Optimal clinical management of children receiving ketogenic parenteral nutrition: a clinical practice guide.


AIM:To give evidence-based recommendations on the application of ketogenic diet parenteral nutrition (KD-PN) in emergency situations. METHOD:An international group of experts (n=14) researched the literature and distributed a survey among 150 expert centers. International accepted guidelines (European Society for Clinical Nutrition and Metabolism/European Society for Paediatric Gastroenterology Hepatology and Nutrition and the American Society for Parenteral and Enteral Nutrition) and handbooks for parenteral nutrition were considered general standards of care. RESULTS:In the literature, we identified 35 reports of patients treated by KD-PN. International guidelines and handbooks provided some conflicting information. Twenty-four expert teams from nine countries responded to the survey, reflecting the limited clinical experience. INTERPRETATION:This paper highlights 23 consensus-based recommendations for safe and effective KD-PN (e.g. diet initiation, calculation, application, monitoring, and evaluation) based on the best evidence available and expert opinions. WHAT THIS PAPER ADDS:In acute settings, ketogenic diet therapy (KDT) can be administered parenterally. Parenteral administration of KDT should be started only at the intensive care unit. Initiate ketogenic parenteral nutrition stepwise to the highest ratio possible with the lowest level of complications. Evaluate the risk-benefit ratio of parenteral administration continuously. Restart enteral feeding as soon as appropriate. :MANEJO CLÍNICO ÓPTIMO DE LOS NIÑOS QUE RECIBEN NUTRICIÓN PARENTERAL CETOGÉNICA: UNA GUÍA DE PRÁCTICA CLÍNICA: OBJETIVO: Dar recomendaciones basadas en evidencia sobre la aplicación de dieta cetogénica en la nutrición parenteral (DC-NP) en situaciones de emergencia. MÉTODO: Un grupo de expertos (n=14) investigó la literatura y distribuyó una encuesta en 150 centros especializados. Considerando como estándares de manejo las guías aceptadas internacionalmente (Sociedad Europea para la Nutrición Clínica y Metabolismo/Sociedad Europea de Gastroenterología Pediátrica, Hepatología y Nutrición, y la Sociedad Americana para Nutrición Enteral y Parenteral) y los manuales para la nutrición parenteral. RESULTADOS: En la literatura se identificaron 35 informes de pacientes tratados por DC-NP. Las directrices y manuales internacionales proporcionaron alguna información contradictoria. Veinticuatro equipos de expertos de nueve países respondieron a la encuesta, reflejando la limitada experiencia clínica. INTERPRETACIÓN: Este documento destaca 23 recomendaciones basadas en consensos para una DC-NP segura y eficaz (por ejemplo; iniciación de la dieta, cálculo, aplicación, monitoreo y evaluación) basada en la mejor evidencia disponible y las opiniones de expertos. :MANEJO CLÍNICO ÓTIMO DE CRIANÇAS RECEBENDO NUTRIÇÃO CETOGÊNICA PARENTERAL: UM GUIA PARA A PRÁTICA CLÍNICA: OBJETIVO: Oferecer recomendações baseadas em evidências da aplicação de dieta cetogênica por nutrição parenteral (DC-NP) em situações de emergência. MÉTODO: Um grupo internacional de especialistas (n=14) pesquisou a literatura e distribuiu um questionário em 150 centros especializados. Diretrizes internacioansi aceitas (Sociedade Européia de Nutrição Clínica e Metabolismo/ Sociedade Européia de Gastroenterologia, Hepatologia e Nutrição Pediátrica, e a Sociedade Americana de Nutrição Enteral e Parenteral) e livros sobre nutrição parenteral foram considerados padrão geral de atenção. RESULTADOS: Na literatura, identificamos 35 relados de pacientes tratados por DC-NP. As diretrizes internacionais e os livros forneceram informações conflitantes. Vinte e quatro equips de especialistas de nove países responderam ao questionário, refletindo a experiência clínica limitada. INTERPRETAÇÃO: Este artigo destaca 23 recomendações baseadas em consenso para DC-NP segura e efetiva (ex: início da dieta, cálculo, aplicação, monitoramento e avaliação) com base na melhor evidência disponível e opiniões de especialistas.


Dev Med Child Neurol


van der Louw E,Aldaz V,Harvey J,Roan M,van den Hurk D,Cross JH,Auvin S,Review Group.




Has Abstract


2020-01-01 00:00:00












  • Carpal tunnel syndrome in childhood.

    abstract::Carpal tunnel syndrome is extremely rare in childhood and in almost all previously reported cases it has been secondary to some underlying condition. Three 13- to 14-year-old girls are described with idiopathic carpal tunnel syndrome, confirmed by EMG and relieved by surgical decompression. A noteworthy feature in chi...

    journal_title:Developmental medicine and child neurology

    pub_type: 杂志文章


    authors: Sainio K,Merikanto J,Larsen TA

    更新日期:1987-12-01 00:00:00

  • Bone age and linear skeletal growth of children with cerebral palsy.

    abstract::The aim of this study was to compare the linear growth of children with cerebral palsy (CP) with that of children without CP. The segmental lengths (humerus, ulna, femur, tibia, and spine), recumbent length, body weight, and bone age of 62 children with CP (age range 2.25 to 14 years, mean 7.13 years) were measured an...

    journal_title:Developmental medicine and child neurology

    pub_type: 杂志文章


    authors: Kong CK,Tse PW,Lee WY

    更新日期:1999-11-01 00:00:00

  • Management of apnea in infants with trisomy 18.

    abstract::This case series aimed to characterize the clinical features, management, and outcomes of apnea in infants with trisomy 18. Participants in this study were infants with trisomy 18 who were born alive and admitted to the neonatal intensive care unit in Kyushu University Hospital from 2000 to 2018. Retrospective analysi...

    journal_title:Developmental medicine and child neurology

    pub_type: 杂志文章


    authors: Taira R,Inoue H,Sawano T,Fujiyoshi J,Ichimiya Y,Torio M,Sanefuji M,Ochiai M,Sakai Y,Ohga S

    更新日期:2020-07-01 00:00:00

  • Assessment of risk factors for pneumonia in dysphagic children: significance of videofluoroscopic swallowing evaluation.

    abstract::The purpose of this study was to investigate the relationship between aspiration, as identified by videofluoroscopic swallowing (VFS) study, and pneumonia in children with suspected dysphagia. Data were retrospectively collected and analysed from 142 children referred for VFS over a one-year period. The median age was...

    journal_title:Developmental medicine and child neurology

    pub_type: 杂志文章


    authors: Taniguchi MH,Moyer RS

    更新日期:1994-06-01 00:00:00

  • CSF levels of lactate and hydroxybutyrate dehydrogenase as indicators of neurological sequelae after neonatal brain damage.

    abstract::A prospective study was made of levels of lactate and hydroxybutyrate dehydrogenase in the blood and cerebrospinal fluid of 57 term neonates, in relation to the time elapsed since delivery, neonatal examinations (Apgar score, neurological symptoms and EEG findings) and psychomotor outcome at one year of age. Serum det...

    journal_title:Developmental medicine and child neurology

    pub_type: 杂志文章


    authors: Dalens B,Viallard JL,Raynaud EJ,Dastuge B

    更新日期:1981-04-01 00:00:00

  • Risk factors for emergence and progression of scoliosis in children with severe cerebral palsy: a systematic review.

    abstract:AIM:Scoliosis is a frequently occurring and serious complication of severe cerebral palsy (CP). This systematic review aims to the assess the risk factors associated with the emergence and progression of scoliosis in children with CP functioning at level IV or V of the Gross Motor Function Classification System (GMFCS)...

    journal_title:Developmental medicine and child neurology

    pub_type: 杂志文章,评审


    authors: Loeters MJ,Maathuis CG,Hadders-Algra M

    更新日期:2010-07-01 00:00:00

  • Social cognition in children with epilepsy in mainstream education.

    abstract:AIM:To establish whether deficits in social cognition are present in children with generalized or focal epilepsy in mainstream education, and whether any relation exists between social cognition, communication, and behaviour measures. METHOD:In a cross-sectional study, children with an epilepsy-only diagnoses in mains...

    journal_title:Developmental medicine and child neurology

    pub_type: 杂志文章


    authors: Lew AR,Lewis C,Lunn J,Tomlin P,Basu H,Roach J,Rakshi K,Martland T

    更新日期:2015-01-01 00:00:00

  • Epilepsy in very preterm infants: neonatal cranial ultrasound reveals a high-risk subcategory.

    abstract::The aim of this study was to investigate the association between epilepsy and perinatal brain injury in a cohort of 610 infants born preterm at <33 weeks' gestation. The prevalence of epilepsy in this cohort was 4.3% as determined by a postal questionnaire survey. Most children with epilepsy (16 of 24) had high-risk c...

    journal_title:Developmental medicine and child neurology

    pub_type: 杂志文章


    authors: Amess PN,Baudin J,Townsend J,Meek J,Roth SC,Neville BG,Wyatt JS,Stewart A

    更新日期:1998-11-01 00:00:00

  • Multiple sclerosis in childhood: contribution of serial MRI to earlier diagnosis.

    abstract::The authors report six children (five girls, one boy) aged 11 to 13 years, of whom four had clinically definite multiple sclerosis (MS) and two had laboratory-supported definite MS. All had brain white matter abnormalities indicative of MS. In three cases, positive findings on the first MRI contributed significantly t...

    journal_title:Developmental medicine and child neurology

    pub_type: 杂志文章


    authors: Millner MM,Ebner F,Justich E,Urban C

    更新日期:1990-09-01 00:00:00

  • Pacinioma of the cauda equina.

    abstract::Lesions composed of Pacinian corpuscles or showing Pacinian corpuscle differentiation have usually been described in relation to benign tumours of the peripheral nervous system or reactive hyperplastic processes. On the other hand, mature Pacinian corpuscles have occasionally been detected as part of intraspinal lumbo...

    journal_title:Developmental medicine and child neurology

    pub_type: 杂志文章


    authors: Kojc N,Korsic M,Popovic M

    更新日期:2006-12-01 00:00:00

  • A new motor performance test in a prospective study on children with suspected myopathy.

    abstract::In the development of a new diagnostic motor performance test to spare more children from painful muscle biopsy, seven functional items were used to measure muscle strength and muscle endurance in a prospective study on new patients. Over a 2-year period, 22 patients (12 males, 10 females; mean age 8y 1mo [SD 2y 6mo],...

    journal_title:Developmental medicine and child neurology

    pub_type: 杂志文章


    authors: van den Beld WA,van der Sanden GA,Feuth T,Janssen AJ,Sengers RC,Verbeek AL,Gabreëls FJ

    更新日期:2006-09-01 00:00:00

  • Lobar holoprosencephaly presenting as spastic diplegia.

    abstract::A child with lobar holoprosencephaly presented with spastic diplegia and mild mental retardation, compounded by attention deficits and hyperactivity. His facial features were normal, and except for borderline microcephaly, there were no other predictors of holoprosencephaly. This patient represents the mild end of the...

    journal_title:Developmental medicine and child neurology

    pub_type: 杂志文章


    authors: Shanks DE,Wilson WG

    更新日期:1988-06-01 00:00:00

  • Physical development of hyperactive boys.

    abstract::Anthropometric data were collected on groups of seven-year-old Dunedin (New Zealand) boys, identified as hyperactive-only, aggressive-hyperactive, aggressive-only and non-aggressive/non-hyperactive. Measures taken included stature, weight, skeletal maturity, mid-upper arm circumference, triceps and subscapular fatfold...

    journal_title:Developmental medicine and child neurology

    pub_type: 杂志文章


    authors: McGee R,Birkbeck J,Silva PA

    更新日期:1985-06-01 00:00:00

  • Visuoperceptual profiles of children using the Flemish cerebral visual impairment questionnaire.

    abstract:AIM:To investigate the underlying factor structure of the 46-item Flemish cerebral visual impairment (CVI) questionnaire, differentiate the factor scores of children with and without CVI, and examine the impact of comorbidities on factor scores. METHOD:The records of 630 children (386 males, 244 females; median age 77...

    journal_title:Developmental medicine and child neurology

    pub_type: 杂志文章


    authors: Ben Itzhak N,Vancleef K,Franki I,Laenen A,Wagemans J,Ortibus E

    更新日期:2020-08-01 00:00:00

  • Deep brain stimulation for cerebral palsy: where are we now?

    abstract::Cerebral palsy (CP) is a complex disorder and children frequently have multiple impairments. Dystonia is a particularly frustrating impairment that interferes with rehabilitation and function and is difficult to treat. Of the available treatments, deep brain stimulation (DBS) has emerged as an option with the potentia...

    journal_title:Developmental medicine and child neurology

    pub_type: 杂志文章,评审


    authors: Sanger TD

    更新日期:2020-01-01 00:00:00

  • Periodic and non-periodic sleep apnea in premature and fullterm infants.

    abstract::The sleep states of nine premature infants were observed and concomitant respiration recordings were obtained at 37 and 41 weeks conceptional age. 19 fullterm infants were also studied at 41 weeks conceptional age. Between 37 and 41 weeks significant decreases occurred in the premature infants' percentage of periodic ...

    journal_title:Developmental medicine and child neurology

    pub_type: 杂志文章


    authors: Booth CL,Morin VN,Waite SP,Thoman EB

    更新日期:1983-06-01 00:00:00

  • Evaluation of cutaneous and proprioceptive sensation in children: a reliability study.

    abstract::Forty-three healthy children aged between six and 12 years were tested to determine the intra-rater reliability of four clinical cutaneous and proprioceptive sensory assessment tools: touch pressure, vibration perception, thermal discrimination and kinaesthesis. The tests were carried out bilaterally on proximal and d...

    journal_title:Developmental medicine and child neurology

    pub_type: 杂志文章


    authors: Thibault A,Forget R,Lambert J

    更新日期:1994-09-01 00:00:00

  • Maturation of finger-synchronization skills.

    abstract::The ability to move two fingers at the same time was measured in young and older adults. This study measured the accuracy with which 45 normally developing children (23 boys, 22 girls; mean ages 8.4 and 8.3 years respectively) and 49 young adults (25 males, 24 females; mean ages 19.8 and 20.5 years respectively) could...

    journal_title:Developmental medicine and child neurology

    pub_type: 临床试验,杂志文章


    authors: Milling-Smith O,Eunson P,Walsh EG

    更新日期:2002-03-01 00:00:00

  • Sucking behaviour in infants born preterm and developmental outcomes at primary school age.

    abstract:AIM:To determine the association between sucking in infants born preterm and developmental outcomes at 5 years. METHOD:Thirty-four infants were included (mean gestational age 30wks 4d, mean birthweight 1407g). The Neonatal Oral-Motor Assessment Scale was used longitudinally from 37 to 50 weeks postmenstrual age. At 5 ...

    journal_title:Developmental medicine and child neurology

    pub_type: 杂志文章


    authors: Wolthuis-Stigter MI,Da Costa SP,Bos AF,Krijnen WP,Van Der Schans CP,Luinge MR

    更新日期:2017-08-01 00:00:00

  • Neurophysiology of lower-limb function in hemiplegic children.

    abstract::Equinus in hemiplegic children is multifactorial. In some cases it is due to a short muscle, in others to simple foot-drop, tonic spasticity, rigidity, compensation for a short limb, fixed flexion contracture at the hip, dominantly inherited forefoot deformity, forefoot equinus secondary to chronic toe-walking, or abn...

    journal_title:Developmental medicine and child neurology

    pub_type: 杂志文章


    authors: Brown JK,Rodda J,Walsh EG,Wright GW

    更新日期:1991-12-01 00:00:00

  • MRI findings in patients with spastic cerebral palsy. II: Correlation with type of cerebral palsy.

    abstract::The authors studied MR images of the brain in 152 patients, aged 1 to 19 years (mean 3.3), who had spastic cerebral palsy (CP) and were attending two hospitals in Japan in 1993 and 1994. Eighty-one patients had diplegia, 45 had quadriplegia, and 26 had hemiplegia. Of patients with diplegia, 72 had periventricular leuk...

    journal_title:Developmental medicine and child neurology

    pub_type: 杂志文章


    authors: Okumura A,Kato T,Kuno K,Hayakawa F,Watanabe K

    更新日期:1997-06-01 00:00:00

  • Translational studies exploring neuroplasticity associated with motor skill learning and the regulatory role of the dopamine system.

    abstract::Cerebral palsy (CP) is a heterogeneous group of neurodevelopmental disorders associated with lifelong motor impairment and disability. Current intervention programmes aim to capitalize on the neuroplasticity of the undamaged part of the brain to improve motor functions, by engaging individuals in active motor learning...

    journal_title:Developmental medicine and child neurology

    pub_type: 杂志文章,评审


    authors: Diaz Heijtz R,Forssberg H

    更新日期:2015-04-01 00:00:00

  • Comparison of reflex modification procedures and auditory brainstem response in high-risk neonates.

    abstract::This study compared the results of reflex modification (RM)--an objective technique for assessing brainstem sensorineural processing--with those of auditory brainstem response (ABR) for a group of high-risk infants at comparable postconceptional ages. For the RM procedure, an eyeblink-eliciting tap to the glabella was...

    journal_title:Developmental medicine and child neurology

    pub_type: 杂志文章


    authors: Anday EK,Cohen ME,Hoffman HS

    更新日期:1991-02-01 00:00:00

  • The development of independent walking in children with cerebral palsy.

    abstract::Electromyographic and kinematic data were collected during treadmill locomotion by normal infants and infants with cerebral palsy. Locomotor patterns of the infants with cerebral palsy were similar to those of normal infants during the stage of supported locomotion, but as they matured, some of the characteristics of ...

    journal_title:Developmental medicine and child neurology

    pub_type: 杂志文章


    authors: Leonard CT,Hirschfeld H,Forssberg H

    更新日期:1991-07-01 00:00:00

  • Applying Dutch and US versions of the BSID-II in Dutch children born preterm leads to different outcomes.

    abstract::The aim of the present study was to evaluate whether the application of Dutch versus US test procedures and norms of the Bayley Scales of Infant Development - 2nd edition (BSID-II) leads to different developmental outcomes. The BSID-II was administered to 376 preterm infants (191 males, 185 females; mean gestational a...

    journal_title:Developmental medicine and child neurology

    pub_type: 杂志文章


    authors: Westera JJ,Houtzager BA,Overdiek B,van Wassenaer AG

    更新日期:2008-06-01 00:00:00

  • Conservative interventions for positional plagiocephaly: a systematic review.

    abstract::This review aimed to synthesize current research evidence to determine the effectiveness of conservative interventions for infants with positional plagiocephaly. A systematic review was conducted, where papers were sourced from 13 library and internet databases. Research was included if published in English between 19...

    journal_title:Developmental medicine and child neurology

    pub_type: 杂志文章,评审


    authors: Bialocerkowski AE,Vladusic SL,Howell SM

    更新日期:2005-08-01 00:00:00

  • Uncommon syndromes of cerebellar vermis aplasia. II: Tecto-cerebellar dysraphia with occipital encephalocele.

    abstract::Two new cases are reported of a rare syndrome of malformation consisting of occiptal encephalocele, aplasia of the vermis and deformity of the tectum. Less consistent components are aplasia of mammillary bodies, fusion of thalami, anomalies of cerebral gyral patterns, bifid atlas or bifid occipital squame, elevation o...

    journal_title:Developmental medicine and child neurology

    pub_type: 杂志文章


    authors: Friede RL

    更新日期:1978-12-01 00:00:00

  • Regional cerebral blood flow in weight-restored anorexia nervosa: a preliminary study.

    abstract::Twenty-one individuals (19 females, two males) with teenage-onset anorexia nervosa (AN), 19 of whom were weight restored, were assessed using single-photon emission computed tomography (SPECT) 7 years after onset of AN, at a mean age of 22 years. For comparison we recruited a younger group without neuropsychiatric dis...

    journal_title:Developmental medicine and child neurology

    pub_type: 杂志文章


    authors: Råstam M,Bjure J,Vestergren E,Uvebrant P,Gillberg IC,Wentz E,Gillberg C

    更新日期:2001-04-01 00:00:00

  • Prevalence and risk factors for autism spectrum disorder in epilepsy: a systematic review and meta-analysis.

    abstract:AIM:To assess the prevalence and risk factors for autism spectrum disorder (ASD) in epilepsy, and to better understand the relationship and comorbidity between these disorders. METHOD:PsychINFO and PubMed were searched for articles published in the past 15 years that examined the prevalence of ASD in individuals with ...

    journal_title:Developmental medicine and child neurology

    pub_type: 杂志文章,meta分析,评审


    authors: Strasser L,Downes M,Kung J,Cross JH,De Haan M

    更新日期:2018-01-01 00:00:00

  • The prediction of long-term functional outcomes of children with cerebral palsy.

    abstract::Current information was obtained from 117 respondents, including 71 who completed interviews, of a population of 810 individuals who had been diagnosed with cerebral palsy between 1951 and 1974. Original chart reviews constituted the basis for predicting employment capabilities of the interviewed cohort. A comparison ...

    journal_title:Developmental medicine and child neurology

    pub_type: 杂志文章


    authors: O'Grady RS,Crain LS,Kohn J

    更新日期:1995-11-01 00:00:00