P378 NUTRITIONAL DIAGNOSIS AND ANTHROPOMETRIC EVALUATION AFTER LIVER TRANSPLANTATION IN CHILDREN AND ADOLESCENTS

Paediatrics 1 P377 THE NUTRITIONAL STATUS (NS) AS PROGNOSTIC INDICATOR OF LIVER TRANSPLANTATION IN THE PAEDIATRIC PATIENT A. Carollo1 , S. Bavetta1 , S. Cammarata1 , R. Di Stefano1 , A. Provenzani1 , M. Sidoti1 , F. Venuti1 , V. Zampardi1 , P. Polidori1 . 1 Clinical Pharmacy, Mediterranean Institute for Transplantation ISMETT, Palermo, Italy Rationale: Malnutrition (M) is a multifactorial process in children with chronic liver disease and carries an increased risk of morbidity and mortality. Maintaining optimal NS can prevent further derangement of liver function: increasing metabolic energy and improving the immunology status. In fact, M adversely affects on the outcome of surgical patients (pts). In this study we intend to demonstrate how the NS can influence the outcome of liver transplant (LTx) in the paediatric population. Methods: We evaluated 74 paediatric pts over 24 months from 2006 to 2007 who underwent LTx at ISMETT. The age of the pts ranged between 18 months and 12 years. The causes of the LTX were: 43%biliary atresia, 10%hepatoblastoma, 10%acute fulminant hepatitis, 7%graft non function, 5%autoimmune hepatitis and 25%other. Upon admission, the pts undergo a nutritional screening by a multidisciplinary team (physicians, clinical pharmacists, dietitians) who assess the NS and establish a customized nutritional plan based on the clinical needs. The nutritional assessment includes: clinical history, a retrospective analysis of the NS, anthropometrical (National Center of Health Statistics Tables) and biochemistry data. Results: Of the 74 pts assessed immediately before the LTx, 14 were between 3º-5ºpercentile weight/height (wt/ht): severe M, 20 were between 10º-25º: moderate M, 30 between 25º-50º: normal NS and only 5 pts were above 50º: good NS. Of the 14 pts between 3º-5ºpercentile wt/ht, there were 2 deaths and 7 pts underwent redo-LTx and the average length of stay (LOS) was 50 days. Of the 20 pts between 10º-25ºpercentile wt/ht only 2 underwent redo-LTx and 12 had post-surgery complications, the average LOS was 30 days. Of the 35 pts between 25º50ºpercentile wt/ht there was 1 death and 7 pts had complications post-surgery while the average LOS was around 30 days. Conclusion: As the results show, the NS can effectively be a prognostic indicator in the LTx, as optimal nutrition may prevent further derangement of liver function. Disclosure of Interest: None declared

P378 NUTRITIONAL DIAGNOSIS AND ANTHROPOMETRIC EVALUATION AFTER LIVER TRANSPLANTATION IN CHILDREN AND ADOLESCENTS A.F. Delgado1 , P. Zamberlan1 , C. Leone1 , R. Feferbaum1 , T.S. Okay1 . 1 Pediatrics, S˜ ao Paulo University, S˜ ao Paulo, Brazil Rationale: Poor nutritional status is especially common in children with chronic liver disease because of anorexia, fat malabsorption, abnormal nutrient metabolism, and increased energy expenditure. Malnutrition can be an

189 important factor to increase mortality, provoking a difficult recovery of these patients. Methods: We performed anthropometric nutritional evaluation of 45 patients after liver transplantation with cadaveric or living donors during the first 12 hours. A standardized prospective protocol was established with the following data, including Z scores: height/age, weight/ height, body mass index, midarm circumference/height (National Center of Statistics/2000 standards). Mean and standard deviation of all data and nonparametric analysis (Mann Whitney test) was calculated to identify significant differences between Z scores for height/age, midarm circumference/height and the other parameters. Results: We analysed 45 children and adolescents with mean of 41.6 months (sd 33.3) admitted in a tertiary intensive care unit between January of 2005 and march of 2008. Mean and standard deviation of Z scores were: height/age ( 2 sd 1.9), midarm circumference/height ( 2 sd 1.9), weight/height (0.5 sd 1.4), body mass index (0.8 sd 1.3). There were significant differences (p < 0.05) considering the first two measures (height/age and midarm circumference/height Z-scores) in comparison to the other parameters. Conclusion: Nutritional evaluation during early postoperative period was effective to diagnose chronic malnutrition with a statistically significant relationship considering height/age and midarm circumference/height Z-scores (p < 0.05). Parameters that are commonly used to identify acute malnutrition (weight/height Z-score for example) can underestimate nutritional condition although there was a good relationship between weight/ height and body mass index Z-scores. References Ramaccioni V, Soriano H, et al. Nutritional aspects of chronic liver disease and liver transplatation in children. Disclosure of Interest: None declared

P379 OUTCOME OF INTESTINAL FAILURE ASSOCIATED LIVER DISEASE (IFALD) 1 15 YEARS AFTER STARTING INTRAVENOUS FEEDING IN THE NEONATAL PERIOD R. Tomar1 , V. Horn2 , S.M. Hill1 . 1 Paediatric Gastroenterology, 2 Pharmacy, Great Ormond Street Hospital for Children, London, United Kingdom Rationale: To investigate the incidence and outcome of liver disease in children with intestinal failure from the neonatal period treated with parenteral nutrition (PN) for >12 months who were discharged home still on treatment. Severity of liver disease was compared with the incidence of sepsis in infancy. Methods: 39 children (17 male, 22 female) born between 1990 and 2002 and discharged home on intravenous feeding were reviewed. Aetiology of intestinal failure was short gut in 20 (53%), enteropathy in 11 (29%) and dysmotility in 7 (18%). One child with early-onset microvillous atrophy was excluded. Results of serum bilirubin levels were recorded at 6 and 12 months and 2, 5, 10 and 15 years. Numbers of episodes of sepsis before 12 months of age were calculated. Results: Incidence of liver disease at 6 months was 52% (7/25 mild {serum bilirubin 50 99 umol/L}, 6/25 severe