Nerve Ultrasound for Detecting Morphologic Changes in Malnourished Children Under 5 Years of Age: A Comparative Study of Nutritional Intervention Outcomes in Bangladesh.

Introduction/aims: Malnourished children may experience disrupted peripheral nerve myelination, leading to impaired nerve conduction. However, ultrasound data on nerve morphology in severely malnourished children are lacking. Therefore, we performed a systematic study, comparing nerve ultrasound in malnourished children to controls.

Methods: Nerve cross-sectional area (CSA) was assessed in three categories of malnourished (severe acute malnutrition [SAM], stunted, and wasted) and healthy Bangladeshi children aged 6-59 months to compare morphological changes at baseline (pre-intervention) and post-nutritional intervention.

Results: A total of 74 children were enrolled, including 17 with SAM, 19 wasted, 18 stunted, and 20 healthy controls. SAM children showed smaller nerve CSA compared to wasted peers, particularly in the sciatic nerve (8.25 mm² vs. 11.48 mm², p = 0.035) and median nerve proximal wrist (2.65 mm² vs. 2.90 mm², p = 0.004) among 6-23-month-olds. In the 24-59-month group, the median nerve proximal wrist CSA in SAM children was 2.30 mm² versus 3.90 mm² in healthy children (p = 0.019), and sciatic nerve CSA was 9.05 mm² versus 16.60 mm² (p = 0.008). Nutritional intervention improved z-scores in SAM children numerically, though not significantly within the study period.

Discussion: SAM children had smaller nerve CSA compared with wasted, stunted, and healthy children at specific nerve locations. These findings underscore the substantial impact of SAM on nerve morphology and the importance of early, sustained nutritional interventions, warranting further validation through animal models and large-scale studies in both children and adults.