Breaking News
March 20, 2019 - Piece of puzzle unlocked in what drives alcohol addiction
March 20, 2019 - Researchers investigate whether Zika reservoirs are found in the Americas
March 20, 2019 - Compounds found in coffee may inhibit growth of prostate cancer
March 20, 2019 - Lab Innovations returns to the NEC on 30 & 31 October 2019
March 20, 2019 - How genes affect tobacco and alcohol use
March 20, 2019 - Plant cellulose bone implants are “viable” option to support new bone growth, study finds
March 20, 2019 - Older people living in retirement communities benefit from improved health
March 20, 2019 - UTSA professor helps train first responders to detect prescription opioid overdoses
March 20, 2019 - Biohaven’s Verdiperstat Receives Orphan Drug Designation From FDA For Multiple System Atrophy
March 20, 2019 - Smoking may limit body’s ability to fight dangerous form of skin cancer
March 20, 2019 - Researchers receive $9.7-million grant to develop new hearing-loss treatments for deaf
March 20, 2019 - TGen and ABL sign agreement to distribute new TB test technology
March 20, 2019 - UCD researchers lead development of new urine test to detect prostate cancer
March 20, 2019 - Miniature brains that can move muscles, grown in the lab
March 20, 2019 - Servier and Oncodesign announce research and drug development partnership
March 20, 2019 - FDA warns marketer of unapproved products claiming to treat addiction, chronic pain
March 20, 2019 - TB Medicine Pretomanid Enters Regulatory Review Process in the United States
March 20, 2019 - Breastfeeding can erase effects of prenatal violence for newborns
March 20, 2019 - Tens of Thousands of Heart Patients May Not Need Open-Heart Surgery
March 20, 2019 - Space worries – shingles affecting astronauts says NASA
March 20, 2019 - Study shows how AI can improve physicians’ diagnostic accuracy
March 20, 2019 - Dolomite Bio launches new scRNA-Seq Reagent Kit at AGBT 2019
March 20, 2019 - World’s oldest semen viable for artificial insemination
March 20, 2019 - FDA Approves Zulresso (brexanolone) for the Treatment of Post-Partum Depression
March 19, 2019 - How it manipulates us to tribalism
March 19, 2019 - How can doctors encourage patients to adopt healthier behaviors?
March 19, 2019 - Meet Hal: He's One Sick Robot
March 19, 2019 - Blood test and mathematical model can estimate preterm birth rate in low-resource countries
March 19, 2019 - TAVR procedure safe in patients with unusual valve anatomy
March 19, 2019 - Proteins in the eye may be potential source for cost-effective test to predict Alzheimer’s disease
March 19, 2019 - Opioid Prescriptions Dropped for New Users From 2012 to 2017
March 19, 2019 - New method may better predict the best treatment for burn wounds
March 19, 2019 - “Asian” isn’t specific enough for health data, research suggests
March 19, 2019 - ColumbiaDoctors Presents Honors for Outstanding Commitment to Patient Safety
March 19, 2019 - Innovative model identifies primate species with potential to transmit Zika in the Americas
March 19, 2019 - One-off surgery could offer hope to patients with high blood pressure
March 19, 2019 - Many pet owners interested in feeding their pets with plant-based diet
March 19, 2019 - How to Protect Your Kids From Drowning
March 19, 2019 - CEA Test: MedlinePlus Lab Test Information
March 19, 2019 - Two years after face transplant, Andy Sandness’ smile shows his progress
March 19, 2019 - Registration now open for Stanford’s Big Data in Precision Health conference
March 19, 2019 - Gene Keeps Fear at Bay, But Only in Females
March 19, 2019 - Cholesterol lowering drug can also help treat cancer-associated cachexia
March 19, 2019 - GARDP and Evotec partner to tackle growing threat of antimicrobial resistance
March 19, 2019 - Ultrasound offers precise, minimally invasive way to measure cardiac output in children
March 19, 2019 - Study suggests potential new approach to treat atopic dermatitis
March 19, 2019 - Sense of control over life makes older adults feel younger
March 19, 2019 - Study shows how probiotics influence gut microbiota
March 19, 2019 - Study offers new evidence that narcolepsy is an autoimmune condition
March 19, 2019 - Breastfeeding may offer long-term heart health benefits for women
March 19, 2019 - Study of young athletes suggests snoring and sleep apnea are linked to sudden cardiac death
March 19, 2019 - Did Your Doctor ‘Ghost’ You? An Employment Contract May Be To Blame
March 19, 2019 - Food pantry clients more likely to make healthy choices when meal kits and recipe tastings are available
March 19, 2019 - Mental health problems among children increasing
March 19, 2019 - New ISO standard helps evaluate and manage impact of environmental damage
March 19, 2019 - CardioMEMS heart failure sensor reliably safe, effectively reduces hospitalizations
March 19, 2019 - Researchers report promising results of potential reversal agent
March 19, 2019 - Scientists identify brain circuit responsible for cocaine-seeking behavior during relapse
March 19, 2019 - First African-American Neuroscience Research Initiative launched to close the gap in health disparities
March 19, 2019 - Bimekizumab Demonstrated Long-Term Maintenance of Complete or Almost Complete Skin Disease Resolution for Psoriasis Patients in BE ABLE 2 Extension Study
March 19, 2019 - Attitudes about health affect how older adults engage with negative health news
March 19, 2019 - Huron Digital Pathology to unveil new ‘Scan Index Search’ platform at USCAP 2019
March 19, 2019 - Frequent intake of sugary drinks tied to greater risk of premature death
March 19, 2019 - Bruker showcases new analytical systems and applied market solutions at Pittcon 2019
March 19, 2019 - Framingham cardiovascular risk prediction model from the 1990s still gives the best results
March 19, 2019 - New article focuses on integrative health, value-based medicine, and whole systems research
March 19, 2019 - Foamix Announces FDA Acceptance of New Drug Application for FMX101 Minocycline Foam for the Treatment of Moderate-to-Severe Acne
March 19, 2019 - National survey of emergency dept management of self-harm highlights successes, room for improvement
March 19, 2019 - Scientists reverse alcohol-seeking behavior in rats with flip of a switch
March 19, 2019 - Researchers hope blood test that accurately diagnoses fibromyalgia could be available within five years
March 19, 2019 - New Planmeca ProScanner 2.0 offers fast and dependable intraoral imaging
March 19, 2019 - A new option for reducing LDL cholesterol in patients at high risk for heart attack, stroke
March 19, 2019 - Common medications to treat heartburn linked to increased risks for kidney failure
March 19, 2019 - Current HBV genome sequences help deduce ancient human population movements into Australia
March 19, 2019 - Pure omega-3 prescription drug significantly reduces the occurrence of ischemic events
March 19, 2019 - Researchers use big data to gain better understanding of hepatitis E virus
March 19, 2019 - Use of synthetic psychedelic linked to improvements in depression and anxiety
March 19, 2019 - GARP protein can be a potential target for immunotherapy against colorectal cancer
March 19, 2019 - Knee Pain Not Tied to Activity Levels in Knee Osteoarthritis
March 19, 2019 - Study shows benefits of delayed cord clamping in healthy babies
Malnutrition in children with Crohn’s disease linked with increased risk of surgical complications

Malnutrition in children with Crohn’s disease linked with increased risk of surgical complications

image_pdfDownload PDFimage_print

Results of a medical records study of children with Crohn’s disease by Johns Hopkins researchers have added substantial evidence for a strong and direct link between malnutrition and increased risk of surgical complications and poor outcomes.

The investigators say children with Crohn’s disease were selected for the data analysis because a common hallmark of their disease is malnutrition, and surgery is often used to treat it. But they say their results also are likely to shed light on the links between pediatric malnutrition in general and all kinds of surgical outcomes unrelated to Crohn’s disease.

A report of the study’s findings was published in the November issue of Journal of Pediatric Surgery.

“We knew that poor nutrition in adults was linked to complications after surgery, but research to examine the effect of malnutrition in children has been limited,” says Mitchell Ladd, M.D., Ph.D., a surgery resident at The Johns Hopkins Hospital and the report’s first author.

According to the National Institutes of Health, more than 500,000 people in the United States suffer from Crohn’s disease, a chronic inflammation of the digestive tract that has no cure. Symptoms include repeated bouts of abdominal pain, diarrhea, fatigue and malnutrition, and surgery to remove portions of damaged bowel is a common treatment in those with recurrent disease. A recent study estimates that approximately 38,000 children in the U.S. suffer from Crohn’s disease.

To better understand how malnutrition might affect surgical outcomes in children undergoing major bowel surgery, Ladd and colleagues used data from the American College of Surgeons National Surgical Quality Improvement Program Pediatric database from 2012 to 2015 to examine post-operative complications and other outcomes for children ages 5 to 18 years with Crohn’s disease. Malnutrition and its severity were determined using one of the American Society for Parenteral and Enteral Nutrition’s malnutrition criteria, specifically body mass index of each child compared with the national average growth charts provided by the Centers for Disease Control and Prevention.

The research team looked at the rate of wound infection, respiratory complications such as pneumonia, septic shock (a life-threatening infection complication), reoperation and readmission within 30 days of surgery.

Of the 516 patients included in the study, 97 (18.8 percent) had documented mild malnutrition, as revealed by their body mass index calculated based on their weight and height data, 49 (9.5 percent) showed moderate malnutrition and 21 (4.1 percent) severe malnutrition. Children with moderate or severe malnutrition have very low weight for their height and experience loss of muscle mass. Without urgent treatment, severe malnutrition can lead to death.The remaining 349 (67.6 percent) patients were not malnourished.

The midrange age of all study participants was 15.5 years, 218 (42.3 percent) were female and 425 (82.4 percent) were white. Of the 516 patients in the study, the researchers counted 68 (13.2 percent) post-operative complications, 27 (5.2 percent) reoperations and 36 (7 percent) readmissions.

The researchers found that for each degree of worsening malnutrition (i.e., not malnourished, mild, moderately and severely malnourished), the rate of complications, when taking no other patient factors into account, increased from 9.7 percent for not malnourished to 18.6 percent, 20.4 percent and 28.6 percent, respectively. When other patient factors were accounted for, malnutrition still increased the odds of a complication occurring, especially in the severely malnourished, who had more than three times the odds of post-operative complications compared with children who were not malnourished. Worsening malnutrition was also associated with an increased rate of reoperations, though no association between malnutrition and readmissions rates was found. For severely malnourished children, the midrange total length of hospital stay and post-operative length of stay were longer by six and two days, respectively.

“It’s well known that poor nutrition negatively affects processes such as wound healing and immune function. We need nutrients for energy, to fight infections and to heal wounds. Children are even more susceptible to poor nutrition because they also need nutrients to grow, and when they are ill, nutrients are diverted from growing to support these more essential functions. Thus, while the current study does not prove that malnutrition causes these complications, it is certainly biologically plausible that malnutrition may play a direct role,” says Ladd.

“Much more research needs to be done to answer questions like what doctors can do to optimize patients’ health before they enter the operating room, to define what being ‘optimized’ is in children, and thus increase the likelihood children are properly nourished before surgery,” Ladd says. Possible methods to improve pre-surgical nutrition include feeding children specialized tube feeds, if they can be tolerated by the child, or if not, intravenous nutrition for several weeks before surgery if surgery can be delayed.

“We studied the effects of malnutrition in this population because patients with Crohn’s disease are already prone to being malnourished, but the same concept is likely to be at work for other types of surgeries in children just as it is in adults,” said Daniel Rhee, M.D., M.P.H., assistant professor of surgery at Johns Hopkins University School of Medicine and director of the Pediatric Surgical Oncology Program.

Source:

https://www.hopkinsmedicine.org/news/newsroom/news-releases/malnutrition-common-in-children-with-crohns-disease-increases-risk-for-post-operative-complications

About author

Related Articles