Journal of Pediatric Gastroenterology and Nutrition最新文献

Objectives: Fortification of breast milk (BM) is recommended to enhance protein, vitamin, and mineral content, supporting improved growth in preterm infants. However, the impact of fortification on the oxidant-antioxidant balance in BM has not been previously studied. This study aims to evaluate the effects of fortification with a bovine milk-based fortifier on the total antioxidant capacity (TAC) and total oxidant status (TOS) in preterm BM.

Methods: In this prospective cohort study, transitional milk (TM) (6-10 days postpartum) and mature milk (MM) (>15 days postpartum) samples were collected from mothers of preterm infants receiving fortified BM. TAC and TOS were measured in BM samples before and after fortification. The oxidative stress index (OSI), defined as the TOS-to-TAC ratio, was used to assess oxidative stress levels.

Results: Seventy-five BM samples from 59 preterm infants, with a mean gestational age of 31.4 ± 2.8 weeks, were analyzed. TAC levels were consistent between TM and MM of the preterm infants. TOS levels and OSI were lower in TM compared to MM (p = 0.019 and p = 0.033, respectively). Fortification led to increased TAC and TOS in both TM (p < 0.001 each) and MM (p < 0.001 each). The OSI was higher in fortified TM (p = 0.032) compared to unfortified TM, while OSI remained unchanged in fortified MM (p = 0.39).

Conclusions: Preterm TM exhibits a more favorable oxidant-antioxidant profile compared to MM. Fortification elevates both TAC and TOS in preterm BM. In MM, the oxidant-antioxidant balance is maintained post-fortification; however, in TM, the increase in TOS exceeds that of TAC, resulting in a higher OSI.

Objectives: This systematic review and meta-analysis evaluated the effectiveness of nasogastric versus orogastric tube feeding on feeding performance in preterm neonates.

Methods: Randomized, quasi-randomized, and cross-over trials published in peer-reviewed journals with no language or country restrictions were included. Preterm neonates (<37 weeks) receiving nasogastric or orogastric enteral feeding until full oral feeds were established formed the exposure and comparison groups.

Primary outcome: time to achieve full enteral feeding; secondary outcomes: feeding performance, growth, and adverse events. A comprehensive literature search across multiple databases was conducted up to January 2024. Two authors independently screened studies, assessed the risk of bias, and performed a meta-analysis using a random effects model. Evidence levels were determined following Grades of Recommendation, Assessment, Development, and Evaluation guidelines.

Results: Six studies, including 273 preterm neonates, were included. Nasogastric feeding reduced the time to achieve full enteral feeds compared to orogastric feeding (mean difference [MD], -1.62 days; 95% confidence interval [CI], -2.25 to -0.99 days) with very low certainty of evidence. Combined episodes of bradycardia and desaturation per hour were higher in nasogastric feeding than orogastric feeding (MD, 0.24; 95% CI, 0.14-0.34), as were episodes of bradycardia (MD, 0.08; 95% CI, 0.04-0.13) and desaturation (MD, 0.16; 95% CI, 0.10-0.22). No significant differences were found in time to regain birth weight, apnea, necrotizing enterocolitis, or sepsis.

Conclusions: Nasogastric tube feeding reduces the time to achieve full enteral feeds but increases episodes of bradycardia and desaturation compared to orogastric feeding in preterm neonates. Cautious interpretation is required as the low to very low certainty evidence highlights the need for larger, well-designed trials for evidence-based recommendations.

Objectives: Liver biopsy is the gold standard for diagnosing and staging liver diseases. Endoscopic ultrasound-guided liver biopsy (EUS-LB) has been reported in adults with equivalent or better safety profiles than percutaneous liver biopsies. The aim of this study was to retrospectively assess the safety and efficacy of EUS-LB in pediatric patients.

Methods: This was a retrospective chart review of consecutive pediatric patients undergoing EUS-LB at Cincinnati Children's Hospital Medical Center from March 2020 to April 2023. Patients ≤21 years old were included. EUS-LB was performed via fine-needle biopsy technique with transduodenal and/or transgastric approach. Histology was independently reviewed by one of two expert pathologists, including length (cm) and complete portal tract (CPT) number per the American Association for the Study of Liver Diseases (AASLD) adequacy criteria. Demographics, clinical data, technical information, diagnostic success, and adverse events were recorded.

Results: Eighty-three patients were included in the analysis, with various indications that required liver biopsy. All biopsies achieved diagnostic and technical success, with 77 (93%) meeting both AASLD criteria for adequacy. Most patients (57, 69%) underwent biopsy of both hepatic lobes, with an overall median of two needle passes. Total specimen length was a median of 7.9 cm (interquartile range [IQR] 5.2-10.3), and the median maximum intact specimen was 4.2 cm (IQR 3.1-5.4). The median CPT number was 24 (IQR 17-32) per patient. Four mild adverse events (5%) occurred; none involved bleeding.

Conclusions: EUS-LB was well tolerated and yielded samples that were technically and diagnostically successful in a pediatric population, with comparable safety to percutaneous liver biopsy.

Objective: This study aimed to assess the utility of magnetically controlled capsule endoscopy (MCE) in the diagnosis of pediatric gastrointestinal diseases.

Methods: A retrospective cohort study was conducted, which collected data from 1040 children (546 males and 494 females; mean age: 11.0 ± 2.6 years) who underwent MCE at Shanghai Children's Hospital between June 2017 and February 2023. Information on gastric visualization, cleanliness, examination times, lesion detection rates, and other parameters were recorded. A 2-week follow-up monitored capsule excretion and adverse reactions.

Results: Of the 1055 patients, 78 had difficulty swallowing the capsule, and 15 could not swallow even with assistance, which led to their exclusion. The small intestine was successfully examined in 94.5% (206 out of 218) of the 218 children who were able to proceed with the procedure. The remaining 822 underwent esophagus and stomach examinations. The average transit time of the endoscopy capsule in the esophagus, stomach, and small intestine was 5 (3, 9) s, 57.0 (29.0, 102.0) min, and 306.0 (234.0, 500.0) min. In the examined cases, complete small bowel visualization was achieved in 94.5% of the patients. The most common symptoms reported by the patients were abdominal pain (77.9%) and nausea with vomiting (13.5%). Lesion detection rates were 38.8% in the stomach, 21.1% in the duodenum, and 43.1% in the jejunoileum. No complications, such as capsule retention or intestinal obstruction, were observed.

Conclusion: MCE is a feasible and safe method for examining the gastric cavity and small bowel in pediatric patients.

Objectives: Optimal nutrition is associated with positive outcomes in critically ill children. In 2017, the Society of Critical Care Medicine (SCCM) and the American Society of Parenteral and Enteral Nutrition (ASPEN) updated guidelines for nutritional support for this population. However, implementation of these guidelines may be delayed due to clinical barriers. We aimed to assess our practice against the recommendations of the ASPEN guidelines, hypothesizing that caregiver bias and clinical factors may hinder their implementation in our pediatric intensive care unit (PICU).

Methods: We focused on two ASPEN recommendations: (1) feeding within 48 h (48H) of admission and (2) meeting two thirds of estimated caloric requirements after seven calendar days. All children aged 1 month to 16 years admitted to our PICU from July 2017 to January 2020 were eligible. Using a retrospective chart review, nutritional and clinical data were collected at the time of admission, at 48H, and 7 calendar days after admission.

Results: A total of 533 patients were included. After 48H of admission to the PICU, 402 out of 533 (75.4%) patients received feeding. The following factors were associated with not reaching nutritional goals at 48H: invasive ventilation support, inotropic and vasoactive support, and extracorporeal life support. After 7 days, 95 out of 118 (80.5%) received two thirds of caloric needs. At 7 days, the main obstacle to meeting caloric goals was invasive ventilation.

Conclusion: In a representative tertiary PICU, barriers to meeting ASPEN nutritional recommendations included hemodynamic instability or invasive ventilator support, especially within the first 48H of admission.

Objectives: The objective of the present study is to determine whether the apparent nutrient digestibility differs between very preterm infants fortified with bovine colostrum (BC) compared to those fortified with a conventional fortifier (CF), building on previous findings that BC was associated with looser stools and reduced need for laxatives in very preterm infants (VPI).

Methods: We conducted a 24-h digestibility balance study in 10 VPIs to assess the retention of protein, energy, and wet-weight following the intake of fortified human milk and collection of faecal excretions. Infants (n = 5) were matched by gestational age and birthweight.

Results: In the 10 infants, the mean gestational age and birthweight were 28 ± 1 weeks and 899 ± 182 g, respectively. Infants fortified with BC had a higher faecal energy loss compared with infants fortified with CF (BC: 178 [range 111-205] vs. CF: 153 [96-235] kJ/kg, p < 0.05). No differences (p > 0.05) were found for wet-weight intake (421 [360-427] vs. 494 [328-500] kJ/kg), relative absorption of protein (60 [33-75] vs. 50 [33-75]%) or absolute protein absorption (249 [159-310) vs. 281 [210-347]).

Conclusion: Nutrient absorption was similar between groups although higher energy loss indicates reduced overall digestibility of BC versus CF, however, with a large variation within each group. Studies on more infants are required to confirm these results. A 24-h digestibility balance study can successfully be used to assess nutrient and energy retention in preterm infants.

Objectives: Acute respiratory infections (ARIs) and diarrhea are common in toddlers. Milk free of A1 β-casein (A1PF milk) may support the immune system, but few studies have investigated A1PF milk in toddler formula and any potential effects on ARI/diarrhea. This study's objective was to investigate the incidence of ARI and diarrhea with two toddler formulas, A1PF formula (A1PF) or conventional formula (CON), which differed in milk base and nutrient composition.

Methods: This randomized, open-label, multicenter study (19 December 2022 to 17 May 2023) evaluated the occurrence of ARI and/or diarrhea in toddlers (aged 2-3 years) who consumed A1PF or CON over 90 days.

Results: A total of 200 toddlers were enrolled, and 180 completed the study. The relative risk of ARI or diarrhea in the A1PF group versus the CON group did not differ significantly, but the median (interquartile range) ARI duration was significantly shorter in the A1PF group (3 [2-4] days vs. 5 [3-6] days, p = 0.012). At Day 90, toddlers consuming A1PF had significantly less severe bloating, gassiness, and fewer regurgitation events (all p < 0.05). Both formulas were well tolerated, and no serious adverse events were reported.

Conclusion: Toddlers who consumed A1PF had a reduced duration of ARI and improved diarrhea outcomes, reducing the burden on their families compared with toddlers who consumed CON. Although this is consistent with other studies, further research is required to determine whether these effects are solely attributable to the A1PF milk base or other differences between the formulas.

Objectives: We aimed to characterize the histologic gut phenotype of pediatric primary sclerosing cholangitis (PSC)-associated inflammatory bowel disease (IBD) against non-PSC colitis, and to assess Nancy Index (NI) performance in pediatric PSC-IBD.

Methods: Single-center retrospective cohort study including children diagnosed with PSC-IBD or non-PSC colitis (ulcerative colitis [UC] or IBD-unclassified) from 2000 to 2018, with diagnostic intestinal biopsies. Biopsies were re-reviewed by two independent pathologists who assessed microscopic disease distribution, NI scores, and specific histological features in the right and left colons, overall and stratified by endoscopic severity (moderate-severe vs. no more than mild). We examined NI inter-rater reliability with Fleiss' weighted (quadratic) kappa and NI construct validity against global endoscopic severity (Spearman correlation) and clinical outcomes (logistic regression).

Results: Fifty children with PSC-IBD and 81 colitis controls were included. Histologically, pancolitis (84% vs. 55%), right colon-predominant colitis (48% vs. 3%), and backwash ileitis (53% vs. 12%) (all p < 0.01) were significantly more common in PSC-IBD; histologic rectal sparing occurred at similar rates (6% vs. 10%, p = 0.54). Lamina propria-predominant neutrophils, prominent eosinophilic infiltration (left colon), and surface villiform change (right colon) were more common in PSC-IBD than colitis controls (p < 0.01). NI showed excellent inter-rater reliability (kappa > 0.9) and correlated moderately with global endoscopic severity but poorly with clinical activity in PSC-IBD.

Conclusions: Pediatric PSC-IBD has a distinct histologic phenotype that largely mirrors the endoscopic phenotype in distribution and includes a greater frequency of features not included in conventional UC histologic activity indices. Future work should investigate whether a PSC-IBD-specific index incorporating these features is warranted.