Journal of Pediatric Gastroenterology and Nutrition最新文献

To compare gamma-glutamyltransferase (GGT) levels in non-jaundiced breast and formula-fed newborns as a function of age, we retrospectively studied the laboratory findings of all infants without jaundice, infection, or known liver dysfunction, who underwent liver function tests, including GGT levels, in the emergency departments of the two university hospitals in Marseille, France, between January 2022 and October 2023. GGT levels were higher in breastfed newborns (mean ± standard deviation, 101 ± 74 IU/L) than in mixed-fed (77 ± 93 IU/L) or formula-fed newborns (64 ± 54 IU/L), and were significantly and independently associated with age (p < 0.001) and feeding method (p = 0.018 for formula-fed vs. breastfed children; β, p = 0.18 for mixed-fed vs. breastfed children). GGT levels were not associated with sex, gestational age at birth, or birth weight. Clinicians should bear these relationships in mind when investigating high liver enzymes in breastfed newborns.

Objectives: Pediatric patients with chronic gastrointestinal (GI) conditions including inflammatory bowel diseases (IBD) and irritable bowel syndrome (IBS) on average endorse lower health related quality of life (HRQOL) than their healthy counterparts. Both diagnoses are conceptualized as products of the brain-gut-axis and impacted by stress responsivity and disease coping. This study examined the effect of a virtual, heart rate variability (HRV) biofeedback enhanced coping skills intervention on HRQOL in pediatric patients with IBD and IBS.

Methods: Patients (13-18 years) diagnosed with IBD (N = 51) and IBS (N = 21) were grouped by diagnosis and randomized to immediate treatment or waitlist control groups. The intervention consisted of 6 virtually delivered, weekly group sessions combining cognitive behavioral therapy (CBT) with HRV biofeedback training. Outcomes included youth and parent-rated measures of HRQOL and GI symptoms. Assessments were conducted at baseline and post-intervention.

Results: Postintervention and compared to controls, youth with IBD endorsed improved overall HRQOL as well as improvements in physical, emotional, school, and psychosocial subdomains. No significant changes emerged for youth with IBS postintervention compared to controls. Within the treatment condition, parents of youth with IBD reported improved emotional HRQOL, while parents of youth with IBS reported improved physical and overall HRQOL.

Conclusions: This study offers preliminary support for a biofeedback-enhanced, coping skill intervention for improving patient-reported HRQOL outcomes in youth with IBD. Future studies are needed to understand mechanisms of change for patients with IBD and how the intervention could be tailored to better address HRQOL in patients with IBS.

Trial registration: NCT05202418, https://clinicaltrials.gov/study/NCT05202418.

Children with inflammatory bowel diseases (IBD) have limited access to the available advanced therapies, given the lengthy gap between adult and pediatric approval. We aimed to review key hurdles for pediatric trials and recommend practical solutions. This position paper was developed jointly by the European and North American Societies for Pediatric Gastroenterology Hepatology and Nutrition (ESPGHAN and NASPGHAN), in consultation with patient representatives. A systematic review was performed for identified topics, and two voting rounds with two group meetings led to agreement on 24 statements. The systematic review (reviewing 4366 manuscripts, of which 123 were included in tables of evidence and 213 in support of 23 statements) found similar biologic pathogenesis, and similar or better effectiveness and safety in children older than 2 years compared to adults. Pharmacokinetics were similar in adolescents but dissimilar in younger children. The review also found sufficiently accurate noninvasive endpoints to reflect post-induction treatment response. There was no significant added benefit for ileocolonoscopy over sigmoidoscopy in ulcerative colitis. Drugs should be approved in children >12 years and ≥40 kg based on extrapolation from adult and real-world data. While efficacy may be extrapolated to children <40 kg, pharmacokinetics cannot and thus one open-label single-arm study should be performed to establish a dose that matches adult exposure-response from the adult trial in which adolescents may be enrolled if not exposed to placebo. Full colonoscopies should be minimized in the pediatric dosing trial. Efficacy in patients with infantile IBD cannot be extrapolated from adult data.

Objectives: Published clinical prediction rules propose to determine risks of event recurrence and serious underlying condition in infants with brief resolved unexplained event (BRUE). The objective of this study was to evaluate these rules in a prospectively recruited cohort of infants with BRUE to test the hypothesis that the rules may be helpful in predicting risk but their test characteristics may differ from those previously reported.

Methods: To determine the validity of prediction rules for risk of recurrent events and serious diagnoses, we applied the calculators to patients with BRUE who were prospectively recruited at our institution. Infants were recruited during their index hospitalization, caregiver-reported symptoms were obtained by questionnaires during the 6-month follow-up period, and charts reviewed for clinical data. Receiver operating characteristic (ROC) analyses were used to calculate values for the sensitivity and specificity of each calculator.

Results: The cohort included 178 subjects and 73% (130) completed questionnaires. Overall, 78% (101/130) had persistent caregiver-reported symptoms, 12% (16/130) recurrent BRUE, and 28% (50/178) a serious condition diagnosis. The most common serious condition was oropharyngeal dysphagia with aspiration (78% of serious diagnoses, representing 22% of the cohort). On ROC analysis, area under the curve was 0.7 (95% confidence interval [CI]: 0.57-0.83, p = 0.004) for recurrent BRUE and 0.59 (95% CI: 0.49-0.68, p = 0.08) for serious underlying condition. The calculators provided 81% sensitivity, 52% specificity, 20% positive predictive value, and 96% negative predictive value for predicting recurrent BRUE and 54% sensitivity, 68% specificity, 40% positive predictive value, and 79% negative predictive value for predicting a serious condition in our cohort.

Conclusions: Our results suggest that published clinical prediction rules may accurately predict event recurrence but may have relatively low discriminatory power and tend to underestimate risk of serious underlying diagnoses, which may limit their clinical impact.

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.

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: Enteral nutrition interruptions (ENIs) are common in critically ill children and may cause underfeeding. Volume-based feeding practices (VBFPs) mitigate ENIs, but their use has not been reported in pediatric critical care. We analyzed whether a modified VBFP (MVBFP), based on compensatory feeding over the subsequent 24 h, is feasible and safe.

Methods: Prospective longitudinal study of critically ill children aged 1 month-18 years receiving enteral nutrition in whom an MVBFP was applied. Compensatory increased enteral feeding goal rates (CIEFGR) were defined as instances in which the volume lost due to an ENI was replaced gradually over the subsequent 24 h by increasing the infusion rate. Data included demographics, ENI characteristics, volume and rate during compensatory feeding, caloric and protein intake, and gastrointestinal or metabolic adverse effects. We also recorded pre-existing gastrointestinal conditions and formula type.

Results: Twenty-eight CIEFGR were recorded in 21 children. The median compensatory period was 24 h (interquartile range [IQR]: 17.5-24), with a median additional volume of 20 mL/kg (IQR: 10.5-33.1), corresponding to increases of 18.8 kcal/kg (IQR: 9.8-27.8) and 0.5 g/kg protein (IQR: 0.23-0.8). The infusion rate rose from 21 to 27 mL/h (IQR: 20-33). Gastrointestinal signs (increased gastric residual volume, abdominal distension, nausea) occurred in 10.7% of episodes, were mild, and required no intervention. No significant metabolic alterations were observed.

Conclusions: An MVBFP using compensatory feeding in critically ill children appears feasible and safe, improving caloric and protein delivery without increasing gastrointestinal side effects.