40 research outputs found
Recognizing and documenting undernutrition in hospitalized children with cerebral palsy
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Digestive outcomes and risk factors at short- and medium- term in esophageal atresia
No full textLes progrès des dernières décennies dans la prise en charge néonatale et chirurgicale des enfants présentant une atrésie de l’oesophage (AO) ont permis une amélioration significative de leur espérance de vie. Cependant une morbidité importante persiste - en particulier digestive - à court, moyen et long terme, même si la prévalence de ces complications et leurs facteurs de risque restent actuellement mal identifiés. L’objectif de ce travail était d’étudier chez les enfants nés avec une AO, en population, trois complications digestives et leurs déterminants à trois périodes différentes de l’évolution d’une AO.Le premier travail s’est intéressé à la prévalence du dumping syndrome (DS) à l’âge de 3 mois, à l’aide d’une étude prospective multicentrique (n=38). Les nouveau-nés bénéficiaient systématiquement d’une hyperglycémie provoquée par voie orale entre l’âge de 2,5 et 3,5 mois. La glycémie était évaluée de façon discontinue pendant 4 heures, ce qui permettait de repérer les hyperglycémies précoces et les hypoglycémies tardives. Trente pour cent des patients avaient un DS, sans association identifiée avec les signes cliniques observés. Aucun facteur associé au DS n’a pu être mis en évidence dans cette étude.Le deuxième travail s’est intéressé aux facteurs de risque de sténose de l’anastomose (SA) à 1 an, par une étude prospective longitudinale multicentrique en population (n=1082). Les données à la naissance et à un an étaient relevées grâce au registre national français de l’AO (RENATO). Vingt-trois pour cent des enfants présentaient une SA à l’âge de 1 an, et les seuls facteurs de risque de SA identifiés étaient chirurgicaux (anastomose sous tension et anastomose retardée).Le troisième travail a porté sur les facteurs de risque et l’histoire naturelle du reflux gastro-oesophagien (RGO) à l’âge de 6 ans, par une étude prospective longitudinale multicentrique d’une cohorte nichée dans le registre RENATO (n=286). Les données à 6 ans étaient relevées grâce au réseau des centres participant au registre, avec la même méthodologie que le registre. Un tiers des enfants présentaient un RGO à l’âge de 6 ans, et 20% d’entre eux en avaient été opérés. La présence d’un RGO à l’âge de 1 an, un antécédent de gastrostomie avant l’âge d’un an, le sexe masculin et la dénutrition étaient les 4 facteurs prédictifs de RGO à l’âge de 6 ans. Le RGO pouvait disparaître, persister ou apparaître de novo à l’âge de 6 ans.Ce travail a permis la description du DS, nouvelle complication fréquente observée à court terme dans l’AO, d’individualiser des groupes à risque de complication digestives à court et moyen terme (1 an pour les SA et 6 ans pour le RGO) et de décrire l’évolution naturelle à moyen terme du RGO. Ses perspectives sont d’étudier la physiopathologie du DS dans l’AO et de poursuivre le suivi de la cohorte nichée à 12-13 ans, afin de mieux décrire l’histoire naturelle et d’aider à repérer les populations à risque pour adapter le suivi et le traitement de ces patients.Advances in neonatal and surgical management of children with oesophageal atresia (OA) over the last decades lead to a significant improvement in life expectancy. However, significant morbidity persists - in particular digestive - in the short, medium and long term, even if the prevalence of these complications and their underlying risk factors remain poorly identified. The aim of the thesis was to investigate digestive complications and their short- and medium-term determinants in children born with OA, at the level of the French population, by studying three complications occurring at three different ages.The first study focused on the prevalence of dumping syndrome (DS) at 3 months of age, through a prospective multicenter cohort (n=38). All newborns systematically underwent an oral glucose tolerance test between 2.5 and 3.5 months of age. Blood glucose levels were recorded discontinuously over a 4-hour period, in order to identify early hyperglycaemia and/or late hypoglycaemia. Thirty percent of the included patients had a DS, which did not correlate with the presenting clinical signs. No factors associated with DS could be identified.The second study focused on the risk factors for anastomotic stenosis (AS) at 1 year of age, through a prospective longitudinal multicenter population-based study (n=1082). Data at birth and at one year were collected from the French national registry for OA (RENATO). Twenty-three percent of OA patients had AS at 1 year of age, and the only risk factors identified were surgical (anastomosis under tension and delayed anastomosis).The third study focused on the risk factors and natural history of gastrooesophageal reflux disease (GORD) at the age of 6 years, through a prospective longitudinal multicenter study of a nested cohort from the RENATO registry (n=286). Data at 6 years were collected through the CRACMO network of centers of the registry, using the same methodology as for RENATO. One third of patients had GORD at the age of 6 years, 20% of whom underwent fundoplication. Presence of GORD at the age of 1 year, history of gastrostomy before the age of 1 year, male gender, and undernutrition were the 4 independent predictive factors of GORD at the age of 6 years. From the age of 1 year, GORD could disappear, persist, or appear de novo at the age of 6 years.This work allowed the description of DS, a new frequent short-term complication in OA, the identification of groups at risk for digestive complications in the short and medium term (at 1 year for AS and at 6 years for GORD) and the description of the natural evolution of GORD in the medium term. Its perspectives are to study the pathophysiology of DS in AO and to continue the follow-up of the nested cohort at 12-13 years, to better describe the natural history and to help to identify populations at risk, thereby allowing to adapt the follow-up and personalize treatment of these patients
Complications digestives et facteurs de risque à court et moyen terme dans l’atrésie de l’œsophage
No full textAdvances in neonatal and surgical management of children with oesophageal atresia (OA) over the last decades lead to a significant improvement in life expectancy. However, significant morbidity persists - in particular digestive - in the short, medium and long term, even if the prevalence of these complications and their underlying risk factors remain poorly identified. The aim of the thesis was to investigate digestive complications and their short- and medium-term determinants in children born with OA, at the level of the French population, by studying three complications occurring at three different ages.The first study focused on the prevalence of dumping syndrome (DS) at 3 months of age, through a prospective multicenter cohort (n=38). All newborns systematically underwent an oral glucose tolerance test between 2.5 and 3.5 months of age. Blood glucose levels were recorded discontinuously over a 4-hour period, in order to identify early hyperglycaemia and/or late hypoglycaemia. Thirty percent of the included patients had a DS, which did not correlate with the presenting clinical signs. No factors associated with DS could be identified.The second study focused on the risk factors for anastomotic stenosis (AS) at 1 year of age, through a prospective longitudinal multicenter population-based study (n=1082). Data at birth and at one year were collected from the French national registry for OA (RENATO). Twenty-three percent of OA patients had AS at 1 year of age, and the only risk factors identified were surgical (anastomosis under tension and delayed anastomosis).The third study focused on the risk factors and natural history of gastrooesophageal reflux disease (GORD) at the age of 6 years, through a prospective longitudinal multicenter study of a nested cohort from the RENATO registry (n=286). Data at 6 years were collected through the CRACMO network of centers of the registry, using the same methodology as for RENATO. One third of patients had GORD at the age of 6 years, 20% of whom underwent fundoplication. Presence of GORD at the age of 1 year, history of gastrostomy before the age of 1 year, male gender, and undernutrition were the 4 independent predictive factors of GORD at the age of 6 years. From the age of 1 year, GORD could disappear, persist, or appear de novo at the age of 6 years.This work allowed the description of DS, a new frequent short-term complication in OA, the identification of groups at risk for digestive complications in the short and medium term (at 1 year for AS and at 6 years for GORD) and the description of the natural evolution of GORD in the medium term. Its perspectives are to study the pathophysiology of DS in AO and to continue the follow-up of the nested cohort at 12-13 years, to better describe the natural history and to help to identify populations at risk, thereby allowing to adapt the follow-up and personalize treatment of these patients.Les progrès des dernières décennies dans la prise en charge néonatale et chirurgicale des enfants présentant une atrésie de l’oesophage (AO) ont permis une amélioration significative de leur espérance de vie. Cependant une morbidité importante persiste - en particulier digestive - à court, moyen et long terme, même si la prévalence de ces complications et leurs facteurs de risque restent actuellement mal identifiés. L’objectif de ce travail était d’étudier chez les enfants nés avec une AO, en population, trois complications digestives et leurs déterminants à trois périodes différentes de l’évolution d’une AO.Le premier travail s’est intéressé à la prévalence du dumping syndrome (DS) à l’âge de 3 mois, à l’aide d’une étude prospective multicentrique (n=38). Les nouveau-nés bénéficiaient systématiquement d’une hyperglycémie provoquée par voie orale entre l’âge de 2,5 et 3,5 mois. La glycémie était évaluée de façon discontinue pendant 4 heures, ce qui permettait de repérer les hyperglycémies précoces et les hypoglycémies tardives. Trente pour cent des patients avaient un DS, sans association identifiée avec les signes cliniques observés. Aucun facteur associé au DS n’a pu être mis en évidence dans cette étude.Le deuxième travail s’est intéressé aux facteurs de risque de sténose de l’anastomose (SA) à 1 an, par une étude prospective longitudinale multicentrique en population (n=1082). Les données à la naissance et à un an étaient relevées grâce au registre national français de l’AO (RENATO). Vingt-trois pour cent des enfants présentaient une SA à l’âge de 1 an, et les seuls facteurs de risque de SA identifiés étaient chirurgicaux (anastomose sous tension et anastomose retardée).Le troisième travail a porté sur les facteurs de risque et l’histoire naturelle du reflux gastro-oesophagien (RGO) à l’âge de 6 ans, par une étude prospective longitudinale multicentrique d’une cohorte nichée dans le registre RENATO (n=286). Les données à 6 ans étaient relevées grâce au réseau des centres participant au registre, avec la même méthodologie que le registre. Un tiers des enfants présentaient un RGO à l’âge de 6 ans, et 20% d’entre eux en avaient été opérés. La présence d’un RGO à l’âge de 1 an, un antécédent de gastrostomie avant l’âge d’un an, le sexe masculin et la dénutrition étaient les 4 facteurs prédictifs de RGO à l’âge de 6 ans. Le RGO pouvait disparaître, persister ou apparaître de novo à l’âge de 6 ans.Ce travail a permis la description du DS, nouvelle complication fréquente observée à court terme dans l’AO, d’individualiser des groupes à risque de complication digestives à court et moyen terme (1 an pour les SA et 6 ans pour le RGO) et de décrire l’évolution naturelle à moyen terme du RGO. Ses perspectives sont d’étudier la physiopathologie du DS dans l’AO et de poursuivre le suivi de la cohorte nichée à 12-13 ans, afin de mieux décrire l’histoire naturelle et d’aider à repérer les populations à risque pour adapter le suivi et le traitement de ces patients
OUTCOMES WITH ODEVIXIBAT TREATMENT IN PATIENTS WITH ALAGILLE SYNDROME: ANALYSIS OF PRURITUS RESPONDERS FROM THE PHASE 3 ASSERT STUDY
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FAT-SOLUBLE VITAMIN LEVELS IN PATIENTS WITH ALAGILLE SYNDROME TREATED WITH ODEVIXIBAT IN THE PHASE 3 ASSERT STUDY
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INDIVIDUAL PRURITUS AND BILE ACID RESPONSES OVER TIME WITH ODEVIXIBAT TREATMENT: POOLED DATA FROM THE PHASE 3 ASSERT AND ASSERT-EXT STUDIES IN PATIENTS WITH ALAGILLE SYNDROME
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Influence of Percutaneous Endoscopic Gastrostomy on Gastroesophageal Reflux Disease in Children
No full textInternational audienceOBJECTIVE: To determine if gastroesophageal reflux disease (GERD) is present at long-term follow-up after percutaneous endoscopic gastrostomy (PEG), and to identify factors associated with the occurrence or aggravation of GERD after PEG placement. STUDY DESIGN: This prospective, observational study was conducted in our single tertiary center over a 13-year period (gastrostomy performed from 1990 to 2003 and follow-up to 2015). Every child who underwent PEG in our center (N = 368) from 1990 to 2003 was eligible. GERD was defined by clinical manifestations requiring antisecretory or prokinetic treatment, occurrence of a GERD-related complication, or the need for antireflux surgery. Outcomes among patients without antireflux surgery were also assessed. Multivariate analysis was used to identify factors aggravating GERD after PEG placement. RESULTS: A total 326 patients (89%; 56% with a neurologic impairment) were studied with a median follow-up after 3.5 years (range, 2.0-13.5 years). After PEG placement, GERD appeared in 11% of patients and was aggravated in 25% of patients with preexisting GERD. Factors associated with GERD worsening after PEG placement were neurologic impairment and preexisting GERD. Only 53 patients (16%) required antireflux surgery, among whom 22 required surgery in the year after PEG. Neurologic impairment was the only factor significantly associated with the need for antireflux surgery. CONCLUSIONS: GERD predominantly remains clinically controlled after PEG placement. Routine antireflux surgery at the time of PEG placement is not justified
Tube Feeding in Neurologically Disabled Children: Hot Topics and New Directions
No full textTube feeding is a therapeutic intervention that is aimed at providing nutritional support and is important in the nutritional and gastrointestinal management of children with neurological disability (ND) worldwide. Since the publication of the first European Society of Gastroenterology, Hepatology, and Nutrition (ESPGHAN) consensus paper in 2017, some aspects of tube-feeding modalities have attracted the interest of the scientific community more than others, including the type of enteral formulas, enteral access, and the challenging practice of tube weaning. The purpose of this review was to report on the most recent hot topics and new directions in tube-feeding strategies for children with ND
Prevalence of and Risk Factors for Sagittal Posture Abnormalities in Children Born With Esophageal Atresia: A Prospective Cohort Study.
No full textInternational audienceScoliosis is a well-described complication of esophageal atresia (EA) caused by the associated spine malformations and/or thoracotomy. However, the sagittal posture abnormalities in patients with EA have not been described. The aim of this study was to evaluate the prevalence of and risk factors for sagittal posture abnormalities at the age of 6 years in patients operated on for EA. A prospective cohort of 123 patients with EA was examined by the same rehabilitation doctor at the time of a multidisciplinary visit scheduled at the age of 6 years. Children presenting with scoliosis ( = 4) or who missed the consultation ( = 33) were excluded. Univariate and multivariate logistic regression models with Firth's penalized-likelihood approach were used to identify risk factors associated with sagittal posture anomalies. Candidate risk factors included neonatal characteristics, associated malformations, atresia type, postoperative complications, psychomotor development retardation, orthopedic abnormalities, and neurological hypotonia. The prevalence rates of sagittal posture abnormalities were 25.6% ( = 22; 95% CI, 16.7-36.1%). Multivariate analysis showed that minor orthopedic abnormalities (OR: 4.02, 95% CI: 1.29-13.43, = 0.021), and VACTERL (OR: 3.35, 95% CI: 1.09-10.71, = 0.042) were significant risk factors for sagittal posture abnormalities. This study shows that sagittal posture anomalies occur frequently in children operated on at birth for EA and are not directly linked to the surgical repair. These children should be screened and treated using postural physiotherapy, especially those with VACTERL and minor orthopedic abnormalities
