Malnutrition Failure to thrive

Malnutrition is absence of adequate caloric and volume feeding of the child

Etiology Recurrent bacterial diarrhea Often upper respiratory tract infections congenital gastrointestinal diseases Diseases of the mother during pregnancy: inadequate feeding, low level of ferments of gastrointestinal tract inadequate food absorption inadequate food intake

Pathogenesis leads to maldigestion and malabsorption syndrome damage of function of all organs and systems of the organism this state is associated with angry infectious complications, high mortality

MALNUTRITION CLASSIFICATION Origin Origin Alimentary factors Infection factors Regime breaking, care and upbringing defects Prenatal factors Hereditary pathology and congenital development defects

Stage I ( mild) II (moderate) III ( severe)

Period InitialProgressiveStabilization Reconvalecsention (recovery)

MALNUTRITIONAL STAGES WEIGHT DEFICITE 10-20% 10-20% 20-30% 20-30% More than 30% More than 30%

WEIGHT DEFICITE LENTH DEFICITE CHULITSKA NUTRITION AL INDEX CHULITSKA NUTRITION AL INDEX 10-20%20-30% More than 30% sm 2-4 sm 7-10 sm 7-10 sm 10 – 15 0 – 10 negative

CHULITSKA NUTRITIONAL INDEX (characterizes a degree of the child fattiness) 3 contours of a shoulder (sm.) + contour of thigh (sm.) + contour of shin (sm.) - growth (sm.); Norm: by one year sm.; smaller 20 sm. - gipotrophija; greater 25 sm. - paratrophija.

I stage – 10-20% weight loss. The general condition of the patient is satisfactory Psychomotorical development is adequate to age coefficient weight / length is about proportion index changes the index degree of nourishment of Chulitskaya reduces to skin elastisity and turgor moderately reduced Subcutaneous fat on abdomen sm.

II stage – 20-30% weight loss. State of moderate severity pallorness, dryiness of the skin pallorness, dryiness of the skin psychomotorical development is reduced psychomotorical development is reduced muskle hypotonia muskle hypotonia Decreasing of appetite, vomiting Decreasing of appetite, vomiting coefficient weight / length low than 56 proportion index changes

the index degree of nourishment of Chulitskaya reduces to 0-10 polyhypovitaminosis the index degree of nourishment of Chulitskaya reduces to 0-10 polyhypovitaminosis anemia anemia hypo and dysproteinemia hypo and dysproteinemia signs of rickets signs of rickets frequent intercurrent infections with poor symptoms frequent intercurrent infections with poor symptoms Decreases immunologic reactivity. Decreases immunologic reactivity.

III stage – more than 30% weight loss. General state of the patient is grave, severe General state of the patient is grave, severe Cachexia Cachexia subcutaneous fat is absent subcutaneous fat is absent menthal retardation menthal retardation athrophy of the muscles athrophy of the muscles temperature of the body is low temperature of the body is low regurgitatio regurgitatiovomiting frequent stools frequent stools lenght loss – more than 4 sm lenght loss – more than 4 sm

the index degree of nourishement of Chulitskaya is negative skin elastisity and turgor are absent skin elastisity and turgor are absent skin and mucus are very dry skin and mucus are very dry great abdomen great abdomen breathing is difficult breathing is difficult Heart beats are quiet Heart beats are quiet Bradycardia Bradycardia immunologic reactivity paralyses immunologic reactivity paralyses all systems and organs are impaired – anemia, rickets, bacterial infections. all systems and organs are impaired – anemia, rickets, bacterial infections.

Leukocytosis with a prepoderanse of neutrophils Electrolyte losses acidosis Hyponatremia Hyponatremia Hypoalbuminemia Hypoalbuminemia Polyhypovitaminoses Polyhypovitaminoses Anemia Anemia Low level of ferments Low level of ferments Low level of T-, B- lymphocytes and immunoglobulines Low level of T-, B- lymphocytes and immunoglobulines Blood in stool with great quantity of leukocytes, fat

TREATMENT FEEDING 1 PERIOD – period of making toleranse to food MALNUTRITION OF 1 STAGE 1 DAY - 1/2 - 2/3 of day volume of food 2 DAY - 2/3 – 3/4 of day volume of food 3 DAY – full volume of food

MALNUTRITION OF 2 STAGE 1 week - 1/2 of day volume of food 2 week - 2/3 of day volume of food 3 week - full volume of food

MALNUTRITION OF 3 STAGE 1 week - 1/3 of day volume of food 2 week – 1/2 of day volume of food 3 week – ¾ of day volume of food 4 week – full volume of food

PARENTERAL FEEDING AMINOASIDS POLIAMIN, ALVESIN, LEVAMIL PROTEIN GIDROLIZATES INFEZOL – 20/ ml/kg in 10% glucose (1:1) temperature C with 1 IU insuline to 5 gr. of glucose – drops/minute – 5-8 days

MEDICAMENTAL THERAPY 1. FERMENTS FESTAL, PANCREATIN, DIGESTIN FESTAL, PANCREATIN, DIGESTIN 2. BACTERIAL DRUGS 2. BACTERIAL DRUGS HILAC, BIFIDUM – BACTERIN, BIFI-FORMA, LINECS HILAC, BIFIDUM – BACTERIN, BIFI-FORMA, LINECS 3. STIMULATOR THERAPY 3. STIMULATOR THERAPY APILAC, METILURACIL, PENTOKSID APILAC, METILURACIL, PENTOKSID 4. VITAMINS 4. VITAMINS AEVIT, B,C, P AEVIT, B,C, P 5. HORMONE THERAPY 5. HORMONE THERAPY NEROBOL – 0,1 MG/KG/DAY NEROBOL – 0,1 MG/KG/DAY RETABOLIL – 1 MG/KG/DAY RETABOLIL – 1 MG/KG/DAY 6. SYMTOMATIC TREATMENT 6. SYMTOMATIC TREATMENT FEUM-LEK – 1 MG/KG/DAY INTRAMUSCULAR FEUM-LEK – 1 MG/KG/DAY INTRAMUSCULAR PER OS – 5 MG/KG/DAY ACTIFERIN (DROPS) PER OS – 5 MG/KG/DAY ACTIFERIN (DROPS) 7. ANTIOCSIDANT THERAPY 7. ANTIOCSIDANT THERAPY TOCOFEROL ACETATI – 3-5 MG/KG/DAY TOCOFEROL ACETATI – 3-5 MG/KG/DAY