transplantation in babies and children with extrahepatic biliary atresia (1993) J Pediatr Surg, 28, pp. 1044-1047 Cardoso, A.L., Porta, G., Vieira, M.A., Carraza, F.R., Caracterização nutricional de crianças com colestase crônica (1997) J Pediatr (Rio J), 73, pp. 43-50 Chin, S.E., Shepherd, R.W., Thomas, B.J., Cleghorn, G.J., Patric, M.K., Wilcox, J.A., Ong, T.H., Strong, R., The nature of malnutrition in children with end-stage liver disease awaiting orthotopic liver transplantation (1992) Am J Clin Nutr, 56, pp. 164-168 Daniel, W.W., Biostatistics: A foundation for analysis in the health sciences, (C1978), pp. 215-223. , 2nd ed. New York: John Wiley Fomon, S.J., Nutrition of normal children, (C1993), pp. 147-175. , St. Louis: Mosby; Glasgow, J.F.T., Hamilton, J.R., Sass-Kortsak, A., Fat absorption in congenital obstructive liver disease (1973) Arch Dis Child, 48, pp. 601-607 Hamill, P.V., Drizd, T.A., Johnson, C.L., Reed, R.B., Roche, A.F., Moore, W.M., Physical growth: National Center for Health Statistics percentiles (1979) Am J Clin Nutr, 32, pp. 607-629 Kaufman, S.S., Murray, N.D., Wood, R.P., Shaw, B.W., Vanderhoof, J.A., Nutritional support for the infant with extrahepatic biliary atresia (1987) J Pediatr, 110, pp. 679-686 Morcillo, A.M., Lemos-Marini, S.H.V., SISCRES - Sistema de análise do crescimento (2002) Versão Windows Moreno, L.A., Gottrand, F., Hoden, S., Improvement of nutritional status in cholestatic children with supplemental nocturnal enteral nutrition (1991) J Pediatr Gastroenterol Nutr, 12, pp. 213-216 Moukarzel, A.A., Najm, I., Vargas, J., McDiarmid, S.V., Busuttil, R.W., Ament, M.E., Effect of nutritional status on outcome of orthotopic liver transplantation in pediatric patients (1990) Transplant Proc, 22, pp. 1560-1563 Mowat AP. Hepatitis and cholestasis in infancy: intrahepatic disorders. In: Mowat AP. Liver disorders in childhood. 3rd ed. Oxford: Butterworth- Heinemann 1994. p.44-78Novy, M.A., Schwarz, K.B., Nutritional considerations and management of the child with liver disease (1997) Nutrition, 13, pp. 177-184 Pierro, A., Koletzko, B., Carnielli, V., Superina, R.A., Roberts, E.A., Filler, R.M., Smith, J., Heim, T., Resting energy expenditure is increased in infants and children with extrahepatic biliary atresia (1989) J Pediatr Surg, 24, pp. 534-538 Rodeck, B., Melter, M., Kardorff, R., Hoyer, P.F., Ringe, B., Burdelski, M., Oldhafer, K.J., Brodehl, J., Liver Transplantation in children with chronic end stage liver disease: Factors infl uencing survival after transplantation (1996) Transplantation, 62, pp. 1071-1076 Schneeweiss, B., Graninger, W., Ferenci, P., Eichinger, S., Grimm, G., Schneider, B., Laggner, A., Kleinberger, G., Energy metabolism in patients with acute and chronic liver disease (1990) Hepatology, 11, pp. 387-393 Shiau, Y.F., Lipid digestion and absorption Physiology of the gastrointestinal tract, 2 (C1987), pp. 1527-1549. , Johnson LR, editor, 2nd ed. New York: Raven Press; Shiga, C., Ohi, R., Chiba, T., Nio, M., Endo, N., Mito, S., Hino, M., Assessment of nutritional status of postoperative patients with biliary atresia (1997) Tohoku J Exp Med, 181, pp. 217-223 Sokol, R.J., Stall, C., Anthropometric evaluation of infants with chronic liver disease (1990) Am J Clin Nutr, 52, pp. 203-208