morphine and Nutrition-Disorders

Previous studies of risk factors for progression of lung disease in cystic fibrosis (CF) have suffered from limitations that preclude a comprehensive understanding of the determinants of CF lung disease throughout childhood. The epidemiologic component of the 27-year Wisconsin Randomized Clinical Trial of CF Neonatal Screening Project (WI RCT) afforded us a unique opportunity to evaluate the significance of potential intrinsic and extrinsic risk factors for lung disease in children with CF.. Describe the most important intrinsic and extrinsic risk factors for progression of lung disease in children with CF.. Variables hypothesized at the onset of the WI RCT study to be determinants of the progression of lung disease and potential risk factors previously identified in the WI RCT study were assessed with multivariable generalized estimating equation models for repeated measures of chest radiograph scores and pulmonary function tests in the WI RCT cohort.. Combining all patients in the WI RCT, 132 subjects were observed for a mean of 16 years and contributed 1,579 chest radiographs, and 1,792 pulmonary function tests. The significant determinants of lung disease include genotype, poor growth, hospitalizations, meconium ileus, and infection with mucoid Pseudomonas aeruginosa. The previously described negative effect of female sex was not seen.. Modifiable extrinsic risk factors are the major determinants of progression of lung disease in children with CF. Better interventions to prevent or treat these risk factors may lead to improvements in lung health for children with CF.

Topics: Adolescent; Child; Child, Preschool; Cohort Studies; Cystic Fibrosis; Cystic Fibrosis Transmembrane Conductance Regulator; Disease Progression; Female; Genotype; Hospitalization; Humans; Ileus; Infant; Infant, Newborn; Longitudinal Studies; Lung; Male; Meconium; Neonatal Screening; Nutrition Disorders; Oligopeptides; Pseudomonas aeruginosa; Pseudomonas Infections; Radiography; Respiratory Function Tests; Risk Factors; Young Adult

This study was pursued as an extension of a randomized clinical investigation of neonatal screening for cystic fibrosis (CF). The objective was to determine if CF patients with meconium ileus (MI) were more likely to be malnourished compared with those without MI who were diagnosed during early infancy through neonatal screening.. Nutritional status was evaluated from early infancy to 13 years of age based on anthropometric, biochemical, and dietary assessments.. MI patients (n = 32) were smaller at birth (3117 g compared with 3413 g) and were shorter (22nd percentile compared with 48th percentile) and thinner (24th percentile compared with 49th percentile) compared with non-MI early diagnosed patients (n = 50) up to 13 years of age. Poor growth was particularly evident in 26 MI patients who required surgery for MI (height and weight at the 20th percentile), whereas those treated without surgery (n = 6) showed better height (45th percentile) and weight (37th percentile). Abnormal essential fatty acid profiles were significantly more prevalent in MI compared with non-MI early-diagnosed patients before 3 years of age. Daily intakes of calorie (130% compared with 111% recommended dietary allowances) and protein (339% compared with 279% recommended dietary allowances) were higher but the percentage of fat (37% compared with 38%) and linoleic acid (4.5% compared with 4.7%) in the diet were similar between the two groups.. These results demonstrated a clear association of MI with malnutrition in CF. The observed poor growth among our MI patients was not because of poor dietary intakes, but was related to surgical treatment for MI and poor essential fatty acid status. These findings present new challenges regarding the optimal medical treatment and nutritional intervention for CF patients with MI.

Topics: Case-Control Studies; Cystic Fibrosis; Dietary Fats; Fatty Acids, Essential; Female; Growth; Humans; Infant; Intestinal Obstruction; Male; Meconium; Neonatal Screening; Nutrition Disorders; Nutritional Status; Registries

We have just begun our study of fetal growth retardation. Prenatal influences upon fetal growth are poorly understood and little studied. One may list multiple etiologies, catalogue numerous physiologic processes, and still not know in any given child what went wrong. The questions far exceed our preliminary answers. How does maternal undernutrition significantly effect the fetal "parasite?" Is the syndrome of intrauterine growth retardation a manifestation of a host versus graft phenomenon, with "runting" in the offspring? Are deficits in cell number and size unalterable? Can these deficits be overcome with good postnatal care? How can we better detect the fetus who is undergoing deprivation in utero? What altered biochemical processes exist? Can we reverse such abnormal influences in utero and prevent their consequences to the fetus? Certainly there are numerous additional areas for investigation and thought.

Topics: Amniotic Fluid; Estriol; Female; Fetal Diseases; Gestational Age; Growth Disorders; Humans; Meconium; Nutrition Disorders; Pregnancy

Topics: Body Weight; Female; Fetal Death; Fetal Diseases; Gestational Age; Humans; Meconium; Nutrition Disorders; Pregnancy; Pregnancy Complications; Risk