April
21
23:02
Paediatrics

Wasting

Wasting

malnutrition photo Wasting - chronic eating disorder, occurring primarily in children under two years (mainly up to one year), due to the insufficient amount of nutrients entering the body, or a violation of their assimilation.This condition is characterized by a deficiency of body weight, according to various degree.At the time of occurrence, malnutrition is divided into congenital and acquired forms of the disease.

congenital malnutrition may be due to late toxicosis pregnant, which is accompanied by pathological changes of placenta (inflammatory processes, congenital malformations), its detachment or trauma;violation of placental circulation;abuse of alcohol and smoking;Intrauterine infection of the fetus ( syphilis , rubella, salivary gland disease, toxoplasmosis);infectious or physical illness pregnant;malnutrition of pregnant;aged pregnant (older than 30, and / or under the age of 18 years);the impact on the body of a pregnant woman different production hazards.

reasons acquired malnutrition:

hypogalactia (enough mother's milk);artificial or mixed feeding insufficient milk mixture;difficulty suckling at the teats of irregular shape (elongated, flat) or taut breast;qualitative malnutrition in case of late due to the long feeding and feeding breast milk;infectious diseases of the child (frequent ARI, intestinal infections, etc.);birth trauma CNS prematurity;malformations of the digestive system (megacolon, pyloric stenosis, cleft palate and upper lip);endocrine pathology ( diabetes , congenital adrenal hyperplasia);syndrome of impaired intestinal absorption observed in celiac disease, cystic fibrosis, exudative enteropathy, disaccharidase failure and other enzymopathies.

Pathogenesis of intrauterine malnutrition is largely dependent on the etiologic factor.For example, in some cases (in the pathology of diseases of the placenta or pregnant) one of the main links is considered chronic placental insufficiency, which causes the development of acidosis, hypoxia, morphological and functional immaturity of the fetus, and metabolic disorders.In other cases (fetal disease and so on.) Notes morphofunctional immaturity of the fetus to a subsequent breach tissue nutrition and metabolism.

In the case of insufficient supply of food to the baby during the postnatal period, or in the case of violation of its assimilation, the baby having metabolic disorders, functioning of various systems and organs, anemia.The child is slowed psychomotor development and growth, it rapidly loses weight, reduced reactivity.Due to the lack of adequate supply of nutrients and decreased appetite, decreased enzymatic activity and acidity of gastric juice, disrupt the function of the liver, decreases the activity of the digestive enzymes of the pancreas and intestine, reduced portability of various products occur, and disorders of digestive absorption.In addition, while malnutrition can be observed various violations of the central nervous system (depression of acquired and congenital reflexes, decreased excitability of the cerebral cortex, etc.), Of the heart (the metabolic changes in the myocardium, muted tones, slowing heart rate and rhythm disturbances) from the kidney(more frequent urination with a large number of CMV urine, at least - a rare urination with a minimum number of CMV urine and as a result the development of renal failure), from the lungs (pulmonary circulation violation, a change in the depth and rate of breathing).The functioning of the endocrine glands may be reduced up to polyglandular failure - the cumulative decline in the function of the anterior pituitary, adrenal, thyroid gland.Because disorders saline, water, carbohydrate, fat and protein metabolism, decrease in blood glucose, protein, cholesterol, phosphorus, sodium, potassium, etc.;developing metabolic acidosis.When vitamin A deficiency, which occurs due to the limited intake of vitamins in the body with the food consumed, metabolic disorders worse.Arising from nutritional deficiency disorders metabolic processes and functions of the organs, in turn, negatively affect the adequate absorption of nutrients (turns as it were, a vicious circle), which in severe cases often leads to the development of a sharp depletion and subsequent death of the patient

Symptoms of malnutrition

main feature of intrauterine fetal malnutrition is considered to be a violation of the dynamics of its growth, resulting in a backlog of fetal length and weight of his body from the normal values, which correspond to the current pregnancy (symmetric malnutrition).Also in the fetus during normal length can be observed a significant backlog of body weight (asymmetric malnutrition).Based on the severity of pathological changes, postnatal malnutrition are divided into three degrees

Hypotrophy 1 degree

With 1 degree of malnutrition in the child there is a shortage of body weight in the range of 10-20%.In all parts of the body except the face marked thinning of the subcutaneous tissue, the first thickness of the fiber decreases stomach.In infants index Chulitskaya at a rate of 25-20 cm, is reduced to 15-10 cm (the index is calculated using the formula: 3 arm circumference thigh circumference +1 + one lower leg circumference - the length of the body).There is a flattening of the curve of weight gain.Psychomotor development and growth correspond to the actual age.Most often, the child's state of health is satisfactory, sometimes there may be sleep disturbance, loss of appetite and restlessness.Velvety skin disappears, it becomes pale;muscle tone and tissue turgor reduced.The internal organs, as a rule, no change is observed.Urination is not broken, the chair normally

Wasting 2 degrees

At 2 degrees of malnutrition in a child underweight observed in the range of 20-30%.On the chest and abdomen disappears almost completely subcutaneous tissue, and on the face and extremities, it (fiber) is much thinner.A decline in the index Chulitskaya to 10-0 cm. The child lags behind in psychomotor development and growth (up to 5 cm), it has been a significant decrease in appetite, physical inactivity, irritability and weakness.The skin is dry to the touch, pale with a grayish tinge.Muscle tone and turgor sharply reduced.Often, there are signs of rickets, vitamin deficiencies, disorders of thermoregulation (the baby easily supercooled or overheated), heart sounds are muffled, unstable stool (diarrhea replaces constipation ), the liver is enlarged.Quite often there is a dry, dark, fetid "empty" calories that replace liquid bowel movements.In the case of the predominance of carbohydrates in the diet, the chair becomes a liquid with a touch of yellow-green mucus.An excess of protein in the diet is the cause of separation of so-called "protein" of feces.At 2 degrees of malnutrition is observed decrease in the activity of digestive enzymes, Dysproteinemia, hypochromic anemia.Due to the sharp decline in body resistance, often observed the development of infectious and inflammatory diseases intercurrent

Wasting grade 3

At 3 degrees the child malnutrition, underweight observed in the range of 30% or more.3 degree malnutrition or atrophy in most cases observed in children of the first six months of life.In all parts of the body disappears completely subcutaneous fat index Chulitskaya negative.At this stage of malnutrition in children there is a delay of psychomotor development and severe stunting (about 10 cm).The face becomes wrinkled baby, he does not have a reaction to external stimuli.Large fontanelle and eyeballs sink, there is a lack of exercise and increasing lethargy.Tension fabric sharply reduced, the skin is dry, pale gray;visible mucous membranes are bright red and dry, atrophic muscles, shallow breathing (breathing stops periodically arise).Lowered blood pressure, heart rate spasmodic rare heart sounds dull, stomach in, or swollen, often observed constipation, decreased body temperature, urination rare.Quite often there is joining a secondary infection, which occurs without obvious signs of inflammation.In the absence of timely appropriate treatment, a child dies

Wasting - treatment

In case of fetal malnutrition, pregnant women, shall adjust the power prescribed vitamin complexes, improve placental circulation antispasmodic and vasodilators, methionine.After the birth of a baby with malnutrition, in the case of impaired swallowing and sucking reflex, feeding the child (7-8 times a day) through the probe.If diagnosed 1 degree malnutrition treatment on an outpatient basis, with 2 or 3 degrees - in a hospital environment (preferably in a box).The basic principles of treatment of malnutrition include organizing the proper care of the baby, diet, elimination of the causes of malnutrition, the elimination of vitamin A deficiency and metabolic disorders, rehabilitation of foci of infection and conduct supportive therapy.

In the case of the process of diagnosing deficiency in the body of the child any food substance, its introduction is further shown (as an example: the lack of protein and fat appoint enpity protein, protein milk, cottage cheese, yogurt);shortage of fats make up 20% of the cream;to make up for the deficit of carbohydrates baby food or water, add sugar syrup.In severe cases, shows the introduction of nutrients intravenously.If malnutrition is caused by metabolic disorders, showing a special health food.

Regardless of the causes of malnutrition, absolutely all children with this disease shows a massage, therapeutic exercise, intake of enzymes (pancreatin, festal, panzinorm, pepsin, abomin), vitamin complexes and stimulants (Dibazolum, apilak)In severe cases, hormone therapy is appointed.Considerable importance is attached to the correct quality child care.

forecast later in life when wasting the first two degrees in the case of timely adequate treatment is quite favorable, but in the malnutrition of 3 degrees is not so encouraging, as the mortality rate is about 50%

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