DOI: http://dx.doi.org/10.18203/2349-3291.ijcp20202139

Thymus size and its changes during treatment of children with severe acute malnutrition

Stalin Selvaraj, Seenivasan Venkatasamy, Sathyaseelan Sinnathambi

Abstract


Background: The study was conducted to radiologically demonstrate increase in thymus size with clinical recovery following nutritional rehabilitation in children with severe acute Malnutrition and to correlate the improvement with anthropometric and biochemical parameters.

Methods: Prospective observational study was conducted in 60 children in the age group of 6months to 24 months with severe acute malnutrition. Children with severe systemic illnesses were excluded from study. After obtaining informed consent from parents, history focusing on demography, perinatal events, nutrition including breast feeding and immunization status were recorded. Anthropometric parameters were measured. All relevant blood investigations and ultra-sonogram of the chest for thymus size were done. All children were followed up during the course of hospital stay till discharge and were also followed up after 2 months. Relevant blood investigations and ultrasonogram of chest for thymus size were also done during follow up.

Results: The difference in means of thymic area by imaging at admission and at discharge (p and lt;0.0001) and at admission and after 8 weeks (p and lt;0.0001) were statistically significant. The increase in weight, length, weight for length, mid upper arm circumference, hemoglobin, total protein, serum albumin, serum globulin from admission to discharge and from discharge to 8 weeks after admission was statistically significant.

Conclusions: Thymus size can be used as a marker of immunological dysfunction in severe acute malnutrition and as a marker of severity of the illness. The thymus size was found to be increasing in size during nutritionally rehabilitation and recovery from the illness. Correlations between anthropometric parameters and thymic size are not robust in under-nourished state and during nutritional rehabilitation.


Keywords


Immunological dysfunction, Nutritional rehabilitation, Severe acute malnutrition, Thymic size

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References


Rytter MJ, Namusoke H, Ritz C, Michaelsen KF, Briend A, Friis H, et al. Correlates of thymus size and changes during treatment of children with severe acute malnutrition: a cohort study. BMC Pediatrics. 2017;17(1):70.

Moore SE, Prentice AM, Wagatsuma Y, Fulford AJ, Collinson AC, Raqib R, et al. Early-life nutritional and environmental determinants of thymic size in infants born in rural Bangladesh. Acta Paediatrica (Oslo, Norway: 1992). 2009;98(7);1168-75.

Rytter MJ, Kolte L, Briend A, Friis H, Christensen, VB. The immune system in children with malnutrition--a systematic review. PloS One. 2014;9(8):e105017.

Varg I, Nescakova E, Toth F, Uhrinova A, Adamkov M. Nutrition and immune system: the size of the thymus as an indicator of the newborn's nutrition status. Anthropol Anz. 2011;68(3):265-74.

Collinson AC, Moore SE, Cole TJ, Prentice AM. Birth season and environmental influences on patterns of thymic growth in rural Gambian infants. Acta Paediatr. 2003;92(9):1014-20.

Hasselbalch H, Ersbøll AK, Jeppesen DL, Nielsen MB. Thymus size in infants from birth until 24 months of age evaluated by ultrasound. A longitudinal prediction model for the thymic index. Acta Radiol. 1999;40(1):41-4.

Yekeler E, Tambag A, Tunaci A, Genchellac H, Dursun M, Gokcay G, et al. Analysis of the thymus in 151 healthy infants from 0 to 2 years of age. J Ultrasound Med. 2004;23(10):1321-6.

Garly ML, Trautner SL, Marx C, Danebod K, Nielsen J, Ravn H, et al. Thymus size at 6 months of age and subsequent child mortality. J Pediatr. 2008;153(5):683-8, e1-3.

Hasselbalch H, Nielsen MB, Jeppesen D, Pedersen JF, Karkov J. Sonographic measurement of the thymus in infants. Eur Radiol. 1996;6(5):700-3.

Liang CD, Huang SC. Sonographic study of the thymus in infants and children. J Formos Med Assoc. 1997;96(9):700-3.

Namusoke H, Hother AL, Rytter MJ, Kæstel P, Babirekere-Iriso E, Fabiansen C, et al. Changes in plasma phosphate during in-patient treatment of children with severe acute malnutrition: an observational study in Uganda. Am J Clin Nutr. 2016;103(2):551-8.

Benn CS, Jeppesen DL, Hasselbalch H, Olesen AB, Nielsen J, Björkstén B, et al. Thymus size and head circumference at birth and the development of allergic diseases. Clin Exp Allergy. 2001 Dec;31(12):1862-6.