Journal of Pediatric Gastroenterology and Nutrition最新文献

Objectives: Despite the growing use of unsedated transnasal endoscopy (uTNE) in pediatrics, no validated tool exists to assess competence in performing uTNE, hindering effective training and consistent, high-quality performance. Video-based assessment offers a scalable and reliable method for assessing and enhancing procedural skills. Using Delphi methodology, we aimed to identify key competencies and establish content validity evidence for the TransNasal Endoscopy Skills Assessment Tool (TNE-SAT), a video-based tool designed to assess clinician competence in performing uTNE.

Methods: North American pediatric uTNE experts iteratively rated potential assessment items, on a 5-point scale, based on their importance as indicators of endoscopist competence in performing uTNE. After each voting round, items scoring ≤3/5 were eliminated, and the remaining items were re-sent to the panel for further rating until consensus was reached, defined as ≥80% of panelists rating all remaining items ≥4. Items meeting this threshold were included in the final TNE-SAT tool.

Results: Twenty-seven experts from 19 sites across North America participated. One hundred thirty items were generated through literature review, task deconstruction, and Delphi panelist input. Three rounds of surveys were completed before consensus was achieved, with response rates ranging from 85% to 9. Seven items reached consensus for inclusion in the final TNE-SAT.

Conclusions: This North American Delphi study identified core competencies required for effective uTNE performance and informed the development of the TNE-SAT, a structured, video-based tool to assess clinician competence. The TNE-SAT offers a promising tool to guide training and support quality improvement in pediatric uTNE.

Objective: Patient satisfaction (PS) is an important healthcare outcome and should be an integral part of quality improvement agendas. Between 2019 and 2021, the Italian Society of Pediatric Gastroenterology, Hepatology and Nutrition, Endoscopy Interest Group conducted a nationwide quality assessment survey, EndoPed. One of the study's aims was to identify areas for improvement based on the results of a PS questionnaire.

Methods: The smartphone app-based, prospective survey involved 24 Italian pediatric endoscopy centers. Procedure details and quality standards were recorded. The modified Group Health Association of America-9 (GHAA-9m) satisfaction questionnaire consisted of 7 Likert-scale questions that explored waiting times, communication, and staff evaluation. Two additional closed questions investigated the will to confirm the endoscopist and the facility. Dissatisfaction was defined with the arbitrary cut-off of < 7/10.

Results: Questionnaire results were available for 1974 (55%) procedures. The questionnaire's internal consistency was good (Cronbach's α 0.86). Overall satisfaction was high. Shorter operator experience (odds ratio [OR] 4 [95% confidence interval [CI] 1.6 to -10.3]; p < 0.003), prolonged waiting time (OR 2.7 [95%CI 1.6-4.5]; p < 0.000), prolonged procedure duration (OR 2.9 [95% CI 1.8-4.7]; p < 0.000) and conscious sedation (OR 5 [95% CI 3-6.2]; p < 0.000) were confirmed in a multivariate model to be associated to lower satisfaction rates.

Conclusions: Through a standardized methodology, the PS questionnaire is a valuable tool for clinical quality assessment. PS highlight improvement fields different from those identified by quality standards and items, adding elements for an exhaustive quality evaluation. Interventions derived from PS analysis could help to improve pediatric endoscopy.

Objectives: Complete blood count (CBC) is a simple and cost-effective test performed during routine examination. We investigated whether CBC could assist in the assessment of disease phenotype and disease activity at diagnosis in pediatric inflammatory bowel disease (IBD).

Methods: We included 120 pediatric patients (73 ulcerative colitis [UC] and 47 Crohn's disease [CD]) and 120 age-matched healthy controls (6-18 years). CBC indices, including neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR) and neutrophil-to-monocyte ratio (NMR) measured at onset, were compared between the patient and control groups. Optimal cut-off values for absolute lymphocyte count (ALC) and LMR were determined using the ROC curve analysis and the Youden Index to predict disease behavior in patients with CD. Multivariate logistic regression analysis was used to evaluate the independent relationship between these parameters and to predict disease behavior in CD.

Results: UC and CD patients demonstrated significantly higher leukocyte, platelet, neutrophil, monocyte counts and NLR compared to controls (p < 0.05). CD patients had significantly lower ALC than UC and control groups (p = 0.008 and p = 0.039, respectively). Patients with moderate- severe UC and pancolitis exhibited significantly decreased Hgb levels, MCV and increased PLT counts (p < 0.05). After adjusting for age and sex at diagnosis, multivariate logistic regression analysis revealed that decreased ALC (< 1.65 ×109/L) and LMR (< 2.54) were significant predictors of CD with stricturing, penetrating disease and perianal involvement (p = 0.049 and p = 0.004, respectively).

Conclusions: In pediatric IBD, the severity of UC and disease behavior of CD can be assessed using CBC indices at diagnosis. These results demonstrate the potential role of CBC indices in predicting disease phenotype.

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.

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: 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.