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Growth of uremic infants on forced feeding regimens
C L Abitbol1, G Zilleruelo, B Montane
1Department of Pediatrics, University of Miami/Jackson Memorial Medical Center, Florida.
Insights
Infants with congenital renal insufficiency experience poor growth, with height deficits developing early. Nutritional intake did not limit growth, but parathyroid hormone levels correlated with growth velocity in these infants.
Area of Science:
- Pediatrics
- Nephrology
- Nutritional Science
Background:
- Congenital renal insufficiency often leads to poor growth and lasting height deficits in infants.
- Optimal energy and protein requirements for affected infants remain undetermined.
- Early growth failure is a significant concern in pediatric kidney disease.
Purpose of the Study:
- To monitor growth and nutrient intake in infants with congenital renal insufficiency.
- To identify factors influencing growth in these vulnerable infants.
- To determine if nutritional intake or renal insufficiency degree limits growth.
Main Methods:
- Longitudinal monitoring of growth and nutrient intake in 12 infants with creatinine clearance <70 ml/min/1.73 m2 for 2 years.
- Assessment of energy and protein intake relative to Recommended Dietary Allowances (RDA).
- Correlation analysis of growth parameters (length velocity standard deviation score [LV-SDS], weight velocity SDS [WV-SDS]) with nutrient intake, renal insufficiency, and C-terminal parathyroid hormone (PTH) levels.
Main Results:
- Forced feeding was required to meet energy needs (approx. 100% RDA); protein intake exceeded 140% RDA.
- Linear growth did not correlate with energy or protein intake, suggesting they were not limiting factors.
- LV-SDS correlated inversely with PTH levels and was lowest at 6 months, stabilizing near -2 SDS by 12 months.
- Weight for length SDS remained normal, and WV-SDS recovered in the second year, but linear growth deficit persisted.
Conclusions:
- The primary height deficit in infants with renal insufficiency occurs within the first 6 months of life.
- Early nutritional deficits may contribute significantly to subsequent height deficits.
- Parathyroid hormone levels, not just nutritional intake, appear critical for growth in these infants.
Abstract:
Infants born with congenital renal insufficiency generally grow poorly during the first years of life and incur a height deficit that is rarely regained. Actual energy and protein requirements have not been determined for these children. In 12 infants with creatinine clearances less than 70 ml/min per 1.73 m2, growth and nutrient intakes were monitored during the first 2 years of life. Forced feeding regimens after 3 months of age, including gastrostomy in 3 patients, were necessary to maintain energy intakes near 100% of the recommended dietary allowance (RDA). Protein intakes averaged in excess of 140% RDA. Linear growth did not correlate with either energy or protein intakes, suggesting that neither was a limiting factor to growth. Length velocity standard deviation score (LV-SDS) did not correlate with degree of renal insufficiency at any age, but average LV-SDS did relate significantly and inversely to C-terminal parathyroid hormone (PTH) levels. Growth parameters, including LV-SDS and weight velocity SDS (WV-SDS) were lowest at 6 months of age. Weight and length SDS followed with a maximum decline at 12 months of age. While weight for length SDS remained normal and WV-SDS showed recovery during the 2nd year, LV-SDS remained negative. Length SDS stabilized near--2 SDS. In summary, these data suggest that the major height deficit in infants with renal insufficiency is incurred during the first 6 months of life. Ponderal indices suggested that very early nutritional deficits may have been a primary contributor to subsequent height deficits.(ABSTRACT TRUNCATED AT 250 WORDS)