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Background and Aims

Gut microbiome (GM) dysbiosis in cancer patients has been associated with increased rate of complications including febrile neutropenia (FN), severe infections, increased relapse rate, reduced survival. Lactoferrin (LF), a bioactive glycoprotein of bovine and human milk, has shown anti-inflammatory, immunomodulatory and antimicrobial activities. In preterm neonates, bovine LF (bLF) administration reduced late-onset sepsis and necrotizing enterocolitis. The Supportive Care Working Party of the Italian Association of Pediatric Hematology Oncology (AIEOP) promoted a multicentric study on the potential of bLF administration in reducing FN in hematologic malignancies. Here we report data on the bLF impact on GM.

Methods

Multicentric randomized, double-blind, placebo-controlled trial. We enrolled pediatric patients with hematologic malignancies (ALL,AML,NHL), randomized 1:1 to receive bLF or placebo during induction chemotherapy. GM was profiled before and after two weeks of oral administration of bLF 200 mg/die (Mosiac®, Pharmaguida, Italy) or placebo, through next-generation 16S rRNA gene sequencing.

Results

34 patients enrolled from 6 centers. Groups were homogeneous in age, diagnosis and distribution among centers. No differences were observed between groups in antibiotic use in the 30 days prior to therapy and during induction chemotherapy. In patients receiving placebo alpha diversity decreased over time, with an increase in pathobionts (Enterobacteriaceae and Enterococcaceae). LF administration promoted the maintenance of GM diversity, prevented overabundance of pathobionts and increased health-associated taxa with reduced febrile neutropenia (57.1% vs. 90% in the placebo group; p = 0.04). No adverse effects were registered.

Conclusions

Lactoferrin may represent a promising adjunct to current therapeutic strategies in hematologic patients. Further studies are warranted.

Background and Aims

Disturbed sleep and 24-hour activity rhythms are linked to adverse cardiometabolic profiles in adults and adolescents, and these associations may originate in early life. We aimed to study associations of sleep and 24-hour rhythms with cardiometabolic risk factors in school-age children.

Methods

This cross-sectional population-based study comprised 894 children aged 8-11 years from the Generation R Study. Sleep (duration, efficiency, number of awakenings, time awake after sleep onset) and 24-hour activity rhythms (social jetlag, interdaily stability, intradaily variability) were assessed using tri-axial wrist actigraphy for nine consecutive nights. Cardiometabolic risk factors included adiposity (body mass index Z-score, fat mass index using dual-energy-X-ray-absorptiometry, visceral fat mass and liver fat fraction using magnetic resonance imaging), blood pressure and blood markers (glucose, insulin, lipids). We adjusted for season, age, sociodemographics and lifestyle factors.

Results

Each increase in interquartile range (IQR) of nightly awakenings (2 times) was associated with -0.12 SD (95% CI -0.21;-0.04) lower body mass index and 0.15 mmol/L (0.10;0.21) higher glucose. Among boys, an increase in IQR of intradaily variability (0.12) was associated with higher fat mass index (+0.07 kg/m2, 95% CI 0.03;0.11) and visceral FM (+0.08 gr, 0.02;0.15). We observed no associations with blood pressure or clustering of cardiometabolic risk factors.

Conclusions

Already at school-age, greater fragmentation of the 24-hour activity rhythm is associated with general and organ adiposity. In contrast, more nightly awakenings were associated with lower BMI. Optimizing 24-hour activity rhythms may help to reduce obesity from childhood onwards, particularly in boys.

Background and Aims

Webcam technology in neonatal units facilitates live streaming of infants to support parental and family bonding when they are unable to be physically present with their baby. This study aimed to explore the experiences of parents of infants previously admitted for neonatal care and who used webcam technology to view their baby in real-time.

Methods

Qualitive semi-structure interviews were conducted with parents of infants previously admitted for neonatal care on a tertiary level neonatal unit in the UK in 2021. Interviews were conducted virtually, transcribed verbatim and uploaded into NVivo V10 to facilitate analysis. Thematic analysis by two independent researchers was undertaken to identify themes representing the data.

Results

Nineteen participants representing 17 families took part in the interviews. Thematic analysis identified 8 basic themes which were grouped into 3 organizational themes: (1) family integration of the baby (2) implementation of the web camera service and (3) parental control.

Conclusions

Webcams can support parent-infant attachment however clear and consistent information from healthcare professionals is required to minimise anxiety around viewing their baby online. Integration of webcams into Family Integrated Care may help to support their use in practice and facilitate parental partnership in their baby’s care.

Background and Aims

Continuous monitoring of arterial hemoglobin oxygen saturation by pulse-oximetry (SpO₂) guides oxygen titration in preterm infants. Nevertheless, infants spend a significant proportion of time (%time) outside their SpO₂ target-range, which can be further complicated by lack of SpO₂ precision. We evaluated the interchangeability of pulse-oximeters, including the effects of their averaging-time.

Methods

Post-hoc analysis of recordings from two identical pulse-oximeters (recording and controlling device; Radical-7, Masimo SET V7.8.0.1, USA) from an unblinded prospective randomized-controlled automatic-oxygen-control (AOC) cross-over study designed to compare %time in SpO₂ target-range between a) two AOC algorithms, and b) two averaging-times of the controlling SpO₂ signal (2s vs 8s) with routine manual control. The main outcome of this analysis was the %time with a SpO₂ difference of ≥3%-points [%time(ΔSpO₂≥3%)] between controlling and recording devices.

Results

Twenty-four infants receiving non-invasive respiratory support were analyzed (median gestational age at birth 25.3 weeks; age at randomization 30 days).

%time(ΔSpO₂≥3%) was similar between the 3 setups: median=29% (Q1=19% to Q3=49%) during routine manual control (both pulse-oximeters with 2s averaging-time), 32% (27% to 44%) during AOC (both with 2s averaging-time), and 31% (26% to 38%) AOC (recording/controlling pulse-oximeter with 2s and 8s averaging-time).

Conclusions

Irrespective of SpO₂-averaging-time or oxygen control method, readings of two identical pulse-oximeters in the same patient are not interchangeable. They differ by ≥3% for 1/3 of the time, indicating relevant imprecision of pulse-oximetry. This may affect clinical interpretation of SpO₂ and oxygen targeting, potentially leading to adverse events following SpO₂-guided interventions.

Background and Aims

Childhood obesity is a public health problem that causes a significant increase in personal, social and economic burden worldwide in recent years. In addition, there is a syndemic relationship between obesity and COVID 19. The aim of this study is to examine childhood obesity and the factors influencing it.

Methods

This study was planned as cross-sectional. Data were collected from primary school second grade students and their parents between March and May 2022 in the capital city of Turkey. Data were collected by making anthropometric measurements using the information form and the International Physical Activity Questionnaire (IPAQ-S). Descriptive statistics, correlation and OR (95% CI) were used in the analysis of the data. The children's body mass index Z scores were calculated using the R "anthroplus" package program. Ethical approval was obtained.

Results

The obesity rate in selected primary school 2nd grade students was %19.8.The mean score of the IPAQ-S was 2.96±0.03 and the mean score of the sub-dimension that evaluates the level of activity at school was 3.78±0.90.There was a significant difference between the time spent in front of the screen and the frequency of physical activity in distance education and face-to-face education periods (p<0.01). Mothers’ BMI (OR=1.07), fathers’ BMI (OR=1.12), child's gender (OR=0.52), chronic disease status (OR=0.44),weekly physical activity frequency (OR=2.22) and the time spent watching TV series, movies during the distance education period (OR=1.32) was associated with childhood obesity

Conclusions

Evidence-based intervention studies that guide health policies are needed and recommended in order to prevent and control childhood obesity of countries.