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Outcome and growth of infants with severe chronic renal failure
J A Kari1, C Gonzalez, S E Ledermann
1Renal Unit, Gt. Ormond St. Hospital for Children NHS Trust, London, England, United Kingdom.
Insights
Infants with severe chronic renal failure (CRF) have high early mortality, but early enteral feeding improves growth outcomes. With intervention, height standard deviation scores normalize by one year of age.
Area of Science:
- Pediatric Nephrology
- Growth and Development
- Renal Failure Management
Background:
- Assessed outcomes and growth in 101 infants with severe chronic renal failure (CRF), defined by a glomerular filtration rate (GFR) <20 mL/min/1.73 m2.
- Median age at presentation was 0.3 years, with a median follow-up of 7.6 years.
- One- and five-year survival rates were 87% and 78%, respectively.
Purpose of the Study:
- To evaluate the long-term outcomes and growth patterns in infants diagnosed with severe chronic renal failure (CRF).
- To determine the impact of early nutritional interventions on growth parameters in this vulnerable population.
Main Methods:
- Retrospective analysis of 101 infants with severe CRF (GFR <20 mL/min/1.73 m2) presenting between 1986 and 1998.
- Evaluation of growth (height standard deviation score, BMI) in 81 survivors, with detailed analysis of nutritional support (enteral feeding, gastrostomy) and renal replacement therapy (transplantation, dialysis).
Main Results:
- The mean height standard deviation score improved significantly from -2.16 at 6 months to -0.85 at 10 years (P < 0.001).
- Eighty-one percent of survivors received early enteral feeding, with 46% requiring gastrostomy.
- Body mass index remained within the normal range for most patients.
Conclusions:
- Mortality in infants with CRF is concentrated in the first year of life.
- Early enteral nutrition is associated with achieving normal height standard deviation scores by one year of age in infants with severe CRF.
- Aggressive nutritional management and timely renal replacement therapy are crucial for improving growth and survival.
Background:
We aimed to assess the outcome and growth of infants with severe chronic renal failure (CRF). One hundred and one children presented between January 1, 1986, and December 12, 1998, with a glomerular filtration rate (GFR) of <20 mL/min/1.73 m2. The median (range) age at presentation was 0.3 (0 to 1.5) years, and follow-up was 7.6 (1.5 to 13) years. One- and five-year survival rates were 87 and 78%, respectively. The growth of the 81 children who survived over two years was evaluated. Eighty-one percent were enterally fed from age 0.7 (0 to 4.5) years for 1.9 (0.1 to 6.8) years. Forty-six percent had a gastrostomy, and 22% a Nissen fundoplication. Twenty-five were managed conservatively. Twenty were transplanted without dialysis at age 4 (1.7 to 8.5) years, and 36 were dialyzed at age 1.1 (0 to 9.8) before transplantation at age 2. 4 (1.3 to 10) years.
Results:
The mean (SD) height standard deviation score increased from -2.16 (1.34) at 6 months (N = 63) to -1.97 (1.37) at 1 year (N = 75), -1.79 (1.29) at 2 years (N = 75), -1.33 (1.29) at 3 years (N = 68, P = 0.0006), -1.27 (1.04) at 5 years (N = 47, P = 0.0001), and -0.85 (0.82) at 10 years (N = 18, P = 0.001). The body mass index was in the normal range in the majority of patients.
Conclusion:
Mortality in infants with CRF occurs mainly in the first year of life. With early enteral feeding, the mean height standard deviation score is within the normal range from one year of age.