Koen Huysentruyt

Hospital-related undernutrition in children: still an often unrecognized and undertreated problem

To evaluate the nutritional status of hospitalized children in Belgian hospitals and to analyse the impact of undernutrition on the degree of weight loss and duration of hospitalization.

A Belgian consensus-statement on growing-up milks for children 12-36 months old

Growing-up milks (GUM) are milk-based drinks with low protein and added minerals and vitamins intended for children 12–36 months. Since the advantages of GUM are heavily debated, we reviewed the literature. A literature search was done using the classic databases (Pubmed, Embase, Cochrane) on the use of GUM in 12- to 36-month-old young children. Only limited data are available. GUM have a highly variable composition as their marketing is not regulated. Nevertheless, all papers conclude that GUM help to cover nutritional requirements of 12- to 36-month-old infants. Conclusion: Appropriate intakes of macro- and micronutrients in 1- to 3-year-old children have long-term health benefits. Present diets offered to toddlers do in general not meet the requirements. Supplemented foods are therefore helpful, of which GUM is a possibility.

More training and awareness are needed to improve the recognition of undernutrition in hospitalised children

Reports suggest that 10% of hospitalised children in Europe are undernourished. We investigated whether nutritional screening tools (NST) were used in Belgian secondary‐level hospitals, examined strategies for detecting undernutrition and identified barriers preventing the systematic management of undernutrition.

Hospital-related under-nutrition in children: why aren't the numbers falling?

authors concluded that undernutrition is still frequently found in hospitalized children and that hospital-related undernutrition is often an unrecognized problem. We think that undernutrition in hospitalized children is a huge problem in Turkey, which is a developing country. At the Dokuz Eylul University Hospital, we studied 301 hospitalized children aged between 1 month and 18 years (median age: 5 years), with no surgical problems and no conditions that involved large variations in hydration. Nutritional anthropometric data were measured on admission and discharge. Acute and chronic malnutrition on admission was found in 145 children (48.1%), with acute malnutrition detected in 91 children (30.2%). The prevalence of malnutrition in congenital heart disease, malignancies and neurologic disease was 42.4%, 34.3% and 34.3%, respectively. The highest frequency of malnutrition was detected in the 10–18 years age group (38.9%) and the 1–24-month age group (32.6%). The median length of stay was six (range: 1–94) days. There was no correlation between length of stay and frequency of malnutrition (p > 0.05). On discharge, 39.5% of children had lost weight, independent of their nutritional status. The weight for height and body mass index of undernourished children was lowest on discharge in the 10–18 year age group (p < 0.05). There were no differences between admission and discharge anthropometric data in the congenital heart disease group (p > 0.05). However, improvements in the anthropometric data of children with neurologic and malignancy disease were observed on discharge (p < 0.05). More than two-thirds (67%) of the children with neurologic and malignancy disease received nutritional intervention (oral supplements and/or tube feeding) during their hospital stay. Limited data exist on the effects of hospital stay on nutritional status of children in the literature. Furthermore, prevalence rates showed wide differences, varying from 6% to 40% (2,3). Our study showed that a significant percentage of the paediatric patients (48.1%) were undernourished on admission to our tertiary hospital and that more than two in five of the children lost weight during their hospital stay. Increasing awareness of malnutrition, and paying more attention to adequate nutritional care, should positively affect the prevalence of malnutrition in hospitalized children. Nutritional screening should be conducted in daily practice in hospitals, and proper nutritional support should be provided.

Proposal for An Algorithm for Screening for Undernutrition in Hospitalized Children.

Abstract The prevalence of disease-related undernutrition in hospitalized children has not decreased significantly in the last decades in Europe. A recent large multicentric European study reported a percentage of underweight children ranging across countries from 4.0% to 9.3%. Nutritional screening has been put forward as a strategy to detect and prevent undernutrition in hospitalized children. It allows timely implementation of adequate nutritional support and prevents further nutritional deterioration of hospitalized children. In this article, a hands-on practical guideline for the implementation of a nutritional care program in hospitalized children is provided. The difference between nutritional status (anthropometry with or without additional technical investigations) at admission and nutritional risk (the risk of the need for a nutritional intervention or the risk for nutritional deterioration during hospital stay) is the focus of this article. Based on the quality control circle principle of Deming, a nutritional care algorithm, with detailed instructions specific for the pediatric population was developed and implementation in daily practice is proposed. Further research is required to prove the applicability and the merit of this algorithm. It can, however, serve as a basis to provide European or even wider guidelines.

Cranial ultrasound and neurophysiological testing to predict neurological outcome in infants born very preterm

Infants born preterm are at risk of cerebral palsy (CP) and motor or cognitive developmental delay. For clinicians, it is essential to know the relative predictive accuracy of the most commonly used neuroimaging and neurophysiological tests for the early prediction of adverse neurodevelopmental outcome. The aim of this study was to compare the accuracy of these tests in survivors of a population of infants born very preterm.

Opinions and practices of healthcare professionals on assessment of disease associated malnutrition in children: Results from an international survey

BACKGROUND & AIMS Lack of consensus on clinical indicators for the assessment of pediatric disease associated malnutrition (DAM) may explain its under-recognition in clinical practice. This study surveyed the opinions of health professionals (HP) on clinical indicators of DAM and barriers impeding routine nutritional screening in children. METHODS Web-based questionnaire survey (April 2013-August 2015) in Australia, Belgium, Israel, Spain, The Netherlands, Turkey and UK. RESULTS There were 937 questionnaires returned via local professional associations, of which 693 respondents fulfilled the inclusion criteria and were included in the final analysis; 315 pediatric gastroenterologists and 378 pediatric dieticians. The most important clinical indicators of DAM were ongoing weight loss (80.4%), increased energy/nutrient losses (73.0%), suboptimal energy/macronutrient intake (68.6%), a high nutritional risk condition (67.2%) and increased energy/nutrient requirements (66.2%). These findings were consistent across countries and professions. The most common approach to screen for DAM was assessment of weight changes (85%), followed by the usage of growth charts (77-80%). Common perceived barriers for routine nutritional screening/assessment were low staff awareness (47.5%), no local policy or guidelines (33.4%) and lack of time to screen (33.4%). CONCLUSIONS HP who routinely assess and treat children with DAM identified ongoing weight loss, increased losses, increased requirements, low intake and high nutritional risk conditions as the most important clinical indicators of DAM. These clinical indicators should now serve as a basis to form clinical-based criteria for the identification of DAM in routine clinical practice. Low awareness, lack of guidelines or local policy and lack of resources were the most important barriers of routine screening.

The Microbiome in Healthy Children

The knowledge of the importance of the interaction between the gastro-intestinal microbiome and the human being in health and disease has accumulated exponentially during recent years. Colonization of the gastro-intestinal tract during early life is critically important for a balanced development as it will determine digestive and motility maturation, metabolic, immune and brain development in early life. The optimal healthy microbiota during early life still needs further evaluation.

Sofosbuvir/ledipasvir and ribavirin tolerability and efficacy in pediatric liver transplant recipients

The longterm results of pediatric liver transplantation (LT) have become exceptionally good, with >95% longterm survival, but hepatitis C virus (HCV) recurrence for a liver graft was an important cause of morbidity, making prevention of disease relapse after transplantation a major objective. Treating HCV in children remains challenging, but the development of oral direct-acting antivirals (DAAs) has revolutionized the modern approach for HCV treatment in adults. We describe 2 cases of pediatric HCV patients treated with sofosbuvir (SOF)/ledipasvir (LDV) and ribavirin: one treated before LT (a 1-year-old boy transplanted for biliary atresia) and the other after LT (a 16-year-old girl transplanted for Budd-Chiari syndrome and cirrhosis). The protocol used to treat these patients was approved by the local ethical committee, and informed consent was obtained for both patients. Both patients were HCV genotype 1b: the first was diagnosed during a pretransplant check-up, and the second was a recurrence 5 weeks after LT. Both received a 12-week course of SOF/LDV (Harvoni) and ribavirin, which is in accordance with recent recommendations for adults in the LT context. The first patient received 5 weeks of treatment before LT, and the remaining course was continued after LT (dosage was SOF 100mg/LDV 22.5mg once daily and ribavirin 7.5mg/kg twice daily); the second child received the full treatment course after LT. Interestingly, HCV polymerase chain reaction (PCR) on the explanted liver correlated well with the blood PCR after 5 weeks of treatment (both< 30 IU/mL) for the youngest child. Treatment response with nondetectable HCV on PCR was observed at the end of the 12 weeks of treatment, leading to a sustained virological response (SVR) 24 weeks after the end of treatment for both children. None of the commonly reported side effects were observed. For the 1-year-old, singledose and multiple-dose pharmacokinetic (PK) parameters of SOF, its predominant circulating metabolite GS-331007, and LDV were estimated using noncompartmental methods and are summarized in Table 1. Following the first-dose administration, SOF was detectable in 2 samples only; as such, the single-dose PK parameters for SOF could not be estimated reliably and are not included in the summary. The PK was repeated at day 7; mean steady-state exposure parameters for SOF were higher, whereas GS-331007 and LDV exposures were lower than the mean exposures observed in LDV/SOF adult phase 2/3 population PK analyses. Notably, all estimates remained within the ranges (minimum to maximum) of exposures in the phase 2/3 population. In conclusion, a 12-week treatment regimen with SOF/LDV/ribavirin for HCV was well tolerated and led to a SVR in 2 HCV (type 1b)– infected pediatric patients. The PK data in the 1-yearold child was within the ranges reported for adults, using a quarter of the adult DAA dosages. These first 2 successfully treated HCV patients provide us with preliminary evidence that these drugs are safe and Abbreviations: %CV, % coefficient of variation; AUC, area under the plasma concentration-time curve; Cmax, maximum plasma concentration; DAA, direct-acting antiviral; HCV, hepatitis C virus; LDV, ledipasvir; LT, liver transplantation; PCR, polymerase chain reaction; PK, pharmacokinetic; SCT, stem cell transplantation; SOF, sofosbuvir; SVR, sustained virological response.

Albumin and pre-albumin levels do not reflect the nutritional status of female adolescents with restrictive eating disorders

Albumin and pre‐albumin are frequently used as nutritional markers in clinical practice. We examined whether serum albumin and pre‐albumin were predicted by body mass index (BMI), hydration and/or inflammation in female adolescents with a recently diagnosed restrictive eating disorder (RED).