2:00 pm - 3:00 pm
Event details: A graduate exam seminar is a presentation of the student’s final research project for their degree.
This is an ALES MSc Final Exam Seminar by Andrea Razcon Echeagaray. This seminar is open to the general public to attend.
MSc with Dr. Diana Mager
Thesis Topic: Neurodevelopmental, nutritional, and clinical outcomes of infants and children with end-stage liver disease awaiting liver transplantation
Background/Aim: Pediatric end-stage liver disease (ESLD) patients are at high risk for neurodevelopmental delay (NDD) due to malnutrition, hyperammonemia and other medical complications before and after liver transplantation (LTx). The study aimed to determine NDD prevalence and its associations with pre-and-post LTx outcomes. Methods: A secondary analysis from a retrospective study in infants and children (31M/36F aged 0-8 years) who attended the Pediatric LTx Clinic at the Stollery Children’s Hospital (2006-2019) was conducted. NDD was assessed at LTx assessment using the Vineland Adaptive Behaviour Scales [motor skill, socialization, communication, adaptive behavior composite (ABC) scores]. The cohort was categorized as having an adequate adaptive level if the had an ABC score ≥85, and as having an inadequate adaptive level if their ABC score <85. Nutritional data [nutritional status (per Subjective Global Nutritional Assessment (SGNA), McLaren criteria for wasting and World Health Organization (WHO) criteria for stunting), and intake] was collected at LTx assessment. Growth parameters (daily weight/height gain, weight/height velocity SDS) and clinical outcomes [encephalopathy, Intensive Care Unit (ICU)/total hospital length of stay (LOS), ventilation dependence, mortality, infections/complications) were collected at all timepoints. Results: Neurodevelopmental status was predominantly adequate or low average. 72% lacked age-appropriate gross motor skills. A below median motor skills score was associated with increased rates of pre-LTx encephalopathy, post-LTx ICU LOS (trend), and ventilator dependency. Malnutrition was prevalent (36% moderately malnourished, 55% severely malnourished) in the cohort per the SGNA, but not per McLaren and WHO criteria. SGNA was found to be the strongest predictor of neurodevelopmental outcomes, followed by age. An adequate adaptive level ± malnutrition was associated with improved growth parameters in the 6- and 12-month follow-ups. A lower percentage of those with an inadequate adaptive level ± malnutrition achieved age-appropriate weight gain post-LTx. Conclusions: Pediatric patients with ESLD have high rates of NDD, particularly in the motor skill domain. NDD must be considered when developing intervention strategies pre- and post-LTx.