Chronic renal failure in infancy. Two dietetic case reports.

Dietetic care of infants with end stage renal disease (ESRD) involving intensive nutritional support and frequent monitoring in attempts to optimise growth has not been previously quantified. We describe the progress of two male infants born with ESRD due to renal dysplasia. Child A and child B were commenced on continuous cyclic peritoneal dialysis at mean age of 3 months and required nutritional support via a gastrostomy button. Energy intakes pre-dialysis (147 kcal/kg) and energy and protein intakes during the first year of life on CCPD (137 kcal/kg, 2.6 g/kg actual body weight) were greater than recommended for the healthy population. Over the 2 year period without growth hormone, height SDS increased from -1.66 to -0.17 and 0.67 to 0.78 and weight SDS increased from -1.26 to -0.43 and 0.31 to 1.75 for Child A and Child B respectively. Mean dietetic contacts (in/out patient and telephone) over the 2 years were 11.8 contacts/mth pre-dialysis, 8.4 contacts during the first year on CCPD and 4.3 contacts during the second year. We conclude that infants with end stage renal disease require frequent dietetic contact in combination with early dialysis and tube feeding to achieve nutritional goals and optimise growth. In addition, dietetic advice provides valuable family support.