Hypotrophy

Hypotrophy is a chronic nutritional disorder, predominantly occurring in infants up to two years of age( mostly up to a year), due to insufficient nutrients entering the body, or a violation of their assimilation. This condition is characterized by a deficiency of body weight, varying in severity. By the time of occurrence, the hypotrophy is divided into congenital and acquired forms of the disease.

Congenital hypotrophy can be caused by late toxicosis of pregnant women, which is accompanied by abnormal changes in the placenta( inflammatory processes, malformations), trauma or detachment;Violation of the placental circulation;Alcohol abuse and smoking;Intrauterine infection of the fetus( syphilis , rubella, cytomegaly, toxoplasmosis);Infectious or somatic diseases of a pregnant woman;Malnutrition of the pregnant woman;The age of the pregnant( over 30, and / or under the age of 18);Exposure to the organism of a pregnant woman of various industrial hazards.

Causes of acquired hypotrophy: hypogalactia( not enough milk from the mother);At artificial or mixed feeding insufficient quantity of a dairy mix;Difficulty sucking with irregular nipple form( elongated, flat) or tight mammary gland;Qualitatively inferior nutrition in cases of late complementary feeding and as a result of prolonged feeding with mother's milk;Infectious diseases of the child( frequent SARS, intestinal infections, etc.);Birth trauma of the central nervous system, prematurity;Malformations of the digestive system( megacolon, pyloric stenosis, crevices of hard palate and upper lip);Endocrine pathology(

diabetes mellitus , adrenogenital syndrome);Syndrome of impaired intestinal absorption, observed with celiac disease, cystic fibrosis, exudative enteropathy, disaccharidic insufficiency and other fermentopathies.

The pathogenesis of intrauterine hypotrophy mainly depends on the etiologic factor. For example, in some cases( with placental pathology or diseases of the pregnant one), one of the main links is chronic placental insufficiency, which causes the development of acidosis, hypoxia, morphofunctional immaturity of the fetus and metabolic disorders. In other cases( diseases of the fetus, etc.), the morphofunctional immaturity of the fetus is noted with subsequent disruption of tissue trophism and metabolism.

In case of insufficient intake of food in the body of a child during the postnatal period, or in case of a violation of its assimilation, the baby develops metabolic disorders, the functioning of various systems and organs, anemia. The child slows down psychomotor development and growth, he quickly grows thin, the reactivity of the organism decreases. As a result of inadequate supply of nutrients to the body, appetite deteriorates, enzymatic activity and acidity of gastric juice decrease, liver function is impaired, digestive enzymes of the pancreas and intestine decrease, the tolerance of various products decreases, and absorption and digestion disorders occur. In addition, with hypotrophy, various abnormalities from the central nervous system( depression of acquired and congenital reflexes, decreased excitability of the cerebral cortex, etc.), from the heart( metabolic changes in the myocardium, muffling of the tones, reduction of heartbeats and rhythm disturbance), from the kidneys(More frequent urination with a large number of urine, less often - a rare urination with a minimum number of urine and as a result of the development of renal failure), from the lungs( violation of pulmonary circulation, changedDepth and rhythm of breathing).The functioning of the endocrine glands may decrease up to polyglandular insufficiency - a cumulative decrease in the function of the anterior lobe of the pituitary gland, the adrenal gland, and the thyroid gland. Due to violation of salt, water, carbohydrate, fat and protein metabolic processes, the blood glucose, protein, cholesterol, phosphorus, sodium, potassium, etc decreases;Metabolic acidosis develops. With vitamin deficiency, which comes as a result of limited intake of vitamins in the body with food, metabolic disturbances intensify. The disorders of metabolic processes and organ functions that result from nutritional deficiencies, in turn, have an extremely negative effect on the adequate assimilation of nutrients( it turns out to be a vicious circle), which in very severe cases often leads to the development of severe depletion and subsequent death of the patient

Symptoms of hypotrophy

The main sign of intrauterine fetal hypotrophy is a violation of the dynamics of its growth, which is expressed in the lag of the length of the fetus and the weight of its body from the normal parameters that correspond to the current period of pregnancy( symmetric hypotrophy).Also, in the fetus at a normal length, there may be a significant lag in body weight( asymmetric hypotrophy).Based on the degree of severity of pathological changes, postnatal hypotrophy is divided into three degrees

Hypotrophy of the 1st degree

With hypotrophy of 1 degree, the child has a body mass deficit in the range of 10-20%.On all but the face of the body parts is marked thinning of the subcutaneous tissue, and first of all the thickness of the fiber decreases on the stomach. In children of the first year of life, the Chulickaya index at a rate of 25-20 cm, decreases to 15-10 cm( calculate the index by the formula: 3 shoulder circumferences + 1 hip circumference + one shin circumference - body length).A flattening of the weight gain curve is observed. Psychomotor development and growth correspond to current age. Most often, the child's well-being is satisfactory, sometimes a disorder of sleep, a decrease in appetite and anxiety can be noted. The velvety skin disappears, it becomes pale;Muscular tone and turgor tissues are reduced. As a rule, there are no changes from internal organs. Urination is not impaired, stool is normal

Hypotrophy of 2nd degree

At 2 degrees of hypotrophy in a child, body weight deficit is observed in the range of 20-30%.On the chest and abdomen, subcutaneous tissue disappears almost completely, and on the face and limbs it( fiber) is considerably thinner. There is a decrease in the Chulitskaya index to 10-0 cm. The child lags behind in psychomotor development and growth( up to 5 cm), it has a significant decrease in appetite, hypodynamia, irritability and weakness. Skin covers dry to the touch, pale with a grayish tinge. Muscular tone and turgor are sharply reduced. Often there are signs of rickets, vitamin deficiency, thermoregulation disorders( the baby is easily overcooled or overheated), heart sounds are muffled, the stool is unstable( diarrhea replaces constipation ), the liver is enlarged. Quite often there is a dry, dark, fetid "hungry" stool, which is replaced by liquid stool. If carbohydrates predominate in the diet, the stool becomes liquid with an admixture of yellow-green mucus. Excess protein in the diet is the reason for the allocation of so-called "protein" feces. At 2 degrees of hypotrophy, a decrease in the activity of digestive enzymes, dysproteinemia, hypochromic anemia is observed. Due to a sharp decrease in the resistance of the body, the development of infectious and inflammatory intercurrent diseases is often observed.

Hypotrophy of the 3rd degree

. At the 3rd degree of hypotrophy in the child, the body weight deficit is observed within 30% or more.3 degree of hypotrophy or atrophy in most cases is observed in infants of the first six months of life. In all parts of the body, subcutaneous tissue disappears completely, the Chulicki index is negative. At this stage of hypotrophy, children experience a delay in psychomotor development and a pronounced growth retardation( of the order of 10 cm).The face of the baby becomes wrinkled, it does not react to external stimuli. A large fontanel and eyeballs sink, hypodynamia and increasing lethargy are observed. The tissue turgor is sharply reduced, the skin is dry, pale gray in color;The visible mucous membranes are bright red and dry, the muscles are atrophic, the respiration is shallow( respiratory stops periodically occur).BP lowered, cardiac contractions irregular rhythm, heart sounds deaf, belly drawn or swollen, constipation often observed, body temperature lowered, urination rare. It is quite often observed the addition of a secondary infection, which proceeds without pronounced signs of inflammation. In the absence of timely adequate treatment, a child dies

Hypotrophy - treatment

In case of detection of fetal hypotrophy, the pregnant woman undergoes nutrition correction, appoints vitamin complexes, improves placental circulation, spasmolytic and vasodilating agents, methionine. After the birth of the baby with hypotrophy, in the case of impaired swallowing and sucking reflexes, the feeding of the baby( 7-8 times a day) is carried out through the probe. In the case of diagnosed 1 degree of hypotrophy, treatment is performed on an outpatient basis, at 2 and 3 degrees - in a hospital( preferably in a box).The main principles of the treatment of hypotrophy include the organization of proper care for the baby, dietotherapy, elimination of the cause of hypotrophy, elimination of vitamin deficiency and metabolic disorders, sanitation of foci of infection and stimulation therapy.

In case of detection of a deficiency in the body of a child in the course of diagnosing a food substance, its administration is additionally shown( for example, in case of protein deficiency, fat and protein enricates, protein milk, cottage cheese, kefir are prescribed);Deficiency of fats is replenished with 20% cream;To replenish the deficiency of carbohydrates, sugar syrup is added to the food or water for the child. In particularly severe cases, the introduction of nutrients intravenously. In the event that the hypotrophy is caused by a metabolic disorder, special therapeutic nutrition is indicated.

Regardless of the cause of development of hypotrophy, absolutely all children with this disease are shown massage, exercise therapy, enzyme intake( pancreatin, festal, panzinorm, pepsin, abomin), vitamin complexes and stimulants( dibazol, apilac), in especially severe casesHormonal therapy. Important importance is given to proper quality care for the child.

The prognosis of further life with hypotrophy of the first two degrees in case of timely adequate treatment is quite favorable, but with grade 3 hypotrophy everything is not so encouraging, as the mortality is about 50%

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