Pediatric Crohn's Disease
Description
▶Clinical Characteristics:
•About half of new patients present with abdominal discomfort, which is the most common presenting symptom.
•Bowel complaints, dietary concerns, and stunted growth (which separates pediatric from adult disease) are other prevalent problems.
▶Lab results include thrombocytosis, anemia, elevated ESR, and hypoalbuminemia (>50%).
•Abdominal pain
•Weight loss
•Rectal bleeding
•Fever
•Perianal disease
•Joint pain
•Nausea
•Fatigue
•Diarrhea
•Poor growth
•Vomiting
▶Diagnosis
Work-up:
Endoscopy, upper and lower
imaging of the small intestine (capsule endoscopy or MR/CT enterography).
CT enterography is equally useful, however MR enterography is frequently used.
Histology and distribution are used to make the diagnosis.
Distribution (childhood cohort in Europe):
•53 percent ileocolonic
•Colonic isolation (27%).
•restricted cecal (16%).
Prognostic Elements for Unfavorable Results
Failure of growth
Prolonged illness
Stricturing illness or fistulas
Induction therapy failure.
Protocol
▶Medical Treatment
◉ Nutritional Approach
First-line treatment is exclusive enteral nutrition (EEN) (ECCO/ESPGHAN 2014).
100% enteral feeding is necessary (some evidence suggests 80–90% effectiveness).
75–80% in response (steroid equivalent).
If there is no improvement after two weeks, switch therapy.
•The corticosteroid used if EEN was unsuccessful or not practical.
•Over 8–12 weeks, prednisone at a dose of 1–1.5 mg/kg was tapered.
•Answer: 60–80%.
Risks include osteoporosis, poor wound healing, and growth inhibition.
•Methotrexate with Thiopurines
•Only maintenance treatment—not induction.
•Hepatic toxicity, pancreatitis, and immunosuppression are risks associated with thiopurines.
•Methotrexate: danger of liver damage, nausea, and vomiting, as well as myelosuppression.
•Pharmaceuticals (anti-TNF)
•Adalimumab and Infliximab (IFX) are effective for both induction and maintenance.
•used for diseases that are resistant to steroids.
•Early versus late use timing is still up for dispute.
•Uncertain surgical risk due to preoperative usage (conflicting research).
◉ Growth Failure and Malnutrition Issue:
•Because of persistent intestinal inflammation, malabsorption, and elevated metabolic needs, children with Crohn's disease frequently suffer from stunted growth, weight loss, delayed puberty, and malnutrition.
◉ Management:
•First-line treatment is nutritional therapy, and in many situations, exclusive enteral nutrition (EEN) is the best way to induce remission.
•If EEN is not tolerated, more parenteral nourishment is administered.
Iron, zinc, vitamin D, and vitamin B12 micronutrient deficits are monitored for, and supplements are given as needed.
◉Interventions in Nursing:
•regular evaluation of growth metrics, such as height, weight, BMI, and circumference of the mid-upper arm.
•tracking food consumption, enteral feed tolerance, and indications of feeding issues.
•Instruction on the use, preparation, and administration of enteral feeding formulae for caretakers.
•Encouragement to continue following dietary guidelines and assistance in managing dietary restrictions.
•For personalized meal planning and information about hidden sources of lactose or gluten, if intolerant, work with a dietitian.
◉ Active Gastrointestinal Inflammation Problem:
•Symptoms such as abdominal pain, diarrhea, rectal bleeding, and fatigue reduce quality of life and increase hospitalizations.
◉ Management:
•Pharmacological treatment in stages:
•Induction: EEN or corticosteroids.
•Maintenance: biologics (adalimumab, infliximab), immunomodulators (azathioprine, methotrexate).
•antibiotics for problems caused by infections.
•surgical treatment recommended in cases of medically resistant illness, blockage, fistula, or abscess.
◉Interventions in Nursing:
•Keep an eye on the look, consistency, and frequency of stools.
•Evaluate the frequency and severity of pain, offer comfort measures, and assist with the proper use of analgesics.
•Look for symptoms of gastrointestinal bleeding, such as hematochezia or melena.
•Keep an eye out for adverse drug responses, such as infusion reactions with biologics and infection risk with immunosuppressives.
•Inform family members on the necessity of adherence, potential adverse effects, and drug delivery schedules.
•If surgery is necessary, preoperative and after care should be provided, including wound evaluation and early ambulation encouragement.
•strict infection control and close observation of immunocompromised patients for sepsis symptoms.
◉ Development and Delays in Puberty Issue:
•Prolonged inflammation and steroid use cause delayed pubertal development and linear growth.
◉ Management:
•To enable catch-up growth, actively treat the underlying inflammation.
•Reduce the amount of steroids you consume and use biologics or steroid-sparing medicines.
•When there are significant delays, further hormone therapy may be necessary.
◉ Interventions in Nursing:
•Use Tanner staging to keep track of pubertal milestones.
•Children who have delays or issues with their bodies should receive psychological help.
•Family therapy around potential and expected growth patterns
◉ Handling Complications (Obstruction, Abscess, Fistula)Problem:
•Strictures, intestinal blockage, fistulizing illness, or abscess formation brought on by Crohn's disease may necessitate prompt surgical treatment.
◉Management:
•drainage of abscesses, strictureplasty, and surgical resection as necessary.
•Biologics utilization during surgery varies from patient to patient.
◉Interventions in Nursing:
•Keep an eye out for symptoms of obstruction, such as vomiting, severe stomach discomfort, and distension.
•Postoperative care includes wound care, pain management, and stoma management if necessary.
Notes
For more details visit : https://pmc.ncbi.nlm.nih.gov/articles/PMC5825885/
