HYPOTROPHY (Greek hypo-+ trophe food, food) — one of forms of chronic frustration of food at children which is characterized by exhaustion of various degree of manifestation. Occurs preferential at children of early age.
The reasons causing G. are very various, they can be exogenous (insufficient administration of the feedstuffs necessary for growth and development of the child) and endogenous (insufficient use of nutrients an organism) origins.
Can arise also at a fruit during pre-natal development at various diseases of mother. At the same time the hypodermic fatty layer of the newborn obviously does not correspond to his pre-natal age (pre-natal G.).
At chest age the hypogalactia and a galactorrhoea at mother can be the reasons of partial starvation of the child (see. Lactation ), the wrong technology of feeding by a breast, long feeding by the milk mix which is not corresponding to age of the child. In these cases children do not receive necessary amount of all or separate food ingredients and calories. Qualitative inferiority of feeding of children arises at excess purpose of carbohydrate or proteinaceous food.
Frustration of food can be connected with a disease of the child. At pylorospasm (see) and pylorostenosis (see) plentiful vomiting and vomiting lead to the fact that the child appears in the conditions of underfeeding.
At some digestive disturbances and a metabolism, and also at hron, diseases (toxoplasmosis, a cytomegaly, inborn syphilis and others it is long the current diseases) food eaten by the child is not acquired owing to decrease of the activity of enzymes went. - kish. path.
Can develop also as a result of the wrong mode of life and defects of education: insufficient stay of the child in the fresh air, lack of movements, wrong organization of wakefulness, dream and meal and especially lack of positive mental irritations and impressions, contact of the adult with the child. The child becomes sluggish, its normal reaction to influences of the environment is reduced, appetite is broken, he inertly and eats a little and, therefore, it appears in the conditions of malnutrition.
His specific constitutional features to a certain extent can influence G.'s degree at the child.
At children of preschool and school age of G. is, as a rule, a consequence hron, intoxication and infectious diseases.
At insufficient amount of the food received by the child normal increase of weight of his body is broken. At first the hypodermic fatty layer on a stomach, then on other sites of a trunk and extremities and after everything on a face becomes thinner.
At excess feeding cow's or goat milk without timely feeding up at the baby along with weight loss usually clearly expressed pallor and a xeroderma, turgor of soft tissues, but muscles several gipertonichn is considerably lowered. The bent to locks comes to light and increases; kcal of gray-white color, so-called soap and limy, containing a large amount of lime and magnesian soaps, dry, easily scattered, sometimes in the form of balls («a sheep chair»), with a putrefactive smell and alkali reaction. Urine has the expressed ammoniac smell, contains the increased amount of ammonia.
Depending on extent of weight loss distinguish three degrees of G. — the I degree (easy), II (moderately severe) degree and the III degree (heavy).
At a hypotrophy of the I degree the hypodermic fatty layer decreases only on a stomach (fig., 2), turgor of fabrics and a tone of muscles are slightly lowered, pallor of integuments appears nek-paradise. The general condition and health of the child are not broken. The curve of body weight is flattened. The weight of the child lags behind age norm no more than for 20%.
At a hypotrophy of the II degree the hypodermic fatty layer even more decreases on a stomach, utonchatsya on other sites of a trunk and extremities (fig., 3). Turgor of fabrics is reduced considerably, the tone of muscles is lowered. Skin and visible mucous membranes are pale; skin becomes dry, easily gathers in folds, especially on an inner surface of hips. Weight deviates norm for 25 — 30%. Psychomotor development of the child is late, sometimes it loses already available skills. The health of the child worsens, it becomes sluggish, sometimes irritable; the rhythm of a dream is broken.
At a hypotrophy of the III degree deficit of weight of the child makes more than 30%; the weight curve almost does not raise, and in the most hard cases even decreases. Also lag in growth is noted. The hypodermic fatty layer is absent absolutely, is sometimes hardly noticeable on cheeks. Skin is pale, with a grayish shade, dry, wrinkled, gathers in the folds hardly straightened (fig., 4). Skin is shelled by places, on buttocks and a scrotum — small sores of trophic character. On a back and extremities the hypertrichosis is quite often noted. On the blown-up stomach skin is tense, brilliant, with clearly the expressed network of veins; sometimes the stomach is pulled in. Skin on a forehead and cheeks pleated; the nose, cheekbones, a chin are pointed, the person takes a senile form; eyes seem big, sunk down, a look angry. Muscles are atrophied, the tone them is raised. At a radiographic research osteoporosis is observed. General condition of the child very heavy. Body temperature is lowered to 35 — 36 °, rise it to 37 — 37,5 ° is noted from time to time. The child can be indifferent to surrounding, is sometimes uneasy, almost always greedy sucks a cam and drinks water; appetite is more often sharply reduced; crying and weak shout — monotonous.
The most serious condition of the child at G. (the atrophy, an atrepsia is described sometimes under the name) is characterized not only heavy exhaustion, but also considerable disturbance of functions of all bodies and vital processes; it can become irreversible.
At G. of the III degree there are essential aberrations and from c. N of page. Researches N. I. Krasnogorsky the lowered excitability of a cerebral cortex, a condition of a cortical hyporeflexia and an arrest of development of cortical functions are revealed. In lungs emphysema, the shallow breathing which are speeded up uneven is noted. The pulse of the lowered filling which is quite often speeded up and arrhythmic, the ABP lowered. Borders of heart in the most hard cases are narrowed, tones are muffled. Changes in a respiratory organs and cardiovascular system promote development of developments of stagnation in lungs and to developing of pneumonia. At the child appetite, a mucous membrane of an oral cavity dry, bright is lowered, language is laid over, quite often there is stomatitis, cracks in corners of a mouth. The liver and a spleen are quite often increased, plotnovata. Decrease in disintoxication and zymoplastic function of a liver is observed. Gastric acidity and activity of digestive enzymes (tab.) are reduced. Also functions of a pancreas (activity of trypsin, a lipase and amylase are broken) and a small intestine are lowered. It is shown by disturbance of processes of digestion and absorption in a stomach and intestines: their peristaltics is broken, sometimes there are quite persistent locks, sometimes the liquid, so-called hungry chair which is mistakenly taken for display of the dyspepsia demanding restrictions in a diet.
Exchange processes are broken. At G. the resorption of nitrogen makes the III degrees apprx. 60 — 70% whereas at easy forms G. apprx. 85 — 95%; digestion of nitrogen at easy forms of 0,09 g on 1 kg of weight, and at heavy is 5 times less (apprx. 0,017 g on 1 kg of weight); in the most hard cases the nitrogenous balance can be negative. The amount of protein in blood serum is reduced, residual and amine nitrogen in blood is raised by the most part; in urine the urea nitrogen is lowered, and nitrogen of amino acids and ammonia is raised. At severe forms of; the resorption of fat is broken, the amount of cholesterol in blood is reduced. The sugar content in blood is almost always reduced; the glycemic curve at loading is recovered by sugar a little in a slowed-up way. Contents in a blood plasma of calcium, phosphorus, magnesium, potassium, iron and copper is considerably reduced. The condition of an eksikoz speaks about disturbance of water exchange; existence of demineralization indicates disturbance and mineral balance. Alkaline and acid balance is shifted aside acidosis (see).
Gemogramma in mild cases of G. within norm; in the hard cases proceeding with eksikozy as a result of a pachemia the amount of hemoglobin and uniform elements can even be a little increased.
Disturbance of many functions of an organism along with emaciation allows to speak about G. as a condition of a dizergiya.
At children reactivity of an organism is to a greater or lesser extent broken; they badly transfer temperature variations of an ambient air, especially cooling; get sick easier and heavier have pneumonia and intestinal infections; insignificant disturbances in food easily cause in them long went. - kish. dysfunctions.
The diagnosis, as a rule, does not represent difficulties. Objective assessment physical allows to establish it. and psychomotor development of the child. It is much more difficult to establish the endogenous reason of G., napr, a mucoviscidosis, a Gee's disease, others of enzymopathies; in these cases specification of the reason of G. requires careful additional a wedge., tool and laboratory inspection of the child.
Treatment of children with G. any degree needs to carry out treatment strictly individually. Having found out on the basis of the anamnesis and an objective research of the child the main reasons which caused G. first of all need to be eliminated them if it is possible.
If the child of the first months of life received a little maternal milk at enough milk at mother, it is necessary to eliminate the mistakes made during the feeding of the child (to increase duration of each feeding or number of feedings), and at a hypogalactia to finish feeding the child donor milk or milk mix.
Great difficulties arise at treatment of the premature children suffering from G. in view of considerable decrease in activity of various enzymes at them and dysfunction of c. N of page (see. Premature children ). In addition to the correct feeding by maternal or donor milk, in similar cases it is necessary) to carry out complex therapy. At G.'s development in the child who is on artificial feeding it is necessary to eliminate the revealed defect in feeding and to introduce necessary amendments.
If G. resulted from any disease, the child should be treated for a basic disease and at the same time to provide food and all reasonable and admissible regime moments.
At treatment of children with a hypotrophy of II and especially the III degree should consider not only defects in food, the mode and education and a basic disease, but also numerous aberrations from function of separate bodies and exchange processes. The dietotherapy shall be a major factor of treatment; amendments should be introduced in a diet of the child carefully, revealing endurance of an organism of the child to separate ingredients of food.
In the most hard cases, irrespective of age of the child and a diet, to-ruyu it received, sometimes (especially in the presence of dysfunction went. - kish. a path and persistent anorexia) it is necessary to transfer the baby to feeding only by one women's milk. It is necessary to milk about 8 — 10 once a day, gradually increasing its quantity. Having achieved within 5 — 6 days of stabilization of weight of the child, gradually expand a diet, entering into it all necessary types of a dokorm or a feeding up shown on age. At a considerable loss of appetite appoint the concentrated milk mixes.
At the mixed and artificial feeding of babies, especially the second half of the year of life and after a year, sometimes it is possible to do also without women's milk, but expansion of a diet should be carried out especially carefully; almost always it is necessary to enter into a diet the concentrated mixes — Moro, the concentrated proteinaceous milk and others milk mixes (see). During the feeding the concentrated mixes for providing enough water appoint for drink tea (from 5% of sugar), 5% solution of glucose (in ringerovsky or fiziol, solution), carrot soup, rice water and other liquids (see. Feeding of children ).
For compensation of a vitamin deficiency appoint drugs of vitamins or natural vegetable, fruit or berry juice, combining them among themselves and dosing depending on the reasons which caused G., features of the state of health, age of the child and the carried-out dietotherapy.
At a hypotrophy of II and III degrees the stimulating therapy is carried out; intramuscular and intravenous transfusions of blood and a blood plasma carry out according to strict indications taking into account a possibility of an unnecessary sensitization of an organism of the child. At a hypoproteinemia appoint intravenous drop injections of 5 — 10% of solution of albumine (3 — 5 ml to 1 kg of weight), Haemodesum (15 ml to 1 kg of weight, but no more than 200 ml), Polyglucinum (8 — 10 ml to 1 kg of weight), Aminopeptidum or Amincrovinum (on 5 — 8 ml on 1 kg of weight), etc. For increase immunobiol, activities apply gamma-globulin intramusculary.
In the most hard cases purpose of insulin with glucose (to children up to 3 years of 1 — 2 PIECE, to children 3 years of 2 — 4 PIECES, at the same time are more senior than 10 — 20 ml of 10% of solution of glucose intravenously within 7 — 10 days), a short rate (10 — 12 days) of corticosteroid drugs is shown (Prednisolonum: 1 mg on 1 kg of weight, but no more than 15 mg a day); in the absence of appetite and insufficient efficiency of the carried-out dietotherapy it is possible to appoint anabolic steroid drugs (0,1 mg to 1 kg of weight of the patient, but no more than 5 mg a day within 2 — 3 weeks); steroids of the prolonged action (retabolil) are especially effective.
At G. caused by enzymopathies the stimulating and replacement therapy along with use of a special diet is applied (depending on a type of enzymopathies).
Considering decrease of the activity of enzymes went. - kish. a path, as the replacing therapy appoint 1% solution divorced salt to - you with pepsin (1 chayn. l. to food), Pancreatinum (0,2 — 0,5 g 3 — 4 times a day after food), a gastric juice (0,5 chayn. h.p. water of 5 times a day), abomin (according to 1 tab. 3 times a day).
Special attention is paid on the mode. Children with G. need the most attentive and love nursing; they especially negatively react to cooling and therefore the weak and exhausted sometimes should be placed in couveuse (see). In the absence of contraindications early begin massage, gymnastics; ultraviolet rays are appointed carefully, only at special indications.
Forecast at G. is defined by the main reason for starvation and degree of exhaustion. At a hypotrophy of the I degree if etiol, the factor is eliminated, the forecast quite favorable; at a hypotrophy of the II degree if the cause is removed and treatment is carried out correctly, also in most cases favorable; at a hypotrophy of the III degree — not hopeless on condition of the dietary, medicamentous and stimulating treatment which is correctly carried out in appropriate conditions of the hospital mode and a nosotrophy the child. If the weight of the child lags behind norm more than for 30 — 40%, the forecast is defined by weight of the arisen disorders of functions of the main bodies and processes of a metabolism.
the Correct feeding of the healthy child, the rational mode, leaving and his education from the first days of life.
Early detection and timely correct treatment of hereditary and acquired diseases — a necessary condition for effective prevention for the second time the arising G. of an endogenous etiology.
See also Gipostatura .
Table. GASTRIC ACIDITY AND ACTIVITY of ENZYMES AT HEALTHY CHILDREN of CHEST AGE AND AT the HYPOTROPHY
- In titratsionny units. ** In activity units.
Bibliography M. S. coxas and Round A. T. Frustration of food and digestion at children of chest age, M. — L., 1928; Rosenthal A. S. Chronic frustration of food and digestion at early children's age, M., 1948; Speransky G. N. and Rosenthal A. S. Chronic frustration of food at early children's age, M., 1953; Fateeva E. M. Distrofiya of a prenatal origin at early children's age, M., 1969, bibliogr.; Hohenauer L. Pranatale Dystrophie, Klin. Padiat., Bd 184, S. 433, 1972, Bibliogr
A. F. Tour, H. A. Tyurin.