Journal of Pediatric Gastroenterology and Nutrition最新文献

Objectives: Rotavirus vaccine clinical trials and post-licensure evaluations found malnourished children may have lower protection against rotavirus diarrhea hospitalizations than well-nourished children. On a population level, rotavirus vaccines are less protective in high child mortality settings.

Methods: We analyzed rotavirus vaccine effectiveness (VE) among malnourished and well-nourished children categorized using four anthropometric malnutrition indicators, birthweight, and reported malnutrition from medium to high child mortality countries in the Multi-National Subpopulations Study to Evaluate Rotavirus Vaccines (MNSSTER-V) dataset. We calculated child-level z-scores for weight-for-age, length-for-age, weight-for-length, and mid-upper arm circumference (MUAC), and the site-level proportion implausible z-scores. Sites with published VE estimates by nutritional status or those with <3% implausible values were included in the final analysis. Z-scores <-2 were considered moderate-to-severe malnutrition and <-3 were considered severe malnutrition. We calculated complete series rotavirus VE in each malnourished and well-nourished group using an unconditional adjusted logistic regression model, where VE = (1 - odds ratio of vaccination among cases and controls) × 100, where cases and controls were children who tested rotavirus positive and negative, respectively.

Results: Complete series VE was more protective among children without stunting (normal length-for-age) (59%; 95% confidence interval [CI]: 49-67) compared to children with moderate-to-severe stunting (42%; 95% CI: 19-58) and severe stunting (31%; 95%CI: -14 to 58). Adjusted VE point estimates were similar among malnourished and well-nourished children using the other anthropometric and birthweight indicators.

Conclusions: Our findings clearly show that chronic malnutrition negatively impacted rotavirus VE. Efforts to address and prevent malnutrition generally may further reduce the burden of rotavirus morbidity and mortality.

Objectives: Deficiency of serum 25-hydroxyvitamin D [25(OH)D] was associated with decreased short-term response to anti-tumor necrosis factor-alpha (TNF-α) agents in adults with inflammatory bowel disease (IBD). The aim of this study was to evaluate the association between serum 25(OH)D levels and the outcome of children with IBD undergoing anti-TNF-α therapy.

Methods: Children with IBD who were treated with anti-TNF-α agents and whose 25(OH)D levels had been measured at the initiation of therapy were included. Demographic, clinical, and laboratory data were collected retrospectively between 1/2012 and 1/2022. 25(OH)D levels above 30 ng/mL were considered sufficient.

Results: A total of 150 children with IBD were treated with anti-TNF-α agents, and 84 of them (58 Crohn's disease, 26 ulcerative colitis, median [interquartile range] age 15.2 [12.8-16.5] years) met the inclusion criteria. Sixty-five (77%) patients were 25(OH)D-deficient. Adequate 25(OH)D levels were associated with clinical response (hazard ratio [HR] = 4, 95% confidence interval [CI] 1.43-11.11, p = 0.008), and clinical remission (HR = 4.62, 95% CI 2.56-8.33, p < 0.001). While anti-TNF-α trough levels were comparable between 25(OH)d-deficient and non-deficient children, intensification of anti-TNF-α therapy was more prevalent among children with 25(OH)D deficiency (65% vs. 21%, p < 0.001).

Conclusions: Adequate serum 25(OH)D is an independent predictor of a favorable outcome of pediatric IBD under anti-TNF-α therapy.

Objective: To assess whether sports drinks as polyethylene glycol (PEG) solvent improve compliance, bowel preparation, and acceptability in children with autism spectrum disorder (ASD).

Methods: In this randomized trial, 60 ASD children (30 per group) received PEG in sports drinks (experimental) or water (control). Outcomes included compliance, Boston Bowel Preparation Scale (BBPS) scores, need for enemas, safety (glucose and electrolytes), adverse events, and caregiver-reported tolerance.

Results: The sports drink group had higher compliance (83.3% vs. 60.0%, relative risk [RR]:1.39, 95% confidence interval [CI]: 1.00-1.94, p = 0.045), reaching borderline statistical significance, as well as better BBPS (7.5 ± 0.8 vs. 6.0 ± 1.0, p < 0.05), and more adequate preparation (96.7% vs. 66.7%, RR: 1.45, 95% CI: 1.12-1.88, p = 0.003). They required fewer enemas (6.7% vs. 26.7%, RR: 0.25, 95% CI: 0.06-1.08, p = 0.038) and had fewer adverse events (10.0% vs. 33.3%, RR: 0.30, 95% CI: 0.09-0.98, p = 0.028). No concerning side effects were observed, and blood glucose and electrolyte levels remained within normal ranges. Caregiver tolerance scores were higher (median 8 vs. 6, p < 0.001).

Conclusion: Sports drinks as PEG solvent significantly enhance compliance, bowel preparation, and acceptability in ASD children without safety concerns, offering a practical child-friendly strategy.

Objectives: Probiotic effects are strain-specific; each strain needs to be assessed individually. In this review, we evaluated the effectiveness of Limosilactobacillus reuteri DSM 17938 in preventing antibiotic-associated diarrhoea (AAD) in children receiving systemic antibiotics.

Methods: We searched the Cochrane Library, MEDLINE, EMBASE and trial registries (January 2016-July 2025) for randomized controlled trials (RCTs) comparing L. reuteri DSM 17938 with placebo, no treatment, or other probiotics in children. Risk of bias was assessed with Risk of Bias 2 (ROB-2), and certainty of evidence with Grading of Recommendations, Assessment, Development and Evaluation (GRADE).

Results: Three RCTs (1070 randomized, 998 analysed) were included. No significant effect was observed with ≤14-day administration (two RCTs, n = 901; risk ratio [RR] 0.85, 95% confidence interval [CI]: 0.26-2.77; low certainty evidence), with interpretation limited by heterogeneity (I² = 91%) and analytical differences. A regimen of up to 21 days reduced AAD risk (two RCTs, n = 751; RR: 0.50, 95% CI: 0.33-0.75; moderate certainty evidence). A post hoc analysis of trials with follow-up up to 56 days showed no significant effect (three RCTs, n = 998; RR: 0.85, 95% CI: 0.29-2.46; I² = 83%). A subgroup analysis limited to children receiving amoxicillin-clavulanate showed benefit (two RCTs, n = 690; RR: 0.49, 95% CI: 0.32-0.76; I² = 0%).

Conclusions: L. reuteri DSM 17938 may reduce the risk of AAD in children when administered for up to 21 days or in those receiving amoxicillin-clavulanate. No benefit was found with shorter administration or extended follow-up. Further high-quality trials are needed before routine use can be recommended.

Objectives: Baby-Led Weaning (BLW) has been anecdotally linked to healthier eating habits and lower picky eating tendencies, yet empirical evidence remains limited. This study investigates the association between BLW and picky eating in children aged 2-5 years, comparing it with traditional spoon-feeding methods.

Methods: A cross-sectional study was conducted in Metro Manila, Philippines (June to August 2024), using convenience and snowball sampling. Parents (n = 284) reported their child's complementary feeding method, classified it as: (1) Strict BLW (BLW > 90%), (2) Predominantly BLW (BLW 51%-90%), (3) Predominantly traditional spoon-feeding (BLW 10%-50%), or (4) Strict Traditional Spoon-Feeding (BLW < 10%). Picky eating was assessed using the Food Fussiness (FF) subscale of the Children's Eating Behavior Questionnaire (CEBQ), with FF $\ge$  3 indicating picky eating. Logistic regression examined associations between feeding method and picky eating, with sensitivity analyses using FF  $\ge$ 2.8 and FF  $\ge$ 3.2, and linear regression modeling FF as continuous outcome. Associations with other CEBQ subscales were also explored.

Results: Strictly BLW was associated with a 95.4% lower likelihood of picky eating compared to strict traditionally spoon-feeding (p < 0.01). Findings remained robust across alternative cut-offs when FF was modeled as a continuous outcome. Satiety responsiveness, slowness in eating, and emotional undereating were positively associated with fussiness, while higher enjoyment of food and food responsiveness were inversely related.

Conclusion: BLW is consistently associated with substantially lower odds of picky eating in early childhood. These findings support BLW as a potentially effective approach to fostering positive feeding behavior and food acceptance in early childhood.

Objectives: Food insecurity (FI) is a critical determinant of child health associated with increased healthcare utilization and poorer health outcomes. Our objectives were to (1) characterize differences between individuals seen in a pediatric gastroenterology clinic who screen positive versus negative for FI, including demographics, anthropometric data, gastrointestinal (GI) diagnoses, and presence of dietary restrictions and (2) identify specific GI diagnoses associated with greater health care utilization among individuals who screen positive for FI.

Methods: Retrospective study of all patients screened for FI from August 2022 to March 2025 at a single center. Data collected included the FI screen, demographics, anthropometric data, GI diagnoses, emergency department (ED) utilization, hospitalizations, and missed office visits.

Results: A total of 1789 individuals were screened for FI. Compared to individuals without FI, the FI group had significantly higher proportions of individuals identify as Black or African American, Hispanic or Latino, report Spanish as their primary language, and use Medicaid insurance (all p < 0.001). FI was also associated with a diagnosis of enteral feeding tube use (p < 0.001). The FI cohort had greater odds of missed office visits (multivariate: odds ratio [OR]: 1.45, 95% confidence interval [CI]: 1.02-2.05, p = 0.036), ED visits (multivariate: OR 1.58, 95% CI: 1.02-2.39, p = 0.035), and hospitalizations (multivariate: OR 2.21, 95% CI: 1.19-3.93, p = 0.009), compared to patients without FI adjusting for age, gender, race, ethnicity, and use of enteral tube.

Conclusions: In a cohort of pediatric GI patients, FI was associated with a diagnosis of an enteral feeding tube use. FI was further associated with a greater odds of missed office visits, ED visits, and hospitalizations.

Objective: A tracheoesophageal fistula (TEF) is an abnormal communication between the esophagus and trachea, most often associated with esophageal atresia (EA), a rare congenital malformation affecting 1 in 2400-4500 live births. While surgical repair of EA/TEF is typically completed in infancy, recurrent or missed TEF can be diagnosed later. Open repair can be technically challenging, often requiring re-do thoracotomy or neck dissection. We describe our center's experience, using endoscopic electrocautery in combination with esophageal clips for closure of TEF.

Methods: We conducted a retrospective review of all patients who underwent an endoscopic TEF repair with esophageal clip application at our institution (IRB# 20-021016). All patients underwent triple endoscopy (flexible bronchoscopy, esophagogastroduodenoscopy, and rigid bronchoscopy) with pulmonary, gastroenterology (GI), and otolaryngology (ENT). Electrocautery was performed on the tracheal side by ENT or pulmonary and esophageal clip placement by GI.

Results: Between November 2019 and February 2025, 14 patients underwent successful endoscopic closure of 15 TEF. One patient failed endoscopic closure of a proximal missed congenital TEF but had successful endoscopic closure of their recurrent TEF. Ten TEF were closed with electrocautery and esophageal clip placement while five were closed with cautery alone. No significant complications occurred, and all closures were confirmed with follow-up endoscopy.

Conclusion: Endoscopic electrocautery with esophageal clip application, by a skilled multidisciplinary team, offers a minimally invasive alternative to open repair for missed congenital, recurrent, and acquired TEFs. It may be considered as a first line approach, especially in patients with high surgical risk.

Objective: To investigate ultrasound parameters, particularly splenic stiffness, as predictors of pediatric esophageal varices.

Methods: We included all children aged 0-19 years who underwent esophagogastroduodenoscopy, for variceal screening or surveillance, and abdominopelvic ultrasound with splenic elastography measurement. We also recorded biological parameters (platelets count, albumin) to determine a clinical prediction rule (CPR). Derivation and validation cohorts were defined according to measurement date. Receiver-operating characteristic (ROC) statistics and sensitivity, specificity, positive predictive value, and negative predictive value for the optimal threshold value were calculated, and used to assess the performance of each parameter.

Results: Eighty derivation cohort children and 58 validation cohort children formed the study sample. Cohort characteristics did not differ for age, sex, distribution of varices but differ for some etiologies, abdominal surgery, spleen size, splenic stiffness measurement (SSM), ascites, and the presence of spontaneous portosystemic shunts. In the derivation cohort, splenic stiffness was the best independent predictor of esophageal varices, with an area under the ROC curve (AUC) of 0.83, a sensitivity of 0.90, and specificity of 0.73 at a threshold of 22 kPa. In the validation cohort, SSM was no longer significantly associated with esophageal varices at endoscopy, had a lower sensitivity of 0.26, and no other threshold could be found. Liver stiffness measurement (LSM) and CPR had a correct predictive value (AUC 0.70 for LSM; 0.78 for CPR in the derivation cohort and 0.64 for LSM; 0.71 for CPR in the validation cohort) for esophageal varices.

Conclusions: SSM cannot be used as a single parameter to predict esophageal varices. LSM and CPR despite their lower AUC appear to much more robust measures with consistent results across cohorts.

Prebiotics are defined as substrates that are selectively utilized by host microorganisms, conferring health benefits. This technical review focusing on prebiotic-supplemented infant formulas is one of the five manuscripts developed by the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition Special Interest Group on Gut Microbiota and Modifications (SIG-GMM). The SIG-GMM conducted a technical review to evaluate the clinical outcomes of prebiotic-supplemented infant formulas in healthy infants (0-12 months) that were published before 2024. The review focused on the following clinical outcomes: anthropometric measurements, stool frequency and consistency, gastrointestinal symptoms, allergy prevention, infection prevention, and safety/tolerability. Following the review, all 20 SIG members anonymously voted on each statement, scoring them from 0 to 9. A score ≥6 indicated agreement with a statement. A statement was rejected if ≥75% of the members voted <6. Fifty-one publications were included, focusing on prebiotics such as short-chain galacto-oligosaccharides, long-chain fructo-oligosaccharides, acidic oligosaccharides, and polydextrose/galacto-oligosaccharides. This technical review demonstrates that prebiotic-supplemented formulas are well tolerated, with no significant differences in anthropometric parameters compared to those fed non-supplemented formula. Prebiotic supplementation decreased stool consistency and increased stool frequency depending on the dosage and type. This technical review provides information on prebiotic-supplemented infant formulas in healthy infants. Overall, no significant clinical health benefits were observed in terms of infections and antibiotic use, colic, and allergy.