Paratrophy

Paratrophy (raratrophia; rara- + trophe - nutrition) is a pathological condition characterized by chronic impairment of nutrition of children at an early age and is accompanied by a disorder of the body's functions responsible for metabolism, characterized by the presence of excess or normal weight, as well as the hydrolylability of tissues.

The causes of parathrophy

The main reason for the development of paratrophy is excessive, unilateral (usually carbohydrate) nutrition with protein deficiency. This can be with the correct organization of feeding (the predominance of cereal and flour dishes in the diet, a violation of the technique of preparing adapted mixtures recommended for artificial feeding, with excess concentration of dry matter), especially in inactive children

Clinical and biochemical data allow us to distinguish between two forms of paratrophy:

1. lipomatous - alimentary fattening in combination with hereditary hyperliposintetic orientation of metabolism, accelerated absorption and increased absorption of fats;
2. Pastose (lipomatous-pasty) - metabolic disorders in the organs of the nervous, immune and endocrine systems.

Symptoms of paratrophy

Lipomatous form of paratrophy is characterized by excessive deposition of fat in the subcutaneous fatty tissue. In this case, for a long time, pink coloration of the skin and visible mucous membranes remains, a satisfactory tissue turgor.

The parasitic form of paratrophy is often observed in children with a peculiar phenotype (soft rounded body forms, rounded face, wide oval, widely spaced eyes, short neck, relatively broad shoulders, multiple stigmatic dysembryogenesis) and characterized by pastose and decreased tissue turgor, pallor of skin, hypotension , instability of emotional tone, restless behavior, sleep disturbance, delay in motor development).

Children with a pastose form of paratrophy are prone to allergic reactions of immediate type, acute course of rickets, frequent viral and bacterial diseases, intestinal dysbacteriosis. Often in children with a pastose form of paratrophy, thymomegaly is recorded.

The ratio of body weight and height in children with paratrophy is normal, but when comparing these parameters with the average age in children with paratrophy, a tendency to increase (body weight exceeds the average age indices up to 10%, growth by 1-2 cm) is noticeable. The curve of the increase in body weight is steep.

Criteria for the diagnosis of paratrophy

Anamnestic diagnostic criteria allow to detect etiological and predisposing factors, heredity inherent in obesity and metabolic diseases: intrauterine "overfeed", abuse of high-calorie foods, high-protein nutrition, electrolyte overload, high-calorie intake in the second half of the day, lack of mobility of the child, neuroendocrine disorders.

Clinical criteria for diagnosis: the severity of clinical and laboratory signs depends on the severity and clinical form of paratrophy.

Syndrome of metabolic disorders:

• excess of body weight;
• violation of proportionality of build;
• excessive deposition of adipose tissue;
• signs of polyhypovitaminosis;
• pallor;
• pastosity of the skin;
• decrease in tissue turgor;
• lethargy, sleep disturbance and thermoregulation.
• selective reduction (children do not eat vegetable foods of lure, sometimes meat) or increase (prefer milk products, cereals) appetite;
• high uneven weight gain (lability of the weight curve);
• stool disorder (constipation or dilution);
• signs of functional disorders of gastrointestinal digestion (according to the coprogram).

Syndrome of decreased immunological reactivity:

• propensity to frequent infectious diseases with a protracted course;
• Respiratory diseases often recur, occur with obstructive syndrome and severe respiratory insufficiency.

Laboratory diagnostic criteria:

• The blood test is anemia.
• Biochemical blood test - dysproteinemia, decrease in the content of globulins and a relative increase in albumins, hyperlipidemia, hypercholesterolemia, a perverse type of sugar curve.
• Coprogram:
  • in case of dairy nutrition disorder - stools are putrefactive, dense, shiny (fatty-soapy), the reaction of the feces is alkaline, neutral fat, soap, putrefactive microflora is often determined:
  • for cereal disorder - the stool is yellow or brown, dense, abundant (with dysfunction - frothy, green), the reaction of the stool is acidic, extracellular and intracellular starch, iodophilic microflora are often determined.
• Immunogram - dissymunoglobulinemia, decrease in indices of nonspecific resistance.

[1], [2], [3], [4]

Example of the formulation of the diagnosis

Paratrophy of the second degree, constitutional-alimentary, lipomatous-pastose form, period of progression.

[5]

Treatment of parathrophy

• Clarification and elimination of a possible cause of paratrophy.
• Organization of rational dietary nutrition and daily regimen.
• Organization of the motor regime.
• Rehabilitation activities.
• Timely diagnosis and treatment of concomitant pathology.

Principles of dietotherapy

• Organization of rational, balanced nutrition.
• Feeding by mode.
• Optimization of water regime.

Carrying out a step-by-step dietary treatment:

• Stage I (unloading) provides for the cancellation of high-calorie foods and all kinds of complementary foods. The total amount of food corresponds to the age norms. The best product is breast milk. After 6 months, it is advisable to combine breast milk and fermented milk mixtures. The duration of the stage is 7-10 days.
• II stage (transitional) lasts 3-4 weeks. Children older than 4 months are introduced age-appropriate lures, starting with vegetable puree.
• Stage III (minimum-optimal diet) - the child receives all kinds of complementary foods that correspond to age. Calculation of the required amount of protein is carried out on the actual body weight. The need for fats, carbohydrates, calories - for the body weight.

Organization of the motor mode

Daily massage and gymnastics, regular (at least 3-4 hours a day) stay in the fresh air, air and hydroprocedures. Children 2-4 weeks earlier change the age regime of the day.

Scheme of dispensary observation and rehabilitation of young children with chronic eating disorders such as hypotrophy

The duration of observation is 1 year.

The period of clinical manifestations is 1 month. Perform an overall blood test 1-2 times, urine analysis 1 time, a coprogram - 1 time, examination by a pediatrician - weekly. The biochemical blood test (protein and its fractions, urea, creatinine, alkaline phosphatase, calcium, phosphorus, iron, potassium, glucose), feces for dysbacteriosis, conduct pilocarpine test, ECG, ultrasound of the digestive system. Consultations - neurologist, endocrinologist, gastroenterologist.

The period of reconvalescence is up to 1 year. Conduct a common blood test - every 3 months, urine analysis once every 6 months, a coprogram every 3 months, an examination by a pediatrician monthly with anthropometry (height, body weight, chest circumference, head, fatness index of Chulicka). According to the indications, a biochemical blood test (protein and its fractions, urea, creatinine, alkaline phosphatase, calcium, phosphorus, iron, potassium, glucose), feces for dysbiosis, conduct pilocarpine test, perform an electrocardiogram, ultrasound of the digestive tract. Consultations of a neurologist, endocrinologist, gastroenterologist.

Criteria for withdrawal from dispensary registration

Gradual normalization of indicators of physical, psychoemotional and static-motor development. Satisfactory turgor of tissues. Increased resistance to infections. Normalization of clinical and biochemical parameters of blood.

Prophylactic vaccinations

According to the calendar of preventive vaccinations. According to indications in individual terms.