Pediatric Gastroenterology, Hepatology & Nutrition最新文献

Purpose: Detecting the risk of malnutrition in pediatric patients using simple, rapid, and validated screening tools is important. The most frequently used screening tools are the Screening Tool for the Assessment of Malnutrition in Pediatrics (STAMP), Pediatric Yorkhill Malnutrition Score (PYMS), and Screening Tool for Risk on Nutritional Status and Growth (STRONG-kids). We aimed to assess the value of STAMP as a nutritional screening tool for the evaluation of nutritional status compared to other tools in children with respiratory tract infections (RTIs) admitted to a single tertiary referral hospital in a low/middle-income country.

Methods: This cross-sectional study enrolled 80 children aged 1-12 years who were admitted for RTIs. Each participant was evaluated anthropometrically, and three screening tools (STAMP, PYMS, and STRONG-kids) were used.

Results: Anthropometric measurements showed that 65% of the patients were stunted, 77.5% were underweight, and 60% were wasted. The STAMP score showed the most sensitivity (91.9%) and specificity (77.8%) in predicting malnutrition compared to weight-for-age, while STRONG-kids showed a sensitivity of 85.5% and specificity of 50%. Similarly, the STAMP score showed the most sensitivity (88.7%) and specificity (77.8%) in predicting malnutrition compared to height-for-age, while STRONG-kids showed a sensitivity of 81.8% and specificity of 29.6%.

Conclusion: The STAMP is a reliable screening tool for malnutrition in children admitted for RTIs. In addition, STRONG-kids is a simple and quick nutritional screening tool for hospitalized children, and it predicts nutritional status on admission.

Purpose: Upper gastrointestinal endoscopy is important in evaluating gastrointestinal symptoms and providing pathological descriptions. In this study, abnormal endoscopic and histological findings were identified in children, and the factors related to these findings were evaluated.

Methods: We retrospectively analyzed the medical records of patients aged <18 years who underwent upper endoscopies between January 2017 and June 2022. While performing endoscopy, biopsies were taken, and the rapid urease test was performed simultaneously.

Results: The endoscopic and histological findings were abnormal for 86 of (71.7%) and 111 (92.5%) of the 120 patients, respectively. Only four patients had normal endoscopic and histological findings. The most common endoscopic and histological findings were erythema (35%) and chronic gastritis (53.5%), respectively. Age ≥12 years (odds ratio [OR], 2.55; 95% confidence interval [CI], 1.21-6.68; p=0.033), poor eating habits (OR, 0.30; 95% CI, 0.10-0.88; p=0.029), melena (OR, 3.45; 95% CI, 1.22-6.42 p=0.043), and nausea (OR, 0.31; 95% CI, 0.13-0.74 p=0.009) were significant factors related to endoscopic abnormalities in the multivariate analysis. More frequent Helicobacter pylori infection was observed in patients with atrophy and intestinal metaplasia than in those with other histological abnormalities.

Conclusion: Most children with dyspepsia gave endoscopic abnormalities, and routine biopsies are important when performing endoscopy. We identified predictors of endoscopic findings.

Purpose: Human milk microbiota can significantly influence children's health. This study aimed to investigate the composition and diversity of the bacterial microbiota in donated human milk (DHM) and analyze the possible influencing factors.

Methods: Archival samples from single-donor pools of raw DHM expressed from 88 different donors within the first six months postpartum were included. Donor-, infant-, and milk-related data were collected and analyzed using descriptive and comparative statistical methods. The hypervariable region V1-V3 of the bacterial 16S ribosomal ribonucleic acid gene was sequenced using the Illumina MiSeq platform to characterize the microbial profile of the donated milk.

Results: Staphylococcus was the most abundant genus in all analyzed samples. The genus Lactobacillus was also present in all samples, with relative abundances ranging from 0.06-62%. Bacteria of the genus Bifidobacterium were present in 62 (70% n=62) of the samples. A statistically significant difference in Lactobacillus abundance was observed based on the storage container type before pasteurization (p=0.015, median 0.804 in bottles vs. 0.289 in bags). Alpha diversity was higher in milk samples from exclusively breastfed infants, and in the samples that were expressed using manual techniques.

Conclusion: This study provides evidence of the potential influence of donor infant-related factors and milk characteristics on the composition and alpha diversity of bacterial microbiota in DHM. Notably, previous studies utilizing high-throughput sequencing technology to examine the human milk microbiota have not focused on pooled DHM samples.

Purpose: Solitary rectal ulcer syndrome (SRUS) is a benign disease of unknown etiology. This study aimed to evaluate the clinical, endoscopic, and histopathological findings of SRUS in Bangladeshi children.

Methods: This prospective observational study was conducted at the Department of Pediatric Gastroenterology and Nutrition of Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh, between January 2021 and December 2022. A total of 260 children aged <18 years with rectal bleeding were admitted for a full evaluation, including detailed history taking and colonoscopy. Among them, 40 met the inclusion criteria for SRUS. The collected data contained clinical characteristics and macroscopic and microscopic findings, expressed as numbers and percentages.

Results: The mean age of the group was 13.07±2.14 years; male patients comprised 57.5% and female patients 42.5%. Among the 40 children who presented with rectal bleeding, the most common symptoms were straining during defecation (85.0%), followed by constipation (82.5%), sensation of incomplete evacuation (72.5%), mucus passage per rectum (70.0%), tenesmus (57.5%), abdominal pain (45.0%), manual digital evacuation (42.5%), perianal discomfort (37.5%), and diarrhea (22.5%). Colonoscopy revealed that most lesions were located in the rectum (97.6%) and ulcerative (65.9%). The mean distance of the lesions from the anal verge; 6.04±0.91 cm. Histologically, most lesions showed fibromuscular obliteration (95.0%) and crypt distortion (85.0%).

Conclusion: Among the 40 children with SRUS who presented with rectal bleeding, straining during defecation was the most common symptom. Single ulcerative lesions in the rectum were the most frequent colonoscopic findings, and the majority showed fibromuscular obliteration and crypt distortion.

Purpose: Malnutrition affects one in three hospitalized children and is linked to negative clinical outcomes and long-term developmental issues. Therefore, this study aimed to assess body composition indices among children with severe acute malnutrition (SAM) and their association with anthropometry.

Methods: This observational follow-up study investigated medical complications among children with SAM (aged, 12-59 months) who were admitted to the nutrition rehabilitation centre at a tertiary care hospital in India. Data was collected at three timelines: on admission (baseline), at discharge (midline), and upon completing all five follow-up visits over a period of 12 weeks after treatment (endline).

Results: Of the 130 enrolled children, 96.2% (n=125) were discharged and 73% (n=95) completed the study. The fat mass scores exhibited a consistent improvement with time, with the mean (standard deviation [SD]) rising from 0.7 (0.7) at baseline to 0.8 (0.7) and 1.4 (0.8) at the midline and endline, respectively. Similarly, the fat-free mass (FFM) scores showed steady progress, with the mean (SD) increasing from 6.2 (1.4) at baseline to 6.3 (1.5) and 6.9 (1.7) at the midline and endline, respectively. The weight-for-height also demonstrated an upward trend, with the mean (SD) increasing from -3.3 (0.0) at baseline to -2.6 (0.7) and -1.8 (0.9) at the midline and endline, respectively. Significant improvements were observed in other anthropometric and body composition parameters, except in the FFM index. Comparison of cured and non-cured children revealed better parameter values in the former than the latter.

Conclusion: Integration of body composition and anthropometric measurements into routine healthcare for managing children with SAM can enhance treatment outcomes and reduce relapse rates.

Purpose: Human milk oligosaccharides (HMOs) are non-digestible carbohydrates found in breast milk, with 2'-fucosyllactose (2'-FL) being a prominent type. This study examined the effects of HMOs on the incidence of infantile colic (IC) and atopic dermatitis (AD) in full-term infants who were breastfed (BM), formula-fed (FF), or fed formula supplemented with 2'-fucosyllactose (FF_2'-FL) for 1 year.

Methods: This open-label, prospective clinical trial enrolled 338 full-term infants from 2020 to 2024. IC was diagnosed using the ROME IV criteria, and AD was assessed with the PO-SCORAD.The study evaluated the incidence of IC and AD, infant growth, and risk factors for IC and AD.

Results: A total of 113 infants were in the BM group, 111 in the FF group, and 114 in the FF_2'-FL group. Maternal baseline characteristics, including delivery age (p=0.001) and delivery type (p=0.013), differed significantly among the three groups. The incidence of IC in the FF_2'-FL group was comparable to that in the BM group (10.5% vs. 8.8%; odds ratio [OR], 1.21; 95% confidence interval [CI], 0.501-2.929; p=0.795) and lower than in the FF group (10.5% vs. 15.3%, OR, 0.65; 95% CI, 0.295-1.434; p=0.120). Similarly, the incidence of AD in the FF_2'-FL group was close to that in the BM group and lower than in the FF group.

Conclusion: This study suggests that supplementation with 2'-fucosyllactose may help reduce the risk of IC and AD. These findings have important implications for pediatric healthcare and support the development of preventive strategies for IC and AD beyond breastfeeding.

Purpose: Sufficient calcium and phosphorus supplementation in preterm infants may ensure proper bone growth and reduce the risk of osteopenia. This study aimed to assess-in comparison to controls-the calcium and phosphorus intake via both enteral and parenteral routes, as well as growth, of preterm infants with very low birth weight (VLBW) who were diagnosed with osteopenia. Assessment took place during the first 28 days of life; infants were followed throughout hospitalization.

Methods: We conducted a single-center, retrospective study of preterm infants weighing <1,500 g who were admitted to a tertiary healthcare center between January 1, 2017 and June 30, 2022.

Results: The study included 55 infants with osteopenia (case group) and 220 control infants (control group). The average weekly calcium intake in the case group during the first 4 weeks after birth was significantly lower than that of the control group, with values of 1.45, 1.98, 3.06, and 4.02 mEq/kg/day versus 1.64, 3.10, 4.89, and 5.69 mEq/kg/day, respectively (p<0.05). Similarly, phosphorus intake was significantly lower in the case group (0.75, 1.24, 1.29, and 1.45 mmoL/kg/day) compared to the control group (0.75, 1.38, 1.62, and 1.79 mmoL/kg/day; p<0.05). Preterm infants with VLBW and osteopenia exhibited lower average daily weight gain (19.03 g vs. 21.45 g; p<0.001) and a smaller gain in head circumference (0.57 cm vs. 0.68 cm; p<0.001) compared to controls.

Conclusion: This findings highlight the necessity for timely provision of calcium and phosphorus to prevent osteopenia and promote optimal growth in this vulnerable population.

Purpose: The prevalence of disorders of gut-brain interaction (DGBI), previously known as functional gastrointestinal disorders, has increased among children and adolescents, impacting their quality of life. Lifestyle changes during the coronavirus disease (COVID-19) pandemic, such as decreased physical activity and altered dietary habits, may have contributed to this increase rise. This study aimed to assess the prevalence of DGBIs among Indonesian adolescents during the COVID-19 pandemic using the Rome IV diagnostic criteria.

Methods: A cross-sectional survey was conducted from March 2022 to April 2023 involving 5,247 adolescents (aged 13-18 years) from nine provinces in Indonesia (Riau, Riau Islands, Central Java, East Java, Bali, South Kalimantan, East Kalimantan, East Nusa Tenggara, and Papua). Data were collected via online and offline versions of the Rome IV questionnaire and analyzed descriptively to determine DGBI prevalence rates by age, sex, and region.

Results: The prevalence of DGBIs was greater in females than males and among adolescents living in urban areas. We found that 28.4% of adolescents were diagnosed with at least one DGBI, with functional constipation being the most prevalent (21.8%), followed by functional dyspepsia (4.5%). Additionally, 13.5% of respondents experienced two overlapping DGBIs, and 1.3% suffered from three overlapping DGBIs simultaneously. The prevalence rate of DGBI varied significantly across the participating provinces.

Conclusion: DGBIs are highly prevalent among Indonesian adolescents after the COVID-19 pandemic. These findings can guide public health strategies to address adolescent gastrointestinal health in Indonesia and other regions.

Purpose: This study aimed to compare the clinical features and laboratory findings of duodenal strictures caused by Crohn's disease (CD) with those of other etiologies in children.

Methods: We recruited children diagnosed with duodenal strictures through a full investigation. Clinical, laboratory, endoscopic, and radiological data at diagnosis were collected retrospectively.

Results: Of the 11 included patients, four were diagnosed with CD, four with eosinophilic gastrointestinal disorder (EGID), and the other three were grouped together (Helicobacter-associated in one and idiopathic disease in two). Serum anti-Saccharomyces cerevisiae antibody (ASCA) was positive in four of four (100%) CD cases, four of four (100%) EGID cases, and none (0%) of the other cases (p=0.011). The median fecal calprotectin concentration was 994 mg/kg in the CD group (range: 626-2,118 mg/kg), 548 mg/kg in the EGID group (range: 458-1,056 mg/kg), and 124 mg/kg in one patient in the other group (p=0.313). Surgery for duodenal obstruction was performed in four patients (one with CD and three with idiopathic and Helicobacter-associated conditions) (p=0.021), and balloon dilation was performed in one patient with CD and one other patient.

Conclusion: Although acquired duodenal strictures are rare in children, they can develop in pediatric patients with CD or EGID. The measurement of serum ASCA and fecal calprotectin levels before endoscopic and histopathological investigations may identify the presence of organic causes of duodenal strictures in children.