Document Detail

Weight gain following vertical expandable prosthetic titanium ribs surgery in children with thoracic insufficiency syndrome.
MedLine Citation:
PMID:  19927103     Owner:  NLM     Status:  MEDLINE    
STUDY DESIGN: Retrospective review of patients from a multicenter database. OBJECTIVE: To evaluate the nutritional status of children with thoracic insufficiency syndrome (TIS) and to determine if treatment with vertical expandable prosthetic titanium ribs (VEPTR) leads to improvements in weight percentile. SUMMARY OF BACKGROUND DATA: Children with pulmonary insufficiency characteristically have poor nutrition as the energy expenditure from the extra work of breathing approaches the nutritional gain of eating. To our knowledge, no previous studies have examined the relation between VEPTR and potential nutritional improvements in children with TIS. METHODS: Seventy-six patients at 7 different institutions underwent placement of VEPTR devices for treatment or prevention of TIS. Mean age at surgery was 3.7 years (range, 8 months-14 years). All patients were observed for a minimum of 24 months with an average follow-up of 3.3 years (range, 2-6 years). Before surgery and at each postoperative visit, patients were weighed and the Cobb angle was measured. All weights were converted to normative percentiles based on the patient's age. RESULTS: Overall, we found a significant increase in the percentile of patients' weights after VEPTR surgery (P = 0.0004). Of the 76 patients in our series, 60 (79%) were < or =5 percentile in weight before surgery. Of these most nutritionally depleted patients, 40% (24/60) had increase in percentile weight after surgery; more subjects may have improved, but due to the basement effect < or =5 percentile any improvement in which the final weight was under 5 percentile may not have been detected. Of the 16 patients who were >5 percentile weight before surgery, 50% (8/16) had increased weight percentiles after surgery. For most patients, the majority of weight gain occurred between 4 and 8 months after surgery; weight gain continued up to 48 months after surgery. The change in Cobb angle had no relation to the change in weight percentile. CONCLUSION: A total of 79% of patients with TIS were less than 5 percentile in weight, thus meeting the criteria for "failure to thrive." Our study demonstrates a significant improvement in the nutritional status of these children after VEPTR surgery, which is an important outcome measure in this population.
David L Skaggs; Wudbhav N Sankar; Josh Albrektson; Tishya A L Wren; Robert M Campbell
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Spine     Volume:  34     ISSN:  1528-1159     ISO Abbreviation:  Spine     Publication Date:  2009 Nov 
Date Detail:
Created Date:  2009-11-20     Completed Date:  2010-01-26     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7610646     Medline TA:  Spine (Phila Pa 1976)     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2530-3     Citation Subset:  IM    
Children's Hospital Los Angeles, Los Angeles, CA 90027, USA.
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MeSH Terms
Child, Preschool
Databases, Factual
Failure to Thrive / surgery
Follow-Up Studies
Health Status
Linear Models
Nutritional Status / physiology*
Prostheses and Implants*
Prosthesis Implantation
Respiratory Insufficiency / surgery*
Ribs / surgery*
Severity of Illness Index
Thoracic Surgical Procedures / instrumentation*
Treatment Outcome
Weight Gain / physiology*
Reg. No./Substance:

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