The 27:3 issue of Topics in Clinical Nutrition is a unique and exciting departure from our usual format. We are highlighting the expertise of dietitians from one institution of excellence, The Children's Hospital of Philadelphia (CHOP). Sue Konek, Director of the Department of Clinical Nutrition, was instrumental in designing the content and inviting the authors from her staff to present their specialties in pediatric nutrition practice. Her introductory overview highlights the mission of CHOP and how the dietitians and dietetic technicians contribute to comprehensive medical nutrition care of their patients. Important to their success and, of interest to other clinicians, is the description of the clinical laddering at CHOP and the development plans for advanced practice in pediatric nutrition.
Newborn screening, as a public health initiative, has impacted the earlier identification of inborn errors of metabolism and accelerated the use of new products and treatment options. Burfield, Hussa, and Randall offer an impressive update on phenylketonuria, galactosemia, urea cycle disorders, and other inborn errors that may lead to liver transplantation and other treatments. They detail the balance of dietary manipulation with complementary treatments and close monitoring of patients with inborn errors of metabolism. They encourage dietitians to stay informed of nutrition therapy for pre- and post-liver transplant patients and innovations in the field.
Breastfeeding has received a lot of attention in the past decade. Dietitian and lactation consultant Rachelle Lessen reviews the recommendations by health authorities and gives guidance for helping women minimize barriers to breastfeeding. It is important to promote and protect breastfeeding in concert with the guidelines of Healthy People 2020 and to reduce the burden of infections and hospitalizations of formula-fed infants during the first year of life.
Children with neuromuscular disease must be assessed and managed carefully by the health care team. Nutritional goals for children must be established to support growth and development while preserving muscular function. Divito and Meyers provide essential information for those working with children to help them meet their nutritional goals.
Nutritional evaluation for babies with common surgical diseases is vitally important according to Croll and Blinman. For both the disease and the surgical repair, nutritional constraints, including gastric reflux, dysmotility, limited intestinal absorptive capacity, and other common neonatal surgical conditions must be addressed to achieve successful patient outcomes.
Begany skillfully presents a picture of the laboratory and radiologic screening markers for preventing and treating metabolic bone disease and decreasing fracture risk of infants. The evidence for using several of the biomarkers indicates a lack of sensitivity and specificity. More research with serial measurements may reveal the potential for effective screening in the future. Pharmacologic and environmental concerns as well as the imperative for a multidisciplinary team to address bone health in the neonatal intensive care unit are also elucidated.
The importance of nutritional considerations in the neonatal intensive care unit is examined in relation to necrotizing enterocolitis, a serious problem for premature infants. Bingham does a careful and thorough analysis of necrotizing enterocolitis studies. Besides enteral and parenteral nutrition, she discusses trophic feedings, the value and use of human milk for these patients, and guidelines for administering and advancing feedings.
Michel and Mallowe present an overview of cystic fibrosis. Because of newborn screening, early detection can lead to better outcomes for infants, particularly in alleviating protein calorie malnutrition and vitamin and mineral deficiencies. Their article reviews the nutritional management of newborns diagnosed with cystic fibrosis.
Autodore and her colleagues focus on celiac disease that requires attention to a strict gluten-free diet. With 1% to 2% of individuals affected worldwide, the dietitian, working with a multidisciplinary team, plays a major role in assisting young patients with the adoption and management of a gluten-free diet.
Robinson and Estell define double diabetes in youth and recommend nutrition therapy guidelines. Two brief clinical case scenarios provide cogent examples of defining double diabetes and set standards including necessary emphasis on vitamin D nutritional status and the crucial need for more research.
Bailer and Savoca have addressed the care of newborns and infants with congenital heart disease: single ventricle physiology. They detail nutritional approaches through the life cycle. Expert medical nutrition therapy is required when caring for this challenging patient population. Some explanatory figures in color augment the manuscript on the journal's website at http://www.TopicsInClinicalNutrition.com.
With increasing survival rates of children and adolescents with cancer, an overview of recent approaches to nutrition assessment and interventions is beneficial for dietetic practitioners. Sanner and Wallace encourage a proactive response to concerns about cancer treatment effects especially bone health, gastrointestinal function, and changes in body composition.
I want to express our deep appreciation to the leadership of the clinical nutrition staff at The Children's Hospital of Philadelphia for contributions to Topics in Clinical Nutrition. In particular, we value their explanation and weighing of new approaches to pediatric nutrition care and their insights on current and future research. Best practices in pediatric nutrition and the highest quality care for infants and children are paramount to the needs and goals of our readership.
-Judith A. Gilbride, PhD, RD, FADA
Editor