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Improved neurological outcome in children with chronic renal disease from infancy
Insights
Early nutritional support and avoiding aluminum therapy significantly improve neurological outcomes in infants with chronic renal failure (CRF). This approach helps prevent severe developmental delays and encephalopathy in affected children.
Area of Science:
- Pediatric Nephrology
- Neurodevelopmental Pediatrics
- Clinical Nutrition
Background:
- Children with chronic renal failure (CRF) often exhibit neurological issues like developmental delay and microcephaly.
- Malnutrition, aluminum toxicity, and psychosocial deprivation are suspected causes of these neurological deficits.
Purpose of the Study:
- To investigate the impact of avoiding aluminum salts and providing early nutritional and psychosocial support on neurological development in infants with CRF.
- To assess the long-term neurological outcomes in children with CRF managed with a specific supportive care protocol.
Main Methods:
- A cohort of 15 infants with CRF received standard therapy, with no aluminum salts and early, intensive nutritional and psychosocial support.
- Neurological development, head CT scans, electroencephalograms (EEGs), nerve conduction velocities (NCVs), and auditory brainstem evoked responses (ABERs) were assessed.
- Nutritional status was evaluated using the Waterlow classification during the first two years of life.
Main Results:
- No patients developed progressive encephalopathy or recurrent seizures; most had normal neurological exams except for hypotonia.
- Microcephaly was observed in 5 patients, correlating with early-life malnutrition.
- Developmental delay occurred in 3 microcephalic patients; brain atrophy was minimal (3 patients on CT), and EEG/NCV abnormalities were infrequent.
Conclusions:
- A management strategy focused on avoiding oral aluminum therapy and implementing early nutritional support enhances neurological outcomes in infants with CRF.
- Aggressive nutritional and psychosocial interventions appear crucial in mitigating neurological complications associated with pediatric chronic renal failure.
Abstract:
Progressive encephalopathy, developmental delay, microcephaly, electroencephalogram (EEG) and computed tomographic (CT) scan abnormalities have been reported in 80% of children with chronic renal failure (CRF) in infancy. Malnutrition, aluminium intoxication and psychosocial deprivation are proposed as causes. In 15 children with CRF from infancy we evaluated the effect of no aluminium salts and early vigorous nutritional and psychosocial support, in addition to the standard therapy, on neurological development. Six patients underwent dialysis (2 at birth) and 3 received transplants. None of our patients were given aluminium therapy. The nutritional status of the patients in the first 2 years of life was assessed with the waterlow classification. At the end of the follow-up period (mean 50 months range 14-148 months), patients underwent neurodevelopmental assessment, head CT scan, EEG, nerve conduction velocity (NCV) and auditory brain stem evoked response (ABER). None of our patients developed progressive encephalopathy or recurrent seizures. All have a normal neurological examination apart from hypotonia. Microcephaly was present in 5 patients. There was a good correlation between malnutrition in the first 2 years of life and microcephaly. Developmental delay was present in 3 patients; all 3 were microcephalic. There was evidence of brain atrophy on CT scan in only 3 patients. EEG was abnormal in 6 patients, but only severe in 1 patient. Only 1 patient had diminished NCV; all patients had a normal ABER. We conclude that a policy of no oral aluminium therapy and early nutritional support leads to better neurological outcome in children with CRF from infancy.