Journal of Pediatric Gastroenterology and Nutrition最新文献

Objectives: The aim of the study is to evaluate the efficacy of anti-tumor necrosis factor (TNF)-α monotherapy versus combination anti-TNF-α and immunosuppressive therapy.

Methods: A single-center, retrospective, observational study was conducted on inflammatory bowel disease (IBD) children. Patients with at least 6 months of follow-up were enrolled and divided into two groups based on therapy. Combo group included children on combination anti-TNF-α and immunosuppressant therapy; children undergoing anti-TNF-α monotherapy were assigned to Mono group.

Results: One hundred and seventeen children were enrolled, of whom 74 (63.2%) were affected by Crohn's disease (CD) and 43 (36.8%) by ulcerative Colitis (UC) (median age at diagnosis: 11.6 years; range 2.1-16.9; M/F: 56/61). Eighty patients (68.4%) were included in combo group and 37 (31.6%) in mono group. The median follow-up was 2.6 years (0.5-11.3). Twenty-three patients out of 80 (28.7%) in Group 1 showed therapy failure compared with 21/37 (56.8%) children in Mono group (p = 0.04). CD patients in monotherapy showed a significantly increased risk of therapy failure than those treated with combination therapy (p < 0.001). Conversely, no difference was found in UC children (p = 0.7). Children undergoing a reactive approach showed more frequent therapy failure compared to proactive in both groups (combo group: 41.7% vs. 4.3%; p = 0.01; mono group: 87.5% vs. 20%; p = 0.01). In a multivariate regression model, the use of a proactive approach and combination therapy was independently associated with anti-TNF-α durability (odds ratio [OR] = 22.1, OR = 12.9).

Conclusion: Combination therapy reduced overall anti-TNF-α failure in CD children, but not in UC patients. Additionally, a proactive approach was associated with increased anti-TNF-α durability.

Objectives: The aim of this follow-up was to investigate how reduced iron concentration and added bovine lactoferrin in infant formula affect neurodevelopment, iron status, and growth at 12 months of age.

Methods: Swedish healthy term formula-fed infants (n = 180) were randomly assigned to receive, from 6 weeks to 6 months of age, a low-iron formula (2 mg/L) fortified with bovine lactoferrin (1.0 g/L) (Lf+, n = 72), the same formula without lactoferrin fortification (Lf-, n = 72) or a control standard formula with 8 mg/L and no lactoferrin (CF, n = 36). Breast-fed infants were recruited as a reference (n = 72). At 12 months of age, Bayley Scales of Infant and Toddler Development-III (BSID-III), iron status, and anthropometrics were assessed.

Results: There were no intervention effects on BSID-III. Explored outcomes were unaffected by lactoferrin and the two low-iron groups (Lf+ and Lf-) were combined. The low-iron group had lower hepcidin (37.8 vs. 49.4 ng/mL, p = 0.027), compared to the CF group. Furthermore, they had iron status indicators more similar to the breast-fed reference group. The prevalence of iron deficiency (ID) and iron deficiency anemia (IDA) was low with no significant differences among groups. Weight and length were unaffected by intervention, however head circumference was minimally higher in infants fed low-iron formula compared to CF with mean difference (95% confidence interval) of 0.3 (0.0-0.6) standard-deviation-scores, p = 0.03.

Conclusions: Infant formula iron concentration at 2 mg/L was adequate in this population of infants with low risk of ID. Adding bovine lactoferrin did not affect the explored long-term clinical outcomes.

Objectives: Exclusive enteral nutrition (EEN) is a first-line treatment for induction of remission in luminal pediatric Crohn disease (pCD). However, as the efficacy of EEN varies from patient to patient, there is a need to distinguish between responders and nonresponding patients. This study had two aims. First, to develop a model to predict EEN-induced clinical remission (weighted pediatric CD activity index [wPCDA] ≤ 12.5) using baseline clinical information. Second, to develop a model to predict corticosteroid-free sustained clinical remission post-EEN induction (wPCDA ≤ 12.5, for ≥36 weeks after EEN).

Methods: We applied machine learning to clinical and laboratory data from a prospectively followed cohort of pCD patients who received EEN as their first treatment for CD (n = 308). This learning algorithm used feature selection and k-fold (internal) cross-validation to systematically find the model with the best combination of features and hyperparameter settings. To estimate the quality of the learned model, we used k-fold (external) cross-validation.

Results: Clinical, laboratory, and treatment data were compiled into two different datasets: EEN clinical remission at the end of EEN treatment (mean of 60 days; n = 114) and corticosteroid-free sustained clinical remission post-EEN induction (n = 206). Our resulting models were effective, with external area under the curves of 0.65  $\pm$  0.015 and 0.60  $\pm$  0.018. Moreover, a permutation label test showed that our learning process was stable and significantly different from chance, at p-values of 0.002 and 0.01, respectively.

Conclusion: Our models, based on accessible clinical features, were able to effectively predict EEN success above chance. This supports the plausibility of building clinical tools to assist precision therapy for pCD patients.

Objectives: Pediatric inflammatory bowel disease (IBD) has a rising incidence. While the underlying etiology is not fully understood, genetics and environmental factors are known to play a role. Social determinants of health (SDoH) also play a role in worsening morbidity and mortality for chronic diseases. This study evaluated the association between SDoH and pediatric IBD, hypothesizing that individuals residing in more socially vulnerable areas will have worse outcomes during the first year of diagnosis.

Methods: This retrospective cohort study included 222 patients diagnosed with IBD at Children's of Alabama from 2018 to 2022. The social vulnerability index (SVI) was used to quantify neighborhood-level socioeconomic vulnerability. Primary outcomes were hospitalization at diagnosis, hospitalization during the first year, disease activity at 6 months, and persistent disease activity at 1 year.

Results: Patients from neighborhoods in the most socioeconomically vulnerable quartile (top 25% of SVI) were more likely to be hospitalized at diagnosis (adjusted odds ratio [aOR] 2.51, p = 0.028), more likely to be hospitalized during the first year (aOR 3.44, p = 0.031), and more likely to have active disease at 6 months (unadjusted OR 2.47, p = 0.016) compared to those from neighborhoods in the least vulnerable quartile. However, there were no significant differences by neighborhood socioeconomic vulnerability in active disease at 1 year.

Conclusion: Social vulnerability contributes to increased risk of hospitalization and delays in achieving remission during the first year after new diagnosis of IBD. This finding highlights the importance of SDoH screening to identify at-risk patients at the time of diagnosis to guide targeted interventions and prevent worse disease outcomes.

Objectives: Breastfeeding and bottle feeding are frequently used in preterm infants' transition to oral feeding, but there has been limited research regarding which has more favorable effects on the infant when initiating oral feeding. This study aimed to compare breastfeeding by the mother and bottle feeding as the initial oral feeding method on preterm infants' physiological parameters, amount of food taken, and feeding performance.

Methods: This randomized controlled experimental study was conducted with a sample of 90 preterm infants. Half of the infants were breastfed by their mothers, and half were bottle-fed in line with clinical routine practice for their first oral feeding in the transition from gastric feeding. Oxygen saturation and heart rate before, during, and after feeding, weight before and after feeding, and feeding performance were evaluated and compared between the groups.

Results: Oxygen saturation increased and heart rate decreased during feeding in breastfed infants, while bottle-fed infants showed a decrease in oxygen saturation and an increase in heart rate (p < 0.05 for both). The change in weight after feeding (used to assess the amount of food taken) was greater in the breastfed infants (38.67 ± 8.15 g) than the bottle-fed infants (32.82 ± 7.21 g) (p < 0.05). The breastfeeding group also had a higher mean percentage of recommended food taken (91.64% ± 6.53% vs. 85.14% ± 5.76%, p < 0.05) and higher feeding efficiency rate (2.79 ± 0.79 vs. 2.32 ± 0.79 mL/min, p < 0.05).

Conclusions: Preterm infants whose oral feeding was initiated by breastfeeding with their mothers showed more favorable physiological responses and better feeding performance compared to those fed with a bottle.

Trial registration: ClinicalTrials.gov identifier: NCT05651035. Clinical Trials URL: https://clinicaltrials.gov/study/NCT05651035?cond=NCT05651035&rank=1.

Objectives: Methotrexate (MTX) is frequently prescribed in paediatric inflammatory bowel disease (IBD), with routine laboratory monitoring to detect adverse events (AEs), such as hepatotoxicity and myelotoxicity. However, data on the incidence and predictors of these AEs remain limited. This study aimed to assess the incidence of MTX-induced AEs in paediatric IBD, and to identify associated factors.

Methods: We conducted a retrospective monocentre cohort study, including paediatric IBD patients initiating MTX at Amsterdam University Medical Centre between 2010 and 2023. We collected demographic, disease and therapy data, and laboratory results. We evaluated biochemical toxicity (hepatotoxicity or myelotoxicity) and nausea and vomiting, classifying AE severity using common terminology criteria for AEs.

Results: A total of 207 paediatric IBD patients (181 Crohn's disease, 17 ulcerative colitis, 9 IBD-unclassified) starting MTX therapy were included, 114 of whom used MTX as immunomodulator alongside a biological drug. Hepatotoxicity occurred in 41% (61% grade 1, 12% grade 3), and myelotoxicity in 21% (81% mild, 0 severe cases). Nausea was reported in 46%. MTX was discontinued due to an AE in 60 cases (38%), including 27 following hepatotoxicity, 4 following myelotoxicity, and 27 following nausea. Male sex (relative risk [RR] 1.4, p = 0.003) and lower MTX dose (RR 0.9, p = 0.003) predicted biochemical toxicity. Nausea was associated with male sex (RR 1.7, p = 0.002), oral administration (RR 0.5 for subcutaneous route, p < 0.001), and higher MTX dose (RR 1.1, p = 0.005).

Conclusions: MTX-induced AEs are common but rarely severe in paediatric IBD. Male sex, MTX dosage, and oral administration significantly influence the risk of MTX-induced AEs.