Physiology

Effect of pre-transplant vitamin D level on liver transplantation outcome

Sun, 01 Jan 2023 00:00:00 GMT

Effect of pre-transplant vitamin D level on liver transplantation outcome Shalika, K.; Sithamparapillai, K.; Madunil, N.; Dileepa, E.

Timing and pattern of growth faltering in children up-to 18 months of age and the associated feeding practices in an urban setting of Sri Lanka

Sat, 01 Jan 2022 00:00:00 GMT

Timing and pattern of growth faltering in children up-to 18 months of age and the associated feeding practices in an urban setting of Sri Lanka Sithamparapillai, K.; Samaranayake, D.; Wickramasinghe, V. P. Background: Growth faltering is commonly encountered in breastfed infants during 4—6 months of age in low socioeconomic communities. The objective of this study was to describe the changes of growth indices with age, timing of growth faltering and its association with the feeding practices in children up-to 18 months of age. Methods: A cross sectional descriptive study was conducted in 254 children aged 12 and 18 months attending an immunization clinic. Data on growth were extracted from the Child Health Development Record. Weight and length were measured using standard methods. Feeding practices were assessed using interviewer-administered questionnaire. A drop of>0.25 in weight-for-age Standard Deviation Score (SDS) from birth SDS was defned as weight faltering. Results: Weight faltering occurred at some point in 64.2% (n=163) during frst 18 months of life, and 78.5% of whom, had the onset≤4 months of age. Majority (76.6%, n=98) with weight for age faltering by 4 months remained so at 12 months (p=0.497), while 29.7% (n=38) had a weight-for-length below-2SD (p<0.001). Prevalence of weight faltering was 50.4%, 46.1%, 48.4% and 48% at 4, 6, 9 and 12 months respectively. Exclusive breastfeeding was given at least until 4 months in 88% (n=223) and up to 6 months in 60% (n=153) while 92.9% (n=236) were breastfed at 12 months, with 38.2% (n=97) were breastfed on demand after six months. Complementary feeding (CF) was started before 6 months in 40.6% (n=52) with early weight faltering, but only 20.3% received it with proper consistency. Breastfeeding throughout the night was signifcantly associated with current weight-for-length being<-1SD (OR=1.89, CI, 1.04—3.45; p=0.037). Conclusions: Early growth faltering was found in this population with high exclusive breastfeeding rates and persisting growth faltering was associated with poor feeding practices. Therefore, timely individualized interventions need to be taken to improve long term growth.

Successful enteral nutrition in an infant with high-output ileostomy with short bowel – A case study

Wed, 01 Jan 2020 00:00:00 GMT

Successful enteral nutrition in an infant with high-output ileostomy with short bowel – A case study Jayaweera, H.K.D.; Sithamparapillai, K.; Wickramasinghe, P. Introduction and Objective Infants with high-output ileostomies with short bowel should be managed expeditiously to maintain optimal growth and development. Thus, selection between enteral and parenteral nutritional interventions is challenging. Clinical Presentation A two-month-old infant with a high-output ileostomy and short bowel following surgical resection of distal ileum due to Hirschsprung's disease was referred for the management of failure-to-thrive. Her weight was 14.2% below birth weight. Her weight-for-age, weight-for- length was below -3SD and length/age between -1SD to -2SD (WHO standards). She was dehydrated and investigations revealed electrolyte imbalances with moderate anaemia. Management Infant's dehydration and electrolyte imbalances were corrected. Therapeutic feeding was initiated via nasogastric drip feeds to improve nutrient absorption. Energy delivery was gradually increased to provide 200 kcal/kg/day with expressed breast milk and a polymeric formula in addition to on-demand breastfeeds. Coconut oil was added to provide energy and medium chain triglycerides considering deficiency with bile salts. Hyper-osmolar feeds were avoided. Loperamide 50 micrograms/Kg was added to reduce the intestinal motility. Micronutrient supplements including oral zinc and iron with parenteral vitamin B12 were started. Stimulation was commenced. Ileostomy output reduced gradually and there was a steady weight gain of more than 10g/Kg/day. After 2 weeks of therapy, infant's weight- for- length improved (value between -3SD to -2SD) and frequent oral bolus feeds were initiated. At 4 months of age, energy-dense, rice-based, low fiber complementary feeds with semi-solid consistency were started. Hyper and hypo osmolar feeds were avoided. After 2 and half months of therapy, her weight- for-length reached above -2SD with age appropriate development. Conclusion Personalized enteral nutrition interventions together with pharmacotherapy was effective in correcting malnutrition in an infant with high output ileostomy with short bowel.

Prevalence of malnutrition among children under 12 years with congenital heart disease, admitted to the cardiology unit at a tertiary care setting in Sri Lanka

Sun, 01 Jan 2017 00:00:00 GMT

Prevalence of malnutrition among children under 12 years with congenital heart disease, admitted to the cardiology unit at a tertiary care setting in Sri Lanka Gamage, M.P.; Sithamparapillai, K.; Perera, S.N.; Ranawaka, R.; Jayatissa, R. Introduction It is estimated that around 3255 children are born with congenital heart disease (CHD) per year in Sri Lanka and half of them will require surgery within the first few years of life. In this group of children malnutrition affects the body as a whole compromising cardio-pulmonary functions, healing capacity and immunological competency leading to high morbidity and mortality. Therefore, the objective of this study was to determine the prevalence of malnutrition among children with congenital heart disease awaiting cardiac interventions in a tertiary care cardiology unit. Method All patients below 12 years, admitted to the cardiology unit at Lady Ridgeway hospital for children during the month of August 2017 were recruited. As recommended by American society for Parenteral and Enteral Nutrition (ASPEN), Z scores were used for the assessment of nutritional status. In children below 5 years, weight / height below -3SD and between -3SD and - 2SD were taken as severe acute malnutrition (SAM) and moderate acute malnutrition (MAM) respectively. In children above 5 years, the sex specific BMI below -2SD was considered as acute malnutrition. Height / Age below -2SD was taken as stunted and below -3SD was taken as severely stunted. Results Total of 102 children were included (Infants 43, 1 - 5 years 24, >5 years 33). Male population was 49.4% and 50.6% were females. Low birth weight was seen in 30.7%. Prevalence of SAM was 24.5% and 84% of them were infants. MAM was seen in 25.4% of which 61.5% were below 5 years. Stunting below 5 years was 48.4% of which 62.5% were severely stunted. In above 5 years, 36.3% were stunted of which 25% were severely stunted. Conclusion Half of the children with CHD admitted to the cardiology unit in this study sample were malnourished. Majority of them were below 5 years. Therefore, nutritional interventions and further studies of this at-risk group are needed for a better outcome of them.