File Name: stroke in neonates and children 2016 .zip
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Paediatr Child Health 25 1 — Dietary sodium is required in very small amounts to support circulating blood volume and blood pressure BP. Available nutritional surveillance data suggest that most Canadian children consume sodium in excess of their dietary requirements. High sodium intakes in children may be an indicator of poor diet quality. Results from systematic reviews and meta-analyses have demonstrated that decreasing dietary sodium in children leads to small but clinically insignificant decreases in BP.
However, population-level strategies to reduce sodium consumption, such as food product reformulation, modifying food procurement processes, and federal healthy eating policies, are important public health initiatives that can produce meaningful reductions in sodium consumption and help to prevent chronic disease in adulthood.
Sodium is an electrolyte that maintains extracellular fluid volume, thereby supporting effective circulating volume and blood pressure BP [ 1 ]. In infants and children, these essential physiological effects require only small amounts of dietary sodium. Paediatricians ensure that sufficient sodium is being provided for optimal growth in neonates.
Sodium is ubiquitous in the Canadian food supply and high amounts of sodium are common in processed and pre-packaged foods. It is well known that reducing dietary sodium reduces hypertension in adults [ 2 ] — [ 4 ]. However, the impacts of consuming a high sodium diet on risk for hypertension and other chronic diseases in healthy children are less clear. This statement describes the current evidence linking dietary sodium with adverse health outcomes in healthy children and provides recommendations for assessing and managing sodium intake and healthier eating.
For infants aged 0 to 6 months old, the adequate intake AI for sodium is based on amounts found in breast milk. The AI for older infants 6 to 12 months was determined by estimating the sodium content of breast milk and complementary foods. The NASEM committee believed that children aged 12 months have sufficient renal function to maintain sodium balance at these AI levels. Overall, there is insufficient evidence to determine whether reducing mean sodium intakes to 2, mg per day [ 4 ] would more positively influence cardiovascular disease or all-cause mortality outcomes in the general adult population.
Despite these guidelines, sodium intakes in Canadian children are known to be high. The CCHS did not assess sodium intake in infants. In the USA, infants 6 to 12 months of age consume an estimated to mg of sodium per day [ 7 ] [ 8 ]. Also, because there is no recognized CDRR or UL for infants younger than 12 months [ 1 ] , it is impossible to compare infant sodium intakes with guideline recommendations. These estimates are similar to those found in [ 9 ].
Bakery products, mixed dishes, processed meats, cheeses, and soups are the top five dietary sources of sodium. Boys tend to consume more sodium than girls because their overall caloric intakes are higher [ 6 ]. Historically, salt has been added to food for flavour, preservation, and to provide the chemical reaction needed for baking and other types of food preparation. Adding salt and other sodium-containing compounds e. However, this practice can also be deceiving, in that some foods can contain large amounts of sodium without tasting salty [ 11 ].
For examples of how sodium levels increase with food processing, see Table 2. At birth, human infants are either insensitive or indifferent to salty taste.
The development of a preference for salt may begin in infancy. Dietary exposure to sodium in early life may contribute to a preference for a salty taste in the preschool years [ 15 ]. BP response to dietary sodium is believed to vary widely among individuals. Sodium sensitivity is more common in people with hypertension, of African-American heritage, in women, and in individuals with metabolic syndrome [ 16 ].
The actual prevalence of sodium sensitivity in the Canadian population is unknown. The lack of standard definitions or practical, validated assessment methods has limited the ability to identify sodium sensitivity in clinical practice. However, even without a diagnostic test, demographic and clinical phenotypes associated with sodium-sensitive BP can be used to guide dietary advice [ 16 ]. Reduced dietary sodium is associated with small reductions in systolic BP in infants and children [ 2 ] [ 20 ] [ 21 ].
One systematic review [ 2 ] [ 22 ] analyzed data from 9 randomized control trials RCTs , using 14 comparisons, and found that decreases in dietary sodium reduced mean resting systolic BP by 0. However, there was no effect of sodium on systolic or diastolic BP in children when non-randomized trial data were removed from the meta-analysis [ 2 ] [ 22 ].
Another systematic review [ 3 ] found no significant differences in systolic or diastolic BP in children and youth aged 1 to 18 years who participated in short-term sodium reduction interventions. Removal of high or unclear risk for bias studies from the analysis revealed a small 0. Emerging research suggests an association between high sodium intake and obesity in children [ 24 ] — [ 26 ]. Children who consume more sodium may also drink more sugar-sweetened beverages [ 27 ] — [ 29 ].
Higher sugar-sweetened beverage consumption has been speculated to lead to excess energy intake. The associations between sodium consumption and hypertension may be stronger among children and youth whose BMI indicates overweight or obesity [ 30 ] — [ 32 ]. Although mechanisms to explain the association between sodium consumption and hypertension are unclear [ 3 ] [ 34 ] , they may well be mediated by overall diet quality.
Specifically, high sodium intake may be a marker for poor quality diet overall, because children who consume foods that are high in sodium, such as processed foods, may also eat foods that are high in calories, sugar, and fat [ 34 ] — [ 37 ].
Concerns have been raised that reducing sodium intake adversely affects insulin resistance, blood lipids, catecholamines, and cardiovascular disease risk factors [ 38 ] — [ 40 ]. However, such effects may be temporary or only seen in studies of lower methodological quality.
Recent reviews examining trials in adults have concluded that evidence is insufficient to suggest there is harm in lowering sodium intake on measures of serum glucose, insulin resistance [ 3 ] [ 5 ] [ 41 ] , and measures of blood lipid or catecholamines in interventions lasting at least 4 weeks [ 3 ] — [ 5 ]. A similar trend was observed for diastolic BP [ 43 ]. Despite these encouraging findings, one systematic review concluded that adherence to the DASH diet may be suboptimal among adolescents [ 44 ].
It is plausible that adolescents are less concerned about the cardiovascular risks of hypertension than middle-aged adults. Since modest reductions in sodium over the long term in adults have been found to improve BP without adverse effects on hormone or lipid levels [ 45 ] , and because adherence to dietary interventions varies widely among individuals [ 44 ] , population-level sodium reduction interventions to reduce BP have been recommended [ 46 ].
Indeed, population-level interventions may be more effective in reducing dietary sodium consumption than individual, behaviour-based interventions [ 47 ] — [ 49 ]. A recent Cochrane review [ 48 ] reported that multicomponent government-level interventions were best suited to reduce population-level sodium intakes. Food environment interventions, such as the reformulation of specific food products and improved food procurement processes, have yielded positive results by effectively decreasing sodium levels across the food supply chain.
The Canadian government has initiated several policies to lower sodium consumption. In , Health Canada published voluntary sodium reduction targets [ 52 ] and asked the food industry to reduce the amount of sodium in processed foods by [ 53 ]. Almost half of the food categories targeted showed no meaningful reductions in their sodium content and some were even higher in sodium in compared with levels.
There are no regulated maximum sodium limits for food products intended solely for children 1 to 4 years of age. The food industry has until to apply these new labelling requirements [ 56 ]. Front-of-package regulations [ 58 ] in Canada will require that a specific label be displayed on packaged foods deemed to be high in sodium as well as foods high in sugars or saturated fat , based on pre-determined thresholds.
Restricting the marketing of foods and beverages to children and youth continues to be a promising policy initiative. Because dietary preferences for salty foods and overall dietary habits are formed in childhood [ 59 ] , it is logical that interventions to reduce sodium include the paediatric population. Canadian children who ingest high levels of dietary sodium may be consuming a poorer quality diet overall, putting them at risk for obesity and adult hypertension.
Reducing the population-level consumption of processed foods high in sodium may be particularly impactful. Although reducing dietary sodium appears to have only small, clinically insignificant effects on BP response in individual children, lowering dietary sodium intake during childhood and adolescence remains an important public health initiative to prevent chronic disease in adulthood [ 2 ].
Paediatric health care providers must understand the concerns around high dietary sodium, counsel families to reduce intake levels and support government and public health strategies to reduce the high amount of dietary sodium Canadian families consume. The authors wish to thank Nikate Singh, Dr. Boctor MD past member , Linda M. Casey MD, Jeffrey N. Rieder MD PhD. Disclaimer: The recommendations in this position statement do not indicate an exclusive course of treatment or procedure to be followed.
Variations, taking into account individual circumstances, may be appropriate. Internet addresses are current at time of publication. Skip to Content. Home Clinical practice Position statements and… Current: Dietary intake of sodium… Position statement. Posted: Jan 30, Abstract Dietary sodium is required in very small amounts to support circulating blood volume and blood pressure BP.
Information for parents Healthy eating for children. Table 1. Data drawn from reference [ 4 ]. Table 2. Comparison of sodium content in unprocessed i. Information drawn from reference [ 5 ]. Figure 1. Average dietary sodium intake in children, according to age group. Figure 2.
Percentage of children in Canada consuming sodium above upper tolerable level ULs , according to age group.
Neonatal stroke can be a cause of long term neurodevelopmental disability, seizures, and impaired cognitive function. We present four cases of neonatal stroke, associated with different risk factors and clinical presentations. Two of these newborns were born to mothers with no prenatal care. Neonatal stroke is an important complication to consider when assessing a newborn as it has the potential for chronic sequelae related to neurodevelopment. Injury to cerebral tissue occurs by a disruption in arterial blood flow either from a thrombus or embolism, also known as PAIS, or from an interruption by a thrombus in a major cerebral vein, otherwise known as CSVT. Here, we present four consecutive cases of neonatal stroke over a period of two years, associated with different risk factors and different clinical presentations. Two of these babies were born to mothers with no prenatal care.
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The Canadian Paediatric Society gives permission to print single copies of this document from our website. For permission to reprint or reproduce multiple copies, please see our copyright policy. Paediatr Child Health 25 1 —