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Abstract
This longitudinal case control study aimed to assess the status of brain activity in PEM patients and its correlation with their neurodevelopment.
The study was conducted after 12 weeks of nutritional rehabilitation on 16 PEM patients recruited from the Outpatient Clinic, Children’s Hospital, Ain Shams University. Their ages ranged between 10-22 months .Eight of our patients were edematous KWO and 8 were non edematous (marasmic). The study also included 9 sex and age matched, apparently healthy infants served as controls.
All patients and controls after completing 12 weeks of nutritional rehabilitation were subjected to the following :
1.Full history taking, thorough clinical and anthropometric examination.
2.Laboratory investigations including CBC, CRP, serum total proteins and albumin, liver and kidney function tests.
3.Neurodevelopmental assessment using BSID-II which is one of the most widely used tools to study infant global development
4.Magnetic resonance spectroscopy of the brain. We studied three brain metabolites namely NAA, choline and creatine interpreted in the form of metabolic ratios namely NAA/Cr, Cho/Cr, NAA/Cho and NAA/Cho+Cr in 3 brain regions bilaterally namely frontal, basal ganglia and thalamus.
After nutritional rehabilitation of PEM patients, both groups showed a increase in the mean values of Z-scores (Weight for height) and (weight for age)but didn’t reach the control values.
Following nutritional rehabilitation, MUAC in non-edematous and edematous groups increased increase significantly and it was not statistically different when comparing both groups together after nutritional rehabilitation.
Following nutritional rehabilitation, triceps skinfold thickness values significantly increased both groups of PEM patients when compared to controls .
Similary hemoglobin level significantly increased in both edematous and non-edematous groups.
Regarding the mean values of total serum protein in both PEM groups, it showed no significant difference compared to the control group, which denotes complete recovery upon nutritional rehabilitation.
After nutritional rehabilitation, the edema improved clinically coupled by improvement in serum albumin, yet it was still significantly lower in edematous patients and non-edematous patients compared to the controls
As regards ALT and AST, there was no statistical difference after nutritional rehabilitation in both groups of PEM in comparison to controls
BSID-II scores of edematous PEM patients after nutritional rehabilitation were significantly lower than controls except the emotional regulation which didn’t reach statistical significance, whereas only PDI reached statistical significance in non-edematous PEM patients.
As regards MRS metabolic ratios of the brain of our PEM patients the results showed statistically significant decrease of some ratios in both types of PEM as compared to the controls. As regards frontal region all the ratios were not statistically different except in NAA/Cho ,NAA/Cho+Cr which were significantly lower in edematous group compared to controls. As regards the basal ganglia when comparing edematous group to control group we found the ratios NAA/Cho and NAA/Cho+Cr bilaterally were significantly lower in edematous group compared to controls. whereas when comparing non edematous group to controls we found that all the ratios were significantly lower in non edematous group except in Cho/Cr, NAA/Cr ratios which were not statistically different. On comparing both patient groups we found that NAA/Cr ratio was significantly lower in edematous group compared to non edematous group. As regards the thalami the ratios NAA/Cho, NAA/Cho+Cr where significantly lower in edematous group compared to control group, whereas there was no statistical difference between non edematous group compared to control groups. On comparing both groups of patients we found that Cho/Cr ratio was significantly lower in edematous group compared to non edematous group.