Hypotrophy: symptomatology, diagnosis, treatment, prognosis

One type of dystrophy, which is a real threat to a child’s life due to deficiency not only in weight, but also in immunity and susceptibility to infectious diseases, is called hypotrophy. The disease is characterized by chronic malnutrition and tissue trophism, a relative decrease in the child’s body weight in relation to its length, disrupts the correct development of the baby and the functions of individual organs and systems.

The development of the pathology also involves the hormones that control the child’s eating behavior: leptin and ghrelin. According to the time of the debut of the pathology there are prenatal, postnatal and mixed hypotrophy. The frequency of the pathology is about 5% of underweight gain.

Contents:

1. General information.
2. Classification.
3. Triggers (causes).
4. Symptoms.
5. Diagnosis.
6. Treatment.
7. Prognosis.

General information

Most often hypotrophy is diagnosed in utero or in the first three years of life. This does not mean that the disease cannot be detected in adults, but there we are usually talking about muscular hypotrophy. According to statistics, the prevalence of pathology ranges from 2 to 30% according to different data and is correlated with socio-economic conditions. Hypotrophy can be thought of when the child’s body weight lags behind the age norm by more than 10%.

The pathology is not harmless at all. The most serious consequences are metabolic disorders, retardation in psychophysical development, immunodeficiency.

Classification

Hypotrophy is divided according to the time of debut of the pathology into congenital, acquired and mixed:

1. Congenital or perinatal, which develops during pregnancy, is based on a failure of uteroplacental blood flow. As a result, the fetus becomes hypoxic, tissue trophism is inhibited, and intrauterine development is delayed.
2. Acquired or postnatal develops due to deficiency of proteins and energy reserves against the background of insufficient nutrition and incorrect digestion. In other words, energy expenditure is not replenished with incoming nutrients, all these processes are affiliated with leptin – the hormone of adipose tissue, which is responsible for the feeling of satiety.
3. Mixed – a combination of provocative factors that affect the fetus during its intrauterine development, and infectious or nutritional, social factors that affect the child already after birth.

There are three degrees of hypotrophy according to the severity of the lack of body weight:

1. Hypotrophy of the 1st degree develops in newborns, for it is typical underweight up to 20% in comparison with the norm.
2. Hypotrophy of the 2nd degree is typical for children with a body weight below the norm of up to 30%, and their growth lags a couple of centimeters behind the age norm.
3. Hypotrophy of the 3rd degree is diagnosed if the weight is below the norm by more than 30%. There is also a slight lag in growth.

Hypotrophy proceeds in stages, with only four periods:

1. Debut.
2. The progression stage.
3. Stabilization of the process.
4. Recovery.

Triggers

The disease is polyetiological and can accompany numerous pathologies. All causes can be divided into endogenous and exogenous.

The exogenous ones usually include:

1. Alimentary factors: underfeeding, overfeeding, imbalanced intake of nutrients. Infant nutrition is associated with leptin levels in the blood.
2. Infectious: from acute bacterial or other infections to generalized sepsis.
3. Toxic: poisoning, burns, use of cytostatics.
4. Social: defective upbringing, low social level of the family.

Endogenous causes are:

• endocrine and neuroendocrine disorders;
• malformations;
• inherited enzymeopathies;
• intestinal absorption disorders;
• cystic fibrosis;
• metabolic disorders;
• genetic problems.

Symptomatology

Clinical manifestations correlate with the degree of hypotrophy:

1. In the 1st degree of pathology body weight deficit no more than 20: in this case, the condition of the baby is satisfactory, visually observed reduction of hypodermis in the abdominal area.
2. In degree 2, the weight deficit reaches 30%, growth retardation – up to 4 cm: the general condition has not changed significantly, but lethargy, apathy, low emotional tone is observed, the skin becomes dry, flaky, loses elasticity, hypodermis is saved only on the face, microcirculation is broken, hypothermia, dyspepsia is diagnosed, respiratory disorders, arrhythmia, hypotension and anemia are possible.
3. In the 3rd degree of weight deficit of more than 30%: a pronounced lag in the child’s development. The general condition is severe – lethargy, anorexia, loss of previously acquired skills. The skin is dry and pale, no hypodermis, muscles are atrophic, the fontanelle is sunken, breathing is shallow, heart tones are muffled, hypotonia, hypothermia, strong thirst. Voltaire’s triangle (facial shape) is visualized, stunting of more than 6 cm.

There is a prenatal gradation of hypotrophy, in which all forms are characterized by delayed fetal development, brain hypoxia:

• neuropathic – minimal weight loss with impaired appetite and sleep;
• neurodystrophic – decreased body weight and body length, anorexia and delayed psychomotor development;
• neuroendocrine – imbalance of endocrine regulation of all body functions, internal organs;
• encephalopathic – serious developmental disorders, neurological deficit, hypoplasia of bone tissue, hypovitaminosis in all types of vitamins.

Diagnosis

The approach to diagnosis is standard: collection of anamnesis – obstetric and postnatal: the course of gestation, childbirth, toxicosis, diseases of the mother, weight gain by month, diseases of the baby in the neonatal period. A social anamnesis, hereditary diseases of relatives are also mandatory. Then involve examination – anthropometry, the condition of the skin and hypodermis, and physical findings. Weight deficiency is calculated using the formula of the ratio of true weight to normal body weight in percent or by height, using the Mazurin and Vorontsov’s table of centile distributions of weight by body length.

Treatment

Therapy for hypotrophy is complex and includes:

1. The dietary regimen is ambulatory for 1st and 2nd degree pathology. The basis – massage and LFC. Hospitalization is carried out at the age of under one year, with concomitant diseases, infections, low tolerance to food loads in these stages, as well as at the 3rd stage of the problem.

Therapeutic nutrition is different at different stages of the pathology:

 The first involves adaptation with increased receptivity of the baby to the food received, normalization of electrolyte balance. Nutritional loads are minimized compared with the norm to 2/3 of the required amount of food for hypotrophy of degree I, to half or a third for degrees II-III. It is possible to be guided by 100 ml of breast milk per 1 kg of actual body weight in degrees I-II.

Third stage – intensified nutrition to restore the normal intake of nutrients in recalculation of the age norm. In stage III, depending on the severity, half or a third is administered parenterally.

The second stage is reparation. The goal is to restore all types of metabolism and switch to intestinal nutrition. Feeding through a tube in stage II assumes one third of the received volume of food. Calculation of the diet is carried out on the basis of energy consumption (about 180 kcal/kg) with gradual introduction of all food and vitamin supplements in age-related proportions. Parenterally administer colloids and crystalloids in a 1:1 ratio.

2. Medications are widely used at all stages of hypotrophy. Use vitamins: C, group B, PP, A acid, E, folic lota, calcium pantothenate. Use enzyme preparations Pancreatin, Panzinorm forte. To activate appetite and anabolic processes – royal jelly, bitters, orotic acid. Bone-age controlled anabolics: Nandrolone, Metandienone. Parenteral nutrition drugs, Levocarnitine. For allergies – antihistamines, for intestinal dysbiosis – pro- pre-dysbiotics, for prenatal dystrophy – sedatives, Cerebrolysin, Glutamic acid, if necessary connect hormones – Thyroidin, Insulin and antibiotics to treat infectious complications.

Prognosis

If therapy is started in time and is rational, the prognosis is favorable. Poor care for the baby, concomitant somatic, endocrine diseases and infections complicate the disease. In prenatal hypotrophy, the prognosis is correlated with the degree of cerebral hypoxia in the fetus.