Journal of Pediatric Gastroenterology and Nutrition最新文献

Objective: Feeding difficulties (FDs) are common among children with esophageal atresia (EA) and tracheoesophageal fistula (TEF), but knowledge about their prevalence and risk factors is limited. This multicenter study aimed to assess the prevalence, subtypes, and associated factors of FD in children with EA/TEF.

Methods: Parents of children who underwent surgery for EA/TEF in four tertiary centers in Israel (2005-2022) completed a structured questionnaire. Pediatric feeding disorder (PFD) was diagnosed by means of the Montreal Children's Hospital Feeding Scale and classified by consensus criteria into four subtypes: feeding skills, nutritional, medical, and psychosocial dysfunctions.

Results: Seventy-five children were included (median age: 40 months; 48 males), of whom 57 (76%) were reported to have FD, primarily due to impaired feeding skills (42%). Lower gestational age, low birth weight, and delayed oral feeding were significantly associated with PFD (37 vs. 39 weeks, p = 0.001, 2130 g versus 3084 g, p = 0.001 and 14 versus 10 days, p = 0.05, respectively). Only half of the children received timely and appropriate multidisciplinary follow-up care.

Conclusion: FDs are highly prevalent in children with EA/TEF, mostly due to impaired feeding skills. Several clinical and perinatal factors are associated with the development of these problems, calling for early and multidisciplinary intervention to improve outcomes.

Objectives: High protein intake during infancy has been linked to accelerated weight gain and increased obesity risk. This study aimed to examine the effects of a low-protein formula during the first 6 months of life on blood metabolic and hormonal markers during early childhood.

Methods: Formula-fed infants (<45 days) were randomized to receive either a low-protein formula with modified amino acid composition (mLP; n = 90; 1.7 g protein/100 kcal) or a control formula (CTRL; n = 88; 2.1 g protein/100 kcal) until 6 months of age. Breastfed infants served as a reference group (n = 67). Blood samples were collected in cooperating subjects at 1, 2, and 6 years. We measured insulin-like growth factor-1 (IGF-1), IGF-binding proteins (BPs), leptin, glucose, and insulin, and calculated Homeostatic-Model-Assessment-of-Insulin-Resistance (HOMA-IR). Data were analyzed using linear mixed models and linear regression, adjusting for confounders. In addition, results were correlated to priorly published body composition measurement.

Results: Venous blood was collected from 87 (36%), 77 (31%), and 63 (26%) participants at ages 1, 2, and 6 years, respectively. No differences were found in metabolic markers between the formula groups or compared to the breastfed group at any time point. Furthermore, at 6 years of age, a positive correlation was found between some biomarkers (IGF-1, leptin, and HOMA-IR) and body composition measurements, but not all biomarkers showed such an association.

Conclusions: In this relatively small study, providing a modified, low-protein infant formula during the first months of life did not affect hormonal and metabolic markers during early childhood.

Objectives: Eosinophilic esophagitis (EoE) is characterized by eosinophilic inflammation and epithelial remodeling. However, current biomarkers focus predominantly on eosinophilia, overlooking basal cell hyperplasia (BCH), a histologic feature that may persist despite treatment. We aimed to differentiate EoE from non-EoE based on inflammatory biomarker profiles, identify biomarkers associated with BCH, and explore their relation toPPI response and food impaction using high-throughput proteomics.

Methods: We conducted a prospective case-control study of patients aged 6-65 undergoing upper endoscopy for suspected EoE. Histology classified patients as EoE (>15 eos/hpf), non-EoE, and assessed for the presence of BCH. Serum was analyzed using the Olink® Explore 384 Inflammation Panel. We compared biomarker expression between EoE versus non-EoE, and BCH versus non-BCH, with adjustment for age, sex, and atopic disease. Exploratory analyses investigated biomarkers related to PPI response and food impaction.

Results: Among 86 patients, 26 (30.2%) had EoE and 32 (37.2%) had BCH. CCL26, a marker of eosinophilic inflammation, was the most significantly upregulated biomarker in EoE, was also elevated in BCH, and remained nominally significant even after adjusting for maximum eosinophil count. ITGA11 and TNFRSF11A were nominally associated with BCH independent of eosinophil count. COL9A1 was nominally associated with PPI response and downregulated in non-EoE patients. Oncostatin M (OSM) and TGF-α were nominally associated with food impaction.

Conclusions: High-throughput proteomic profiling revealed distinct biomarker signatures in EoE. CCL26 was the most significantly upregulated marker, associated with both eosinophilic inflammation and epithelial remodeling. COL9A1 may be associated with GERD-related inflammation and PPI responsiveness. These findings support a dual-pathway model of EoE and suggest potential for biomarker-guided diagnosis and treatment.

Little information exists about social risk among pediatric gastroenterology, hepatology, and nutrition (PGHN) patients. The goal of this study was to examine racial and ethnic differences in social risk among Medicaid-insured PGHN patients. Electronic health records from 1341 patients between May 2022 and February 2024 with responses to the Accountable Health Communities screening tool were included. The main outcome was presence of any social risk. To test the hypothesis that racial and ethnic differences in social risk exist, logistic regression adjusting for child age, sex, and preferred language was used. Overall, 29% of patients reported a social risk. Compared to non-Hispanic white patients, patients with Hispanic/Latino, Black, other, and missing race and ethnicity had higher odds of reporting social risks. To promote health equity, better understanding of effective, holistic strategies to integrate social care into PGHN care is warranted.

Objectives: To characterise early postnatal microbial development across maternal gut, breast milk, and infant gut compartments, and explore potential modulation by maternal stress in a cohort of Chinese mothers practising traditional postpartum confinement.

Methods: This secondary analysis draws on a randomised controlled trial of a maternal relaxation intervention in late preterm and early-term dyads. Vaginally delivered mothers (34 + 0 to 37 + 6 weeks) and their exclusively breastfed infants were followed from 1 to 8 weeks postpartum. Maternal stool, breast milk, and infant stool samples were collected at both time points and analysed via 16S rRNA gene amplicon sequencing. Changes in gut microbiome diversity and composition (alpha andbeta diversity metrics) and the relative abundance of dominant genera were assessed overall and by intervention group.

Results: Microbiome diversity (alpha diversity metrics) remained stable across all sample types. However, we observed a compositional temporal shift in breast milk microbiota (p = 0.039), driven primarily by changes in the control group. Infant gut microbiota showed increased Bifidobacterium and decreased Staphylococcus and Enterobacteriaceae with time. A significant reduction in Staphylococcus was observed in breast milk of the intervention group only. Maternal gut microbiota remained stable.

Conclusions: Microbial composition in breast milk and infant gut shifted over the first 8 weeks postpartum, while maternal gut remained stable. Findings suggest maternal stress-reduction interventions may influence breast milk microbiota. Further research is warranted to confirm these effects and investigate mechanisms.