Weight of Children Presenting with Childhood Cataract

Research Article

Weight of Children Presenting with Childhood Cataract

Corresponding author: Dr. Rosel ine Duke, University of Calabar, University of Calabar Teaching Hospital, Department of Ophthalmology, Pediatric Ophthalmology and Strabismus Unit, Calabar, Nigeria,Tel: +234-8061302925; Email: dr.roselineduke@gmail.com
Abstract
 
Objective: To report the weight of children who presented for cataract surgery at a child eye health tertiary facility.
Subjects and methods: A retrospective cross sectional observational study was conducted. The body weight records of children aged three months to fifteen years who presented for surgery with bilateral congenital and developmental cataracts was documented in kilograms. All subjects had ocular and systemic examinations to detect co-existing systemic conditions.
Results: Sixty-six children with cataract were studied. Children who had lower weight than the mean weight for age were 50/66 (75.8%). Twenty-eight 28/66 (42.4%) were males and 22 (33.3%) females. The mean ages of the 50 children was 5.0 years; SD= 3.62 compared with 5.2 years; SD=3.78 for those who had normal body weights. Children with bilateral congenital cataract 48/66 (72.7%) had a significantly lower weight compared to the mean weight for age and compared to the mean weight for age in children with bilateral developmental cataract 18/66(27.3%) p=<0.001, with the study mean values of 16.3 Kg (SD = 9.03) and 19.5 Kg (SD = 9.56) respectively. Out of the fifty children, 29 (58%) had co-existing systemic morbidity (p < 0.006).
Conclusion: Children with congenital cataracts may present with a lower weight compared to their peers with developmental cataract. Detailed anthropometric measurement should be taken in children with cataract, it can be used as an indicator to suspect other associated systemic problems in such children.
Keywords: Children; Weight; Congenital Cataract; Nutrition Status; Hospital 
Introduction
Nutrition in children is important for physical, mental, cognitive development including visual function [1-3]. Nutritional disorders from any cause weakens the immune system, making a child susceptible to disease, increasing severity of illness and impeding recovery [4]. Recently nutritional disorders in childhood are suspected to cause systemic and ocular pathologies in adulthood [2,3,5]. The result of vitamin A deficiency on the systemic development and ocular health in children has been studied [3]. The
latter includes keratomalacia and night blindness. However, with adequate immunization coverage, the prevalence and incidence of vitamin A deficiency is reduced in most low and lower-middle income countries, causing less corneal blindness in children which was previously the leading cause of childhood blindness and severe visual impairment [6]. Consequently, the current major causes of childhood blindness and severe visual impairment in this region of Nigeria is from childhood cataract [7]. Investigation into the nutritional status of children in developing countries shows that there may be a high rate of malnutrition and micronutrient deficiency [8]. Very few studies have investigated the nutritional health status of children admitted into the pediatric eye ward with childhood cataract. Nutritional support is expected to be an essential aspect of the clinical management of children admitted to hospital. In our environment, ensuring an adequate nutritional support is usually the entire responsibility of the parents or care givers. It has been observed that the primary medical problem of the child while admitted is given most attention during the brief period in the clinic, during admission and also the immediate post-operative interval [8].
One of the most important parameters for assessing the nutritional status of a child is the weight. Attention to the weight of the child is typically brought to the foreknowledge of the Pediatric Ophthalmologist during the preoperative anesthetic period. Detailed anthropometric body mass variables including a childs weight, height, and biochemical assays are used to define nutritional status worldwide with various classification systems and cutoff points used to define malnutrition [9,10] UNICEF, WHO and the World Bank released an updated joint dataset on child malnutrition indicators which include: stunting, wasting, severe wasting, overweight and underweight [11].
Nutritional disorders could further be categorized into malnutrition which could be underweight or cachexia and disease related malnutrition in children.
The nutritional status of children less than 5years or more than four years to fifteen varies from immediate causes such as inadequate dietary intake, to underlying causes and basic causes such as inadequate education and finances [10]. The nutritional status of children with congenital and developmental cataract is yet to be fully investigated. The mechanisms linking childhood cataract with nutritional disorders, has yet to be understood, even though many assumptions can be made.
The purpose of this article is to report the weight status of children with cataract who presented for surgery to a child eye health tertiary facility.
Subjects and Methods
A retrospective preoperative chart review was carried out in children less than 16 years of age with childhood cataract admitted for cataract surgery over a two year period, between January 2010 to the December 2012. Data including the demography, clinical history, ocular and systemic examinations and the weight of the child (in kilogrammes, using a manual weighing scale- Model RGZ-120 Body-weight scale by Medilife, which was calibrated every surgery day) were documented.Children were admitted into the pediatric eye ward for surgery a day prior to surgery. The weight was taken on a naked child prior to administration of anesthesia or carried by an adult and the measured weight of both child and adult subtracted from the adults weight. Linear measurements such as height and length were not routinely measured on the ward or theater. Detailed immunization history was extracted and documented.
Children were referred to the Pediatrician for nutritional assessment and recommendations if the weight was below the expected weight for age.
Data analysis was performed using STATA 11 (Chicago, Illinois).
The study was approved by the University of Calabar Teaching Hospital Ethical Review Committee.
Results
A lower mean weight was seen in 50 (75.8%) out of the 66 children studied.The mean ages of these children was 5.0 years; SD= 3.62 compared with 5.2 years; SD=3.78 for those who had normal body weights.
Children with bilateral congenital cataract 48/66 (72.7%) had significantly lower weight compared to the mean weight for age and compared to the mean weight for age in children with bilateral developmental cataract 18(27.3%) p=<0.001.
There were twenty-eight 28 (42.4%) males and 22 (33.3%) females. The mean weight of the male children who had lower weight was 13.4kg; SD = 5.92 compared to the expected mean weight of 17.5kg; SD = 6.44 (p= 0.017). Males had a lower mean weight than the females with the mean weight for age of 16.3 Kg (SD = 9.03) and 19.5 Kg (SD = 9.56) respectively, p=0.00.
Out of the fifty children, 29 (58%) had significant co-existing systemic morbidity, p < 0.006) including: systemic morbidity such as; congenital heart diseases, Delayed milestones, Mental retardation, Deafness, Epilepsy, Physical handicap including congenital heart lesions which was seen in 18(62%) children.
All the children in the study had received the complete immunizations for age.

Discussion
Children with bilateral congenital cataracts and bilateral developmental cataracts were seen to have a lower mean weight than the expected weight for age. Further, children with bilateral congenital cataracts were more significantly affected than their peers with bilateral developmental cataract. This may be due to the presence of other associated systemic congenital conditions that may be present in such children [12]. Anthropometric measurements in a pediatric Ophthalmology  clinic may be used as an indicator to identify other associated problems in children that present with bilateral cataracts. This is in addition to revealing the nutritional status of the child.
One of the most fundamental challenges of children in our environment is that of childhood malnutrition [13-15]. An opportunity to screen or identify children with nutritional disorders arises when children are admitted into the pediatric ward. The reason for obtaining anthropometric data would be to identify children that will need further investigations including a nutritional assessment. Early identification of nutritional disorders within a hospital setting, can prevent further nutritional deterioration and ensure treatment of the existing nutritional deficiencies. Basic anthropometric parameters that are important in making an accurate diagnosis of a risk or definite nutritional disorder include the height and weight for Body Mass Index, and leg and arm anthropometry. In addition, parameters have been highlighted to define the risk of a nutritional disorder including malnutrition, using hospital screening tools such as the Nutritional Risk Screening 2002 (NRS-2002), Mini Nutritional Assessment-Short Form (MNASF) and Malnutrition Universal Screening Tool (MUST) [14]. The use of such tools we expect may facilitate the identification of common pediatric nutritional conditions for which appropriate interventions can be readily instituted and also to
decrease the frequency of undernutrition among children who leave the hospital after a surgical procedure including cataract surgery. These maybe considered for the future as it would be impractical and too cumbersome in our environment at this time. Referral of children for a detailed evaluation of body composition and physical function performed by experienced health professionals may indicate the a diagnosis of nutritional disorder, including the subtype and underlying cause. The visual and neurodevelopmental consequences of malnutrition can be seen not only in childhood but also in adulthood, hence the importance of early identification [2].
Children with cataract who had a lower mean weight were significantly associated with co existing systemic morbid conditions. The identified co-existing systemic morbid conditions included congenital heart diseases. Congenital heart diseases were seen in another study to have been associated with malnutrition [17]. The reasons for lower weight in these children may range from the underlying heart conditions and metabolic derangement’s to factors related to the socioeconomic lives, beliefs and attitudes of the caregivers and child. The reason for a lower mean age in boys compared to girls is not clear.
Lastly, nutritional status is utilized as an outcome measure for: food availability, caring capacity, health systems efficiency, reflection of the housing and environmental conditions as well as the underlying health conditions of a population. It is suggested as a proxy indicator for poverty [18].
Follow up for post surgical care from childhood cataract surgery in children is extremely important in visual rehabilitation [19]. Information on the weight status may contribute to information on the socioeconomic status and future essential compliance to post surgical care of children with cataract. Investigations are required in this regard.

Conclusion
Complete anthropometric measures should be taken at the earliest contact in children with childhood catarcat. This may point to the need for further systemic evaluation including nutritional screening and early referral for nutritional intervention.

References

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