The prevalence of childhood obesity is a growing epidemic in the United States and as of 2014 its prevalence among children ages two to 19 was 17.0%. Without intervention, obese children are at risk for negative healt...The prevalence of childhood obesity is a growing epidemic in the United States and as of 2014 its prevalence among children ages two to 19 was 17.0%. Without intervention, obese children are at risk for negative health consequences and for the increased likelihood of staying obese through adulthood. St. Louis Children＇s Hospital provides HTT （Head to Toe）, an interactive 12-session fimess, nutrition, and social well-being class focuses on adopting healthier lifestyles through daily exercise, and proper nutrition. One program referral method is through a partnership with the hospital＇s HSC （Healthy Start Clinic）, a multi-disciplinary obesity clinic. Pretest and posttest assessments are used to measure changes in body metrics, health behaviors, knowledge, readiness to change, and self-concept. Between August 2011 and May 2016, 485 children and at least one parent or guardian with them were enrolled in the program, and up to 235 children completed at least one pretest- or post-assessment. Analysis determined multiple statistically significant improvements in body metrics, health behaviors, knowledge, including questions related to nutrition and food guidelines, readiness to change assessment, and self-concept. Total knowledge increased by 22%; questions related to nutrition increased by 28.2%, social emotional by 18.9% and physical activity by 17.8%. Findings suggest that the Head to Toe program is effective in improving nutrition, physical activity, social emotional knowledge and behaviors among participants. Childhood obesity is a growing epidemic and creating a relationship with a pediatric obesity clinic can increase the total number of children and teens that are introduced to weight management programs.展开更多
Purpose: The management of giant omphalocele presents a major challenge to pediatric surgeons. Current treatment modalities often result in wound infection, fascial separation, and abdominal domain loss. Human acellul...Purpose: The management of giant omphalocele presents a major challenge to pediatric surgeons. Current treatment modalities often result in wound infection, fascial separation, and abdominal domain loss. Human acellular dermis (Allo-Derm), as a primary abdominal fascial substitute, may prevent these complications. We present our experience with its application in neonates with giant omphalocele. Methods: Charts of patients with giant omphalocele from January 2003 to September 2004 were reviewed and data collected regarding wound healing, rate of infection, ventilatory support, and outcome. Results: Three neonates underwent abdominal wall closure with Allo-Derm (gestati- onal ages: 38, 37, and 28 weeks; birthweights 2880, 2640, and 1160 g, respectively). All had cardiac anomal- ies; 1 required cardiac surgery and 1 was ventilatordependent, secondary to pulmonary hypoplasia. Omphalocele repair was performed on day-of-life 9, 2, and 87. No fascial dehiscence or infection was encountered. Neovascularization was noted by day 7. Two died of cardiopulmonary disease (6 months and 1 year). The third exhibited normal growth and development without complication. Conclusions: Allo-Derm provides visceral coverage without compromising cardiopulmonary function, diminishing abdominal domain, or requiring multiple operations, allowing prompt treatment of associated anomalies. Allo-Derm represents an exciting alternative in the treatment of giant omphalocele. Further study is required to determine long-term benefits.展开更多
Aim: To determine if home- based nutritional therapy will benefit a signific ant fraction of malnourished, HIV- infected Malawian children, and to determine if ready- to- use therapeutic food (RUTF) is more effective ...Aim: To determine if home- based nutritional therapy will benefit a signific ant fraction of malnourished, HIV- infected Malawian children, and to determine if ready- to- use therapeutic food (RUTF) is more effective in home- based n utritional therapy than traditional foods. Methods: 93 HIV- positive children > 1 y old discharged from the nutrition unit in Blantyre, Malawi were systematica lly allocated to one of three dietary regimens: RUTF, RUTF supplement or blended maize/soy flour. RUTF and maize/soy flour provided 730 kJ· kg- 1· d- 1,whil e the RUTF supplement provided a fixed amount of energy, 2100 kJ/d. These childr en did not receive antiretroviral chemotherapy. Children were followed fortnight ly. Children completed the study when they reached 100% weight- for- height, relapsed or died. Outcomes were compared using regression modeling to account f or differences in the severity of malnutrition between the dietary groups. Resul ts: 52/93 (56% ) of all children reached 100% weight- for- height. Regressi on modeling found that the children receiving RUTF gained weight more rapidly an d were more likely to reach 100% weight- for- height than the other two diet ary groups (p < 0.05). Conclusion: More than half of malnourished, HIV- infecte d children not receiving antiretroviral chemotherapy benefit from home- based n utritional rehabilitation. Home- based therapy RUTF is associated with more rap id weight gain and a higher likelihood of reaching 100% weight- for- height.展开更多
Background:The management of giant omphaloceles (GO) can be quite difficult when there is absence of abdominal domain. Coverage with delayed closure has been described. We present a technique to create an adequate per...Background:The management of giant omphaloceles (GO) can be quite difficult when there is absence of abdominal domain. Coverage with delayed closure has been described. We present a technique to create an adequate peritoneal domain. Methods:This is a retrospective review of our experience using an intraperitoneal tissue expander (IPTE) to create adequate abdominal domain in 2 patients with GO. Results:In 2 children with unrepaired GO,an IPTE was placed into the pelvis and was inflated to the target volume over 3 to 4 weeks. At the definitive operation for the closure of the abdominal defect,the IPTE was removed,allowing reduction of all the viscera into the peritoneal cavity and achieving complete abdominal wall closure. The patients are now 1 year postoperative,each having a normal abdomen and enjoying normal growth and development. Conclusion:Intraperitoneal tissue expander placement can create the needed domain over several weeks in GO. Its use in 2 cases was associated with satisfactory complete abdominal wall closure in short order. This technique should be considered as a treatment option.展开更多
Objective To review the pathophysiology, evaluation, management, and outcomes of children with inherited disorders of surfactant metabolism due to mutations in the genes encoding surfactant proteins-B or -C（SFTPB, SF...Objective To review the pathophysiology, evaluation, management, and outcomes of children with inherited disorders of surfactant metabolism due to mutations in the genes encoding surfactant proteins-B or -C（SFTPB, SFTPC）, ATP binding cassette member A3 （ABCA3）, and thyroid transcription factor （NKX2.1）.Data sources Review of the literature, previous work from the author＇s and collaborators＇ laboratories, St. Louis Children＇s Hospital Lung Transplant Database.Study selection Key articles in the field, author＇s work.Results Inherited disorders of surfactant metabolism present as acute, severe respiratory dysfunction in the neonatal period （SFTPB, ABCA3, NKX2.1） or as chronic respiratory insufficiency in later infancy and childhood which is of variable onset, severity, and course （SFTPC, ABCA3, NKX2.1）. Diagnosis is established with sequencing the relevant genes; lung biopsy with electron microscopy is a useful adjunct. For surfactant protein-B and ABCA3 deficiency presenting with acute neonatal disease, treatment options are limited to lung transplantation or compassionate care. For the more chronic presentations of surfactant protein-C, ABCA3, and NKX2.1 associated disease, the natural history is variable and therefore individualized, supportive care is appropriate,Conclusions Inherited disorders of surfactant metabolism are rare, but informative diseases that provide unique opportunities for understanding mechanisms of respiratory disease in newborns and children.展开更多
文摘The prevalence of childhood obesity is a growing epidemic in the United States and as of 2014 its prevalence among children ages two to 19 was 17.0%. Without intervention, obese children are at risk for negative health consequences and for the increased likelihood of staying obese through adulthood. St. Louis Children＇s Hospital provides HTT （Head to Toe）, an interactive 12-session fimess, nutrition, and social well-being class focuses on adopting healthier lifestyles through daily exercise, and proper nutrition. One program referral method is through a partnership with the hospital＇s HSC （Healthy Start Clinic）, a multi-disciplinary obesity clinic. Pretest and posttest assessments are used to measure changes in body metrics, health behaviors, knowledge, readiness to change, and self-concept. Between August 2011 and May 2016, 485 children and at least one parent or guardian with them were enrolled in the program, and up to 235 children completed at least one pretest- or post-assessment. Analysis determined multiple statistically significant improvements in body metrics, health behaviors, knowledge, including questions related to nutrition and food guidelines, readiness to change assessment, and self-concept. Total knowledge increased by 22%; questions related to nutrition increased by 28.2%, social emotional by 18.9% and physical activity by 17.8%. Findings suggest that the Head to Toe program is effective in improving nutrition, physical activity, social emotional knowledge and behaviors among participants. Childhood obesity is a growing epidemic and creating a relationship with a pediatric obesity clinic can increase the total number of children and teens that are introduced to weight management programs.
文摘Purpose: The management of giant omphalocele presents a major challenge to pediatric surgeons. Current treatment modalities often result in wound infection, fascial separation, and abdominal domain loss. Human acellular dermis (Allo-Derm), as a primary abdominal fascial substitute, may prevent these complications. We present our experience with its application in neonates with giant omphalocele. Methods: Charts of patients with giant omphalocele from January 2003 to September 2004 were reviewed and data collected regarding wound healing, rate of infection, ventilatory support, and outcome. Results: Three neonates underwent abdominal wall closure with Allo-Derm (gestati- onal ages: 38, 37, and 28 weeks; birthweights 2880, 2640, and 1160 g, respectively). All had cardiac anomal- ies; 1 required cardiac surgery and 1 was ventilatordependent, secondary to pulmonary hypoplasia. Omphalocele repair was performed on day-of-life 9, 2, and 87. No fascial dehiscence or infection was encountered. Neovascularization was noted by day 7. Two died of cardiopulmonary disease (6 months and 1 year). The third exhibited normal growth and development without complication. Conclusions: Allo-Derm provides visceral coverage without compromising cardiopulmonary function, diminishing abdominal domain, or requiring multiple operations, allowing prompt treatment of associated anomalies. Allo-Derm represents an exciting alternative in the treatment of giant omphalocele. Further study is required to determine long-term benefits.
文摘Aim: To determine if home- based nutritional therapy will benefit a signific ant fraction of malnourished, HIV- infected Malawian children, and to determine if ready- to- use therapeutic food (RUTF) is more effective in home- based n utritional therapy than traditional foods. Methods: 93 HIV- positive children > 1 y old discharged from the nutrition unit in Blantyre, Malawi were systematica lly allocated to one of three dietary regimens: RUTF, RUTF supplement or blended maize/soy flour. RUTF and maize/soy flour provided 730 kJ· kg- 1· d- 1,whil e the RUTF supplement provided a fixed amount of energy, 2100 kJ/d. These childr en did not receive antiretroviral chemotherapy. Children were followed fortnight ly. Children completed the study when they reached 100% weight- for- height, relapsed or died. Outcomes were compared using regression modeling to account f or differences in the severity of malnutrition between the dietary groups. Resul ts: 52/93 (56% ) of all children reached 100% weight- for- height. Regressi on modeling found that the children receiving RUTF gained weight more rapidly an d were more likely to reach 100% weight- for- height than the other two diet ary groups (p < 0.05). Conclusion: More than half of malnourished, HIV- infecte d children not receiving antiretroviral chemotherapy benefit from home- based n utritional rehabilitation. Home- based therapy RUTF is associated with more rap id weight gain and a higher likelihood of reaching 100% weight- for- height.
文摘Background:The management of giant omphaloceles (GO) can be quite difficult when there is absence of abdominal domain. Coverage with delayed closure has been described. We present a technique to create an adequate peritoneal domain. Methods:This is a retrospective review of our experience using an intraperitoneal tissue expander (IPTE) to create adequate abdominal domain in 2 patients with GO. Results:In 2 children with unrepaired GO,an IPTE was placed into the pelvis and was inflated to the target volume over 3 to 4 weeks. At the definitive operation for the closure of the abdominal defect,the IPTE was removed,allowing reduction of all the viscera into the peritoneal cavity and achieving complete abdominal wall closure. The patients are now 1 year postoperative,each having a normal abdomen and enjoying normal growth and development. Conclusion:Intraperitoneal tissue expander placement can create the needed domain over several weeks in GO. Its use in 2 cases was associated with satisfactory complete abdominal wall closure in short order. This technique should be considered as a treatment option.
文摘Objective To review the pathophysiology, evaluation, management, and outcomes of children with inherited disorders of surfactant metabolism due to mutations in the genes encoding surfactant proteins-B or -C（SFTPB, SFTPC）, ATP binding cassette member A3 （ABCA3）, and thyroid transcription factor （NKX2.1）.Data sources Review of the literature, previous work from the author＇s and collaborators＇ laboratories, St. Louis Children＇s Hospital Lung Transplant Database.Study selection Key articles in the field, author＇s work.Results Inherited disorders of surfactant metabolism present as acute, severe respiratory dysfunction in the neonatal period （SFTPB, ABCA3, NKX2.1） or as chronic respiratory insufficiency in later infancy and childhood which is of variable onset, severity, and course （SFTPC, ABCA3, NKX2.1）. Diagnosis is established with sequencing the relevant genes; lung biopsy with electron microscopy is a useful adjunct. For surfactant protein-B and ABCA3 deficiency presenting with acute neonatal disease, treatment options are limited to lung transplantation or compassionate care. For the more chronic presentations of surfactant protein-C, ABCA3, and NKX2.1 associated disease, the natural history is variable and therefore individualized, supportive care is appropriate,Conclusions Inherited disorders of surfactant metabolism are rare, but informative diseases that provide unique opportunities for understanding mechanisms of respiratory disease in newborns and children.
