Identification of malnutrition in children with severe neuromotor disabilities: A still overlooked aspect in our country

s / Digestive and Liver Disease 46 (2014) e85–e127 e99 Methods: We retrospectively collected data (2000–2014) on children undergoing long-termPN (>6months) for different underlying conditions: Short Bowel Syndrome (SBS), Intestinal Motility Disorders (IMD) and severe Neurological Diseases (ND). The rate of CLABSI/1000 catheter-days was considered as main outcome. Occurrence of mechanical complications and replacement were also recorded. Results: Twenty children were included in the study: 11 with SBS (55%), 6 with IMD (30%) and 3 with ND (15%). During a total of 24,424patients-days, 28mechanical complicationswere registered and 34 central-lines were removed. CLABSI was the major cause of catheter replacement (18/34, 53%). An overall rate of infections of 7.01 CLABSI/1000 catheter-days was registered in the first year of PN and it progressively reduced in the following years reaching 3.06/1000 between 3–4 years and 0.86/1000 after 6 years of PN. CLABSI rate was higher in children with SBS and IMD (7.42 and 7.94/1000 catheter-days, respectively) than in those with ND (2.63/1000 catheter-days). Coagulase-negative Staphylococci were the most commonly isolated pathogens (65%), in 5 cases a polymicrobial infection was detected. Conclusions: Infections are a leading cause of morbidity in children receiving PN. The risk of infection varies according to underlying conditions and progressively decreases, probably in parallel with child growth and improvement of caregivers ability to home management. http://dx.doi.org/10.1016/j.dld.2014.07.089 IDENTIFICATION OF MALNUTRITION IN CHILDREN WITH SEVERE NEUROMOTOR DISABILITIES: A STILL OVERLOOKED ASPECT IN OUR COUNTRY Maria Sangermano1,∗, Roberta D’Aniello1, Grazia Massa1, Pasquale Pisano2, Giangennaro Coppola3, Marco Poeta1, Luca Pierri 1, Dario Di Salvio1, Giulia Paolella1, Pietro Vajro4 1 Universita degli Studi di Salerno, Pediatrics Section Dept Medicine and Surgery, Universita di Salerno, Baronissi Salerno, Italy 2 Universita degli Studi di Salerno, Pediatrics, AOU Ruggi D’Aragona, Salerno, Italy 3 Universita degli Studi di Salerno, Neuropediatrics Section Dept Medicine and Surgery, Univ Salerno, Baronissi Salerno, Italy 4 Universita degli Studi di Salerno, Pediatrics Section Dept Medicine and Surgery, Univ Salerno, Baronissi Salerno, ELFID, Naples, Italy Objective: Several neuromotor disorders are associated with nutritional difficulties, a quite often underestimated or overlooked problem. Our study aims to delineate the frequency ofmalnutrition in a series of non-hospitalized, neurologically impaired Southern Italy children. Methods:Thirty patients, 21males and9 females, agedbetween 2 and 15 years with cerebral palsy (n=15), epileptic encephalopathy (n=6), severe psychomotor developmental delay (n=5), genetic syndromes (n=4). Nutritional status was assessed by anthropometric parameters [weight, estimated height by specific body segments measurement, BMI, Plicometry], blood count, serum levels of iron, albumin, transferrin, calcium, phosphorus. Feeding and a 3 days food diary were recorded. Results: Approximately from one third to half of the study population was at serious risk of malnutrition according to the reported feeding difficulties [about 90% of patients required conTable 1 kcal/die Carbohydrates Lipids Proteins Patients 1092±215 134.2±19.0 (46%) 45.4±8.9 (37%) 45.9±17.7 (17%) References 1474±411* 55-60% (RDI) 33–30% (RDI) 12–15% (RDI) RDI =Reference Daily Intake. * Krick’s formula (Krick et al., 1996). stant substantial assistance during meals, usually >30min/meal (mean 45min)], progressive weight depletion [ 0.3 unless otherwise specified, are shown. Sleep deprivation/fragmentation, nocturnal breathing problems and daytime sleepiness increased with BMI, correlating with clinical markers of metabolic syndrome (Acanthosis Nigricans and blood pressure). Frequency and amounts of sugary drinks consumption closely paralleled the BMI excess and all the other anthropometric parameters. A positive correlation was found also with factors influencing gut microbiota [bottle formula feeding/antibiotic therapies], whereas probiotics/prebiotics treatments correlated negatively with waist circumference and diastolic blood pressure. In the whole population the average concentration of total urinary BPAwas 1.13±0.89ng/ml. Free and total BPA increased paralleling BMI and all other obesity markers with a remarkable positive correlation (r>0.8), whereas the conjugate BPA behaved the opposite way. Conclusions: Our results confirm the existence of a close relationship between these 4 emerging factors and pediatric obesity, highlighting their possible role as targets for preventive/therapeutic tools. http://dx.doi.org/10.1016/j.dld.2014.07.091