儿童炎性肠病的营养支持治疗

炎性肠病（IBD）是一种复杂的多因素免疫介导性疾病。营养不良在儿童IBD中普遍存在，应定期进行营养风险筛查及营养评定。对于IBD患儿营养治疗无论是作为一线治疗还是预防及纠正营养不良都占有重要地位。文章对儿童IBD管理中的营养策略进行概述，旨在科学证据的基础上为儿科医生临床应用提供依据。     

托幼机构儿童营养摄入量与疾病关系的探讨

托幼机构儿童营养摄入量与疾病关系的探讨上海市儿童保健所（２０００４０）龚群，谭惠玉，袁丽娟，尹英，李斌托幼机构中儿童常见的营养性疾病主要为贫血、营养不良等。这些疾病直接影响儿童生长和智力发育，而这些疾病与膳食不合理有关。但目前对学龄前儿童营养素摄入量...     

儿童营养状况评估研究进展

儿童营养不良不是单一疾病,而是一种异常的状态,包括营养低下和营养过度。但多数国家学者描述儿童营养不良时仍是指儿童能量-蛋白质营养低下。根据体格发育指标判断儿童营养不良有低体重、生长迟缓和消瘦三种情况。身长（高）的改善比体重的增加更能衡量营养补充状况,体重增加应与身长（高）成比例。因此,近年WHO建议以体重/身长（高）判断儿童人群营养不良流行强度和个体儿童营养不良状况以及评估干预情况。评价儿童营养状况包括人体测量（“A”）、实验室或生化检查（“B”）、临床表现（“C”）、膳食分析（“D”）。营养不良儿童要求保证食物摄入Ⅰ类（功能性、预防性营养素）和Ⅱ类（生长营养素）等30余种营养素使生长加速至正常水平。     

神经损伤儿童营养不良管理流程及干预建议

营养不良是神经损伤(neurological impairment, NI)儿童常见的并发症, 合并营养不良的NI儿童需进行临床营养干预。为规范NI儿童营养干预流程, 改善其营养状况, 本建议从NI儿童的营养不良管理及干预的总体流程、营养筛查与评估流程、营养不良原因分析、营养干预方案制定和营养干预方案具体实施的各种问题及干预效果监测和随访等方面进行总结归纳, 并提出了相应营养干预建议。     

恶性实体瘤儿童营养状况及影响因素研究

目的观察恶性实体瘤儿童初诊与治疗3个月后营养状况变化,并分析其影响因素。方法回顾分析2018年3月至2019年9月住院治疗的104例实体瘤患儿的临床资料。患儿均于入院24小时内采用STRONGkids进行营养风险筛查,并行膳食摄入分析;根据WHO 2006儿童生长标准评定患儿营养状况。比较分析患儿入院时及治疗3个月后营养状况及影响因素。结果实体瘤患儿中男61例、女43例,中位年龄4.5岁。实体瘤患儿初诊时营养不良发生率27.9%;治疗3个月后体质指数Z评分明显下降,差异有统计学意义(P0.05),治疗3个月后营养不良发生率为48.0%。Logistic回归显示,入院时患儿营养状况、STRONGkids营养风险评分是患儿治疗后营养不良的影响因素(P0.05)。结论实体瘤患儿治疗过程中容易发生营养状况恶化,对于营养不良及营养风险评分高的患儿,应尽早给予合理的营养支持干预。     

儿童营养不良体格测量评估标准

儿童营养不良体格测量评估标准全国提高儿童生命质量学术会议（１９９５年４月上海）儿童的营养状况是衡量儿童健康水平的灵敏指标，蛋白质－热能缺乏（简称营养不良）是儿童营养缺乏性疾病中最常见者，且常伴有其他营养素的缺乏，易发生肺炎、腹泻病而导致死亡。据１９８...     

儿童肝病的营养支持治疗

肝脏疾病是儿童常见的一组消化系统疾病，对儿童的营养状况、生长发育有显著影响，营养不良可导致肝病疾病进一步进展以及并发症、感染率和病死率显著增加等。临床应重视肝病患儿的营养筛查与评估，明确肝病患儿营养需求及差异，制定最佳的营养管理策略，从而改善肝病儿童预后及临床结局。     

住院患儿营养风险筛查工具研究进展

营养不良是指能量、蛋白质或其他营养物质缺乏或过量引起机体发生不良变化的一种营养状态。营养不良在住院患儿中发生率较高,并且与临床预后息息相关。营养管理对改善住院患儿临床预后有重要作用。营养风险筛查是营养管理的第一步,通过筛查可简便有效地识别儿童营养状况进而进行营养支持。及时有效的营养支持可预防感染等并发症的发生,并缩短住院时间、减少住院费用[1-3]。     

儿科住院患者营养状况及营养风险调查

目的探讨使用儿科营养不良筛查方法(STAMP)评估患儿营养状况并进行营养风险筛查。方法采用STAMP调查住院患儿营养状况,以STAMP评分≥4分为高营养风险标准。结果 1 506例住院儿童中高营养风险患儿占26.56%,营养不良(不足)的检出率为19.12%,生长迟缓检出率为10.16%。各科室间儿童生长迟缓检出率的差异有统计学意义(P<0.05),其中儿内科生长迟缓检出率最高。仅有10.09%的患者接受营养支持,其中肠外营养(PN)支持率为7.84%,肠内营养(EN)支持率为2.92%,PN:EN为2.68:1。对有高营养风险住院患儿进行干预和管理后,高营养风险检出率从入院时的26.56%下降至出院时的21.71%,差异有统计学意义(P<0.05)。结论 STAMP评分法评估住院儿童的营养风险,能比较客观地反映患儿可能发生营养不良的风险;通过营养风险管理可改善患儿的营养状况。     

住院儿童营养风险筛查及营养评估的研究进展

营养与疾病关系密切,疾病状态下住院患儿营养消耗和营养不良的现象令人担忧。营养不良不仅影响儿童的生长发育,降低机体功能,而且还可增加相关并发症以及病死率。目前针对住院患儿风险筛查方法以及营养的评价和判定标准各不相同,没有系统、规范、统一的实施方案,导致大量营养不良的病例被漏诊,错过早期干预的时机。因此,对入院患儿应进行营养风险筛查、确切的营养评估和营养监测,以便能及时发现存在的营养问题和采取合理的营养支持及干预措施。该文就住院患儿营养风险筛查和营养评估的研究进展做简要综述。     

The risk approach in preschool children suffering malnutrition and intestinal parasitic infection in the city of S?o Paulo, Brazil

The association between parasitic infection and malnutrition in preschool children in the city of S?o Paulo, was studied according to degree of malnutrition, age, and income. Associations were assessed by risk analysis. Higher risks of malnutrition were found in children above 24 months of age infected with Ascaris, Trichuris or with more than three different parasites. The presence of more than three parasites per child affected nutritional status independently of income level. It is suggested that more attention should be given to intensity and chronicity of intestinal parasitic infection.     

Nutrition in neurologically impaired children

Malnutrition, either under- or overnutrition, is a common condition among neurologically impaired children. Energy needs are difficult to define in this heterogeneous population, and there is a lack of information on what normal growth should be in these children. Non-nutritional factors may influence growth, but nutritional factors such as insufficient caloric intake, excessive nutrient losses and abnormal energy metabolism also contribute to growth failure. Malnutrition is associated with significant morbidity, while nutritional rehabilitation improves overall health. Nutritional support should be an integral part of the management of neurologically impaired children, and should focus not only on improving nutritional status but also on improving quality of life for patients and their families. When considering nutritional intervention, oromotor dysfunction, gastroesophageal reflux and pulmonary aspiration must be addressed and a multidisciplinary team should be involved. Children at risk for nutrition-related problems should be identified early. An assessment of nutritional status should be performed at least yearly, and more frequently in infants and young children, or in children at risk for malnutrition. Oral intake should be optimized if safe, but enteral tube feedings should be initiated in children with oromotor dysfunction, leading to clinically significant aspiration, or in children unable to maintain an adequate nutritional status with oral intake. Nasogastric tube feeding should be used for short-term intervention, but if long-term nutritional intervention is required, a gastrostomy should be considered. Antireflux procedures should be reserved for children with significant gastroesophageal reflux. The patient’s response to nutritional intervention should be carefully monitored to avoid excessive weight gain after initiation of enteral nutrition, and paediatric formulas should be used to avoid micronutrient deficiencies.     

Effects of hospital stay on nutritional anthropometric data in Turkish children

We evaluated the effects of hospital stay on nutritional anthropometric data in children of various age groups and investigated the effects of admission undernutrition on nutritional anthropometric data in children who were hospitalized in our university hospital in Turkey. The adverse effect of hospitalization on nutritional status was shown to be most obvious on the 2-6-year age group with undernourished children. We also found reduced anthropometric parameters in all patients with mild malnutrition at admission (p < 0.05). A significant number of pediatric patients in Turkey are at nutritional risk at the time of hospital admission (31.8 per cent). The well-nourished children do not carry nutritional risk due to hospitalization for other medical reasons. Since undernutrition has an adverse effect on morbidity and mortality, careful nutritional evaluation of children on admission is essential. Special attention should be given to patients who had mild malnutrition on admission since this population of patients seem to be at higher risk of adverse effect of hospitalization.     

Childhood morbidity in mobile hospital camps in Himachal Pradesh

A systematic investigation of morbidity patterns was conducted in 1977- 80 among 2580 children under 12 years of age attending mobile hospital camps in 4 districts on India's Hamachal Pradesh. The children came from remote villages where socioeconomic and educational levels were low and environmental sanitation was rudimentary. There were 1301 cases of protein energy malnutrition in this group, 124 involving children 0-1 year of age, 514 in the 1-5-year age group, and 663 (51%) in the 5-12- year age group. At the time of examination, 287 of the children were infested with worms and 125 had diarrhea. These 3 conditions-- malnutrition, worm infestation, and diarrhea--were present in 32% of the village children surveyed. The most common form of morbidity was nutritional disorders (malnutrition, anemia, and vitamin deficiencies), affecting 70% of the children. The next most common condition was respiratory infection, affecting 35%. Other disorders affecting significant numbers of children were scabies, pyoderma, convulsions, mental retardation, rheumatic fever and congenital heart diseases, and renal diseases. Morbidity from conditions such as gastroenteritis, measles, and pneumonia was often accompanied by malnutrition. Thus, there is a need in this area for child health programs aimed at providing nutrition education as well as improving immunization coverage.     

Interaction between nutrition and measles

Malnutrition and infection are the two major public health problems in develpping countries. In India, severe forms of protein energy malnutrition are seen in 1–2% of preschool children. The condition is particularly serious during the post-weaning period and is often associated with infection. Much has been written about the synergestic interaction and infection in turn adversely affects the nutritional status. Although this relationship is well documented with respect to bacterial infections, it is not clear whether nutrition can influence the incidence or course of viral diseases. Measles is one of the most common viral infections that occur during childhood. The interactions between measles and nutritional status acquire considerable importance in situations where as a result of inadequate food intake, chronic malnutrition is widespread among children.     

Cystic fibrosis and malnutrition.

Cystic fibrosis as a specific disease entity has been known to be associated with malnutrition for almost half a century. The importance of the malnutrition in the disease process remains unknown, as does much information about specific nutritional deficiencies in CF. Supplements for children with CF should include extra energy as fat or carbohydrate, a form of linoleic acid that can be absorbed, hydrolyzed protein, fat-soluble vitamins with vitamins A and E in a water emulsion, vitamin B12, probably B vitamins and vitamin C, and trace minerals. Routine measurements of nutritional status, particularly in children with growth failure, should be made at regular intervals and should include a three-day diet record and a simultaneous 72-hour stool fat determination. If fat malabsorption is not controlled by pancreatic enzymes, the use of antacids or cimetidine should be considered. The true role of nutrition in patients with CF will not be known until the appropriate studies are completed.     

The need for nutrition support teams in pediatric units: a commentary by the ESPGHAN committee on nutrition

The reported prevalence of malnutrition in pediatric hospitals ranges from 15% to 30% of patients, with an impact on growth, morbidity and mortality. Major deficits in nutrition care have been highlighted in European hospitals, and the implementation of nutrition support teams (NSTs) has been suggested as a means to improve malnutrition diagnosis and nutrition care for hospitalized patients.This comment by the ESPGHAN Committee on Nutrition reviews disease related-mechanisms causing malnutrition and consequences of malnutrition and suggests a framework for implementation of NSTs in pediatric units. The recommendations by the Committee on Nutrition include: 1) Implementation of NSTs in hospitals is recommended to improve nutritional management of sick children; 2) The main tasks of the NST should include screening for nutritional risk, identification of patients who require nutritional support, provision of adequate nutritional management, education and training of hospital staff and audit of practice; 3) The NST should be multidisciplinary, with expertise in all aspects of clinical nutrition care; 4) The funds needed to support NSTs should be raised from the health care system; and 5) Further research is needed to evaluate the effects of NSTs in prevention and management of pediatric nutritional disorders, including cost effectiveness in different settings.     

ARM ANTHROPOMETRY IN EVALUATION OF MALNUTRITION IN CHILDREN WITH CANCER

Malnutrition in children with cancer is reported to be relatively uncommon at the time of diagnosis. However, in most studies nutritional status measurement has relied almost exclusively on weight-related indices. This can be misleading, because in children with malignancy, tumor masses can reach more than 10% of total body weight. A controlled study was performed in 62 patients using arm anthropometry to provide a more accurate evaluation of the nutritional status of children with cancer at presentation. Height, weight, midupper arm circumference (MUAC), and triceps skinfold thickness (TSFT) were measured in all patients (40 boys, 22 girls) and controls (18 boys, 13 girls). Weight for height (W FH) of each patient was compared with the national standards. MUAC and TSF T were also interpreted according to the standards developed by A. Roberto Frisancho. The mean ages were 6.5 3.7 years (range 0.08-13) and 5.7 4.7 years (range 0.25-15) in patients and control group, respectively. Results showed that although the W FH values for patients were normal, MUAC and TSF T values were significantly less than control values (P &lt; 0.001). Moreover, 27% of patients showed malnutrition (they had MUAC and TSF T below 5th percentile). Patients with intraabdominal solid tumors had significantly lower MUAC and TSF T values than those with extraabdominal solid tumors (P &lt; 0.05). The data strongly indicate that malnutrition is common at the time of diagnosis in children with cancer, and arm anthropometry should replace the use of weight-related indices to identify malnutrition in children.     

危重患儿营养不良的评估

营养不良是较为常见的临床问题,一些危重患儿存在基础疾病,机体代谢率增高,营养不良发生率较普通患儿更高.营养不良在一定程度上可降低危重患儿机体免疫力,增加感染风险及并发症,延长病程,影响疾病转归,增加病死率.尽早对危重患儿进行有效营养评估,及时发现其营养不良状态,早期指导临床营养支持方式,可促进病情恢复,改善疾病预后.目前国内外营养评估主要是从体格测量、实验室检查及营养风险筛查等几个方面进行,但不同营养评估方法各有其适应性及优缺点.