Related Experiment Videos
Chronic renal failure in infancy. Two dietetic case reports
1Nutrition and Dietetic Department, Nottingham City Hospital NHS Trust.
Insights
Infants with end-stage renal disease (ESRD) need intensive nutritional support and frequent dietetic care for optimal growth. Early dialysis and tube feeding, combined with regular consultations, are crucial for managing ESRD in infants.
Area of Science:
- Pediatric Nephrology
- Clinical Nutrition
- Growth Monitoring
Background:
- End-stage renal disease (ESRD) in infants presents unique challenges for growth and nutrition.
- Quantifying the impact of intensive dietetic care in infants with ESRD is essential.
Observation:
- Two male infants with ESRD due to renal dysplasia were managed with continuous cyclic peritoneal dialysis (CCPD) and gastrostomy tube feeding.
- Nutritional intakes exceeded recommendations for healthy infants.
- Significant improvements in height and weight standard deviation scores (SDS) were observed over two years without growth hormone therapy.
Findings:
- Intensive nutritional support and frequent dietetic interventions were associated with optimized growth in infants with ESRD.
- Higher energy and protein intakes were required to meet nutritional goals.
- Dietetic contact frequency decreased over time while maintaining positive growth outcomes.
Implications:
- Early initiation of dialysis and tube feeding, alongside frequent dietetic support, is vital for achieving nutritional targets and promoting growth in infants with ESRD.
- Dietetic guidance plays a critical role in supporting families managing infants with ESRD.
- This approach may serve as a model for managing pediatric ESRD patients.
Abstract:
Dietetic care of infants with end stage renal disease (ESRD) involving intensive nutritional support and frequent monitoring in attempts to optimise growth has not been previously quantified. We describe the progress of two male infants born with ESRD due to renal dysplasia. Child A and child B were commenced on continuous cyclic peritoneal dialysis at mean age of 3 months and required nutritional support via a gastrostomy button. Energy intakes pre-dialysis (147 kcal/kg) and energy and protein intakes during the first year of life on CCPD (137 kcal/kg, 2.6 g/kg actual body weight) were greater than recommended for the healthy population. Over the 2 year period without growth hormone, height SDS increased from -1.66 to -0.17 and 0.67 to 0.78 and weight SDS increased from -1.26 to -0.43 and 0.31 to 1.75 for Child A and Child B respectively. Mean dietetic contacts (in/out patient and telephone) over the 2 years were 11.8 contacts/mth pre-dialysis, 8.4 contacts during the first year on CCPD and 4.3 contacts during the second year. We conclude that infants with end stage renal disease require frequent dietetic contact in combination with early dialysis and tube feeding to achieve nutritional goals and optimise growth. In addition, dietetic advice provides valuable family support.