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EARLY LIFE ANTIBIOTIC EXPOSURE AND LATER CHILDHOOD CHRONIC GASTROINTESTINAL DISORDERS: A SYSTEMATIC REVIEW
Abstract
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Background: In adults, there is increasing evidence that there is an association between antibiotic use and gastrointestinal disorders, but in children, the evidence is scarce. Therefore, we assessed the association between exposure to antibiotics in the first two years of life and the presence of chronic gastrointestinal disorders during childhood.
Method: This systematic review was conducted according to the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses, PROSPERO registration number CRD42019132631. MEDLINE, Embase, WHO trial register, and Web of Science were systematically searched. Title and abstract screening, full-text screening as well as the quality assessment with the Newcastle–Ottawa Scale were independently performed by two researchers.
Results: Nineteen studies were included, 10 cohort and 9 case-control studies. The association between antibiotics and inflammatory bowel disease (n=5, 1591 cases), eosinophilic esophagitis (n=5, 1695 cases), celiac disease (n=5, 5861 cases), infantile colics (n=2, 2257 cases), functional constipation (n=1, 50 cases) and recurrent abdominal pain (n=1, 111 cases) were examined. A best evidence synthesis was applied. This showed strong evidence for an association between antibiotic exposure in the first two years of life and the presence of inflammatory bowel disease and celiac disease during childhood, moderate evidence for eosinophilic esophagitis and infantile colic, and insufficient evidence for the association with recurrent abdominal pain or functional constipation.
Conclusion: Further studies are necessary to give more insight in the role of early life antibiotic use and the development of GI-disorders during childhood as well as to elucidate the underlying mechanism.
MULTI DISCIPLINARY TEAM APPROACH WITH TRANS ANAL IRRIGATION IMPROVES OUTCOME FOR CHILDREN WITH SEVERE CONSTIPATION AND FAECAL INCONTINENCE.
Abstract
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Background.
Severe constipation and faecal incontinence affect about 1-2% of children. It is a distressing condition and affected children have a poor quality of life. We audited the outcomes of a new multi-disciplinary treatment programme commissioned to improve care for children with this condition.
Methods.
We conducted a case review of the children referred to an MDT service for constipation and encopresis. Demographic details, clinical status at referral, management provided and outcome after 12 months were analysed. Data was stored in Microsoft access and analysed with Microsoft Excel. Simple statistical methods were used for statistical analysis.
Results.
Thirty children (19M) were referred for management. The average age was 8.7 years (range: 2 - 16 years). 28 of 30 (93%) were severely constipated and 21 (70%),encopretic. Ten children (33%) had learning difficulties. The average Cleveland Score at referral was 16.1 and St Mark’s score was 14.9. 65% of the children required two or more medications and two or more teams were involved in 83% of the patients. The paediatrician and psychologist were the most frequently seen professionals, both seeing 60% of the children. Eight children (23%) received regular trans anal irrigation. At 12 months, the average Cleveland Score had fallen to 3.75 and St Marks Score, 6.14. 18 children (60%) were discharged or demonstrated significant improvement. 8 children (26%) were receiving on going multi professional specialist care.
Conclusions.
This multidisciplinary service for children with constipation and encopresis has resulted in significantly improved outcomes for most children by 12 months of referral.
LIVER FUNCTION TESTS AS PREDICTORS FOR CLINICAL OUTCOME OF KAWASAKI DISEASE IN INFANTS: AN ITALIAN COHORT FROM A SINGLE CENTER
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BACKGROUND:Kawasaki disease (KD) is a multisystem vasculitis. Although hepatic involvement is not a significant cause of morbidity or mortality in KD, it reflects the severity of inflammation. Therefore, it could be a biomarker of intravenous immunoglobulin (IVIG) unresponsiveness and cardiac involvement severity. In this regard, no studies have been done in infants. We aimed to assess the potential prognostic role of liver function tests (LFTs) to predict IVIG unresponsiveness and cardiac involvement in infants with KD.METHODS:Retrospective chart review of infants diagnosed with KD between January 2008 and December 2017. Data were analyzed by SPSS Statistical Software version V20.RESULTS:Among 113 KD patients, 31 (27.4%) were infants (M: F= 1.6:1). The median age was 5 months (IQR:5 months). Eighteen (58.0%) had cardiac involvement. 7/31 (22.6%) had AST > 80 UI/L, 8/31 (25.8%) showed ALT > 100 UI/L, 9/13 (69.2%) had GGT > 60 UI/L, and 9/29 (31.0%) presented with albumin <2.9 g/dl. All patients received IVIG and ASA as per protocol. 25/31 were responsive to a single dose of IVIG, 6 (19.4%) needed a second dose and one required a third dose and then additional treatment with anakinra. Univariate analysis showed that patients with AST >80 UI/L and albumin <2.9 g/dl at presentation were at significantly higher risk for IVIG resistance (P = 0.014 and P= 0.05, respectively). No association between LFTs abnormalities and cardiac involvement was found.CONCLUSIONS:KD is a life-threatening vasculitis that could be even more severe in infancy. Our results suggest that hypoalbuminemia and abnormal AST level might predict IVIG-resistant infants with KD.
A PARTLY FERMENTED INFANT FORMULA WITH A SPECIFIC PREBIOTIC MIXTURE, POSTBIOTICS INCLUDING 3’-GL AND HUMAN MILK OLIGOSACCHARIDES 2’-FL SUPPORTS ADEQUATE GROWTH IN HEALTHY TERM INFANTS
Abstract
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Background and aims
This study evaluated nutritional adequacy of a newly developed, partly fermented infant formula with postbiotics, a specific prebiotic mixture, 2’-FL and milk fat in healthy term infants.
Methods
In a randomised, multi-country, double-blind, prospective, controlled study, fully formula fed infants ≤14 days of age were randomised to receive until 17 weeks of age: A) experimental IF containing 26% fermented formula with postbiotics derived from LactofidusTM fermentation process (including 3’-Galactosyllactose; 3’-GL), 0.8g/100ml short-chain galacto-oligosaccharides and long-chain fructo-oligosaccharides (scGOS/lcFOS (9:1)), 0.1g/100ml human milk oligosaccharide 2’Fucosyllactose (2’-FL), and 50% milk fat or B) control IF with 0.8g/100ml scGOS/lcFOS (9:1). Nutritional adequacy was evaluated by equivalence analysis of weight gain at 17 weeks within margins of +/- 3 g/d (primary outcome), evaluation of WHO z-scores and adverse events.
Results
Infants were randomised to receive the experimental (n = 108) or control (n = 107) formula. Equivalence of weight gain was demonstrated for the experimental compared to control group (difference in means -0.08 g/d; 90%CI [-1.47;1.31]) with estimated means (SE) of 31.00 (0.59) g/d and 31.08 (0.60) g/d (PP population). Mean weight-for-age, length-for-age and head circumference-for age z-scores were within +/-1SD of the WHO growth standards, indicative for adequate infant growth and similar between intervention groups. The number and types of (serious) adverse events were not significantly different between formula groups.
Conclusion
A partly fermented infant formula with postbiotics, a specific prebiotic mixture of scGOS/lcFOS, 2’-FL and milk fat supports adequate infant growth and is safe for use in healthy term infants.
REAL-WORLD EFFECTIVENESS OF LACTOBACILLUS REUTERI-CONTAINING FORMULA ON GASTROINTESTINAL TOLERANCE AND INFANTILE COLIC: A MULTI-COUNTRY CROSS-SECTIONAL OBSERVATIONAL STUDY
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Background/aim: Gastrointestinal (GI) tolerance in infants is influenced by feeding type. Our objective was to assess effectiveness of formula containing Lactobacillus (L.) reuteri (DSM 17938) in gut comfort and colic in a real-world setting.
Methods: A multi-country cross-sectional study (Egypt, India, Indonesia, Malaysia, Pakistan, Philippines) in full-term exclusively/predominantly formula-fed (FF) or breastfed (BF) infants aged 6-16 weeks was conducted using the Infant Gastrointestinal Symptom Questionnaire (IGSQ) and a gut comfort questionnaire (both physician-administered). IGSQ composite score (range: 13-65 [no to extreme GI distress]), individual-item IGSQ scores and colic outcomes were compared among BF infants (n=760) and FF infants receiving L. reuteri-containing formula (FF-LR; n=470) or basic formula without probiotics and/or prebiotics (FF-BASIC; n=501) in statistical models correcting for site, sex, age, delivery mode, mother’s education and parental GI disorders.
Results: IGSQ composite scores (mean±SEM) in BF (22.3±0.3) and FF-LR (22.1±0.3) were similar (p=.47) and lower than in FF-BASIC (23.4±0.3; p<.01). Compared with FF-BASIC, FF-LR was associated with lower parental reports of difficulty in passing stools (11% vs. 22%; adjusted-odds ratio [95%CI]=0.45 [0.30-0.67], p<.0001), less harder stools (0.12 [0.05-0.30], p<.0001) and fewer physician-diagnosed colic (Rome IV criteria; 0.63 [0.46-0.85], p=.003), and was closer/similar to BF. Parent-reported crying time (p=.02), incidence of spitting-up/vomiting (p<.01) and fussiness due to spitting-up/vomiting (p<.01) or flatulence (p=.03) were lower in FF-LR vs. FF-BASIC, and similar to BF.
Conclusion: In a real-world observational study, L. reuteri-containing formula was found to be effective in improving overall digestive tolerance and associated behavior outcomes, and in reducing the odds of infantile colic.
INTAKE OF SUGAR-CONTAINING BEVERAGES IN INFANCY AND LIVER FAT ACCUMULATION AT SCHOOL AGE
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Background and aims: Sugar-containing beverage intake is a major risk for obesity in both children and adults and seems to be associated with non-alcoholic fatty liver disease in adults. To examine the associations of sugar-containing beverage intake at 1 year with liver fat accumulation and non-alcoholic fatty liver disease among school age children.
Methods: In a population-based prospective cohort study, we assessed sugar-containing beverage intake at 1 year with a validated Food Frequency Questionnaire among 1,940 infants. Liver fat fraction and non-alcoholic fatty liver disease (liver fat fraction ≥5.0%) were assessed with Magnetic Resonance Imaging.
Results: Higher sugar-containing beverage intake at 1 year was not associated with higher liver fat accumulation at 10 years (p-value for trend 0.38). However, as compared to infants with <1.0 serving/day, those with >2.0 servings/day had the highest odds of non-alcoholic fatty liver disease (Odds Ratio 3.02 (95% Confidence Interval 1.34, 6.83)). These associations were largely independent of sugar-containing beverage intake and body mass index at school age. Stratified analyses suggested stronger associations of sugar-containing beverage intake at 1 year with non-alcoholic fatty liver disease at 10 years among children of mothers with low educational attainment and among overweight or obese children.
Conclusions: Higher sugar-containing beverage intake in infancy was associated with non-alcoholic fatty liver disease in school age children, independent of sugar-containing beverage intake and body mass index at school age. Limiting the intake of sugar-containing beverage already in infancy may be helpful in preventing of liver steatosis at school age.