Caustic Ingestion in Children

Abstract

Caustic ingestion (CI) is an unfortunate event that occurs in families with a poor prevention culture. Its prevalence is unknown in developing countries; it occurs mainly in children < 5 years and is more common in boys. The chemical caustic agents are alkaline (85%) or acid products stored in food or beverage containers without warning labels and safety caps. The immediate symptoms include salivation, oropharyngeal burns, vomiting and oropharyngeal/retrosternal pain. Upper endoscopy is the irst-line tool to identify the type and extension of oesophageal and gastric damage. A barium swallow performed 2-3 weeks after the CI may identify oesophageal stricture. Dysphagia occurs in about one-third of cases. Regarding the nutritional status, children with dysphagia and/or oesophageal strictures may have lower fat reserves or muscle mass than the cases without these complications, meaning impaired nutritional status. All patients should be hospitalized for evaluation and treatment. Hemodynamic stabilization and adequacy of the patient's airway are priorities; vomiting induction and gastric lavage are contraindicated. Methylprednisolone in II-b oesophageal burns for 3 days diminishes the risk of stricture. Selected cases will require oesophageal dilatations, gastrostomy or oesophageal replacement by colon or stomach. There are other promising agents in the management of caustic oesophageal strictures.

Effectiveness of Enteral Versus Oral Nutrition With a Medium‐Chain Triglyceride Formula to Prevent Malnutrition and Growth Impairment in Infants With Biliary Atresia

“…A hydrolyzed protein, glucose polymer, and medium-chain triglyceride formula (Alfare, Nestle ´, Vevey, Switzerland) providing 720 kcal and 24.7 g of protein per 1000 mL was administered as a continuous infusion for a period of 18 hours. The initial caloric input was 100% of the dietary reference intake (DRI) of energy for age and sex according to the Food and Agriculture Organization/ World Health Organization/United Nations University reference (24); this input was gradually increased in the following 5 to 7 days in an attempt to reach 140% of the DRI (11)(12)(13)(14)(15). Protein intake was adjusted to a maximum of 4 to 5 g/kg for present weight (16,17,25).…”

“…These nutritional risk conditions lead most infants with BA to rapid growth impairment and to depletion of muscle mass and adipose tissue, in other words, to severe malnutrition. Along the first year of life, length and head circumference of most infants with BA fall progressively resulting in an impairment of linear and central nervous system growth that is most likely permanent (11,17,18). Loss of muscle mass may be an important added developmental factor to these severe handicaps.…”

“…The outcome of untreated BA is progression to cirrhosis and death within 18 to 24 months (4)(5)(6)(7)(8)(9). Moderate or severe acute and/or chronic malnutrition occur in most infants with BA during the first year of life, even in those with a successful portoenterostomy (4,(10)(11)(12)(13)(14)(15)(16)(17). Loss of muscle and other structural proteins, impaired bone mineralization, and depletion of fat reserves can be devastating for growth and development.…”

“…Loss of muscle and other structural proteins, impaired bone mineralization, and depletion of fat reserves can be devastating for growth and development. In infants with BA, malnutrition and stunting are likely to occur despite receiving special formulas administered orally with medium-chain triglycerides, branched chain amino acids, and extra glucose polymers (11)(12)(13)(14)(15). Ad libitum PO feeding may not be enough to sustain growth, especially if there is delay in liver transplantation (11).…”

“…In infants with BA, malnutrition and stunting are likely to occur despite receiving special formulas administered orally with medium-chain triglycerides, branched chain amino acids, and extra glucose polymers (11)(12)(13)(14)(15). Ad libitum PO feeding may not be enough to sustain growth, especially if there is delay in liver transplantation (11). Nutritional support seems crucial for…”