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Summary: Most of the children operated for esophageal atresia will survive the neonatal period. However, medium-term and late complications are frequent in this population. Gastroesophageal reflux disease is observed in 26 to 75% of the cases and can be responsible for peptic esophagitis, anastomotic stenosis, and Barrett esophagus, which is a risk factor for adenocarcinoma of the esophagus. Dysphagia is frequently observed, sometimes several years after the surgery, affecting up to 45% of children at the age of 5 years. Growth retardation is present in nearly one-third of children at the age of 5 years. Ear, nose, and throat and respiratory complications are also very frequent but tend to improve with time. Tracheomalacia is found in 75% of these children at birth, sometimes responsible for severe complications (malaise, bradycardia). Respiratory symptoms are dominated by chronic cough, wheezing, and infections reported in 29% of the children by the age of 5 years. Restrictive, obstructive syndromes and bronchial hyperactivity can be observed, but usually remain moderate. All these complications can influence the patient''s quality of life, which is moderately impaired compared to healthy controls. The high frequency of late sequelae in esophageal atresia justifies regular and multidisciplinary follow-up through adulthood. [Copyright &y& Elsevier]

The article presents information on features and usage of feeding through Gastrostomy tube. It informs that chronic diseases of childhood can be helped by undernutrition. It states that the enteral tube feeds are helpful in gastrointestinal tracts. It is stated that transpyloric feeding is marked in children with disorders including gastrointestinal abnormalities and at risk of aspiration.

Abstract: Although initial prognosis of oesophageal atresia is nowadays excellent with more than 95% of survival, the long-term complications are frequent. A gastro-oesophageal reflux is found in 26 to 75% of the cases, responsible for peptic oesophagitis, anastomotic stenosis and Barrett''s oesophagus, risk factor of adenocarcinoma of the oesophagus. A dysphagia is frequently observed on these patients, sometimes several years after the surgery, observed in almost 45% of five-year-old children. Growth retardation is found in nearly a third of these children. Respiratory symptoms are particularly frequent, especially in the first years, associating tracheomalacia facilitating the bronchopulmonary infectious episodes (found in about 30% of 5-year-old children). Esotracheal fistula recurrence is very rare. A deformation of the rib cage is reported in 20%, and a scoliosis in 10% of the patients. However, the quality of life of these patients in the adulthood is good, and influenced by the existence of associated malformations. Even if the current prognosis of oesophageal atresia is good altogether, the frequency of the complications (digestive, respiratory, nutritional, orthopaedic) far from the initial intervention, and the necessity of a surveillance of the secondary oesophageal damages, justifies a systematic and multidisciplinary follow-up until adulthood. [Copyright &y& Elsevier]

Abstract: Gastro-oesophageal reflux (GOR) is a physiological event defined as flow of gastric content into oesophagus. GOR is frequent in infants commonly subjected to regurgitation. While this symptom usually disappears within the first year of life, there is evidence that some symptoms may persist during childhood. In non complicated GOR, no investigation is indicated. PH-metry is only indicated in case of doubtful diagnosis or extradigestive manifestation. Upper gastro-intestinal endoscopy is indicated when oesophagitis is suspected. First intention treatment is no intervention or dietetic measures. Thickened feeding reduces symptoms such as regurgitation but does not influence GOR. Except for cisapride which use is nowadays very limited, no prokinetics have demonstrated their efficacy on GOR. Anti-secretory drugs should be restricted to the treatment of oesophagitis. Investigations are necessary before prolonged use. [Copyright &y& Elsevier]

Non invasive tests are available and accurate for the diagnosis of H. pylori infection in children. They are safer and cheaper than endoscopy. Peptic ulcer and severe gastro-intestinal lesions associated with H. pylori infection are rare in childhood. However since the resistance to antibiotics is steadily increasing, biopsies are still required to assess sensitivity of germs to antibiotics. Search of H. pylori infection should be limited to the children presenting digestive symptoms severe enough to justify endoscopy and treatment. [Copyright &y& Elsevier]

The article discusses the challenges that are associated with managing the nutrition of children of cerebral palsy. Answers to several questions related to managing the nutrition of children with cerebral palsy, including whether the psychosocial support needs of the child and the child's family have been met, whether the child is growing properly and whether feeding is safe for the child, which medical professionals need to consider when managing children with cerebral palsy, are presented.

Evaluates the effect of percutaneous endoscopic gastronomy (PEG) and gastroesophageal reflux (GER) in children. pH studies; Reflux index variations; Absence of changes in feeding regimen after PEG.

The article discusses various reports within the issue, including one by Samson-Fang and Bell on the assessment of growth and nutrition in children with cerebral palsy, one by Arvedson on taking the clinical history of children with cerebral palsy and one by Craig on the nutritional management of children with cerebral palsy.

Objectif: l’Inlet Patch (IP) est une hétérotopie de muqueuse gastrique située dans la partie proximale de l’œsophage. Le but de cette étude était d’évaluer les caractéristiques cliniques de l’IP en pédiatrie et son évolution. Patients: Cette étude rétrospective, multi-centrique incluait les observations d’IP recensées dans 7 centres francophones de gastroentérologie pédiatriques. Les données cliniques, thérapeutiques et évolutives étaient recueillies. Résultats: 15 enfants (8 garçons, 7 filles) étaient inclus. L’âge médian au diagnostic était de 9,5 ans (3,3 à 15 ans). Cinq enfants avaient des antécédents d’atrésie de l’œsophage et 9 un reflux gastro-oesophagien. Un patient était asymptomatique. Des symptômes digestifs étaient notés chez 14 enfants (dysphagie, blocages), des signes respiratoires et/ou oto-rhino-laryngés chez 6 d’entre eux. Un inhibiteur de la pompe à protons était prescrit chez 14 enfants pour une durée moyenne de 4,7 mois (1 à 12 mois). Une amélioration était notée chez 8 patients. Conclusion: l’IP semble rare mais probablement sous diagnostiqué en pédiatrie. Il pourrait être responsable d’une symptomatologie digestive et respiratoire. Des études longitudinales sont nécessaires afin de préciser son implication clinique et son devenir à long terme. [ABSTRACT FROM AUTHOR]

Contexte Le prurit est un symptôme invalidant des cholestases chroniques de l’enfant. La prise en charge repose classiquement sur l’association d’acide ursodésoxycholique (AUDC) et de rifampicine. En cas d’échec, des thérapeutiques invasives dont la transplantation hépatique peuvent être proposées. Des études cliniques ont montré chez l’adulte que la sertraline, un inhibiteur de la recapture de sérotonine, diminue le prurit cholestatique. Objectif Déterminer l’efficacité et la tolérance d’un traitement par sertraline dans le prurit cholestatique réfractaire de l’enfant. Méthode Dans cette étude prospective et multicentrique, 20 patients présentant une cholestase chronique (PFIC à γGT normales n = 13, syndrome d’Alagille n = 7) accompagnée d’un prurit réfractaire sans insuffisance hépatocellulaire ont été inclus entre 2007 et 2014. La sertraline était introduite à la posologie de 1 mg/kg/j et augmentée selon la réponse clinique jusqu’à 4 mg/kg/j. Les traitements préexistants (AUDC et rifampicine) ont été maintenus à posologie constante. L’efficacité du traitement était évaluée à 3 mois puis tous les 6 mois à l’aide d’un score de prurit (échelle visuelle analogique), du nombre de réveils nocturnes et des lésions cutanées. Les patients présentant une diminution d’au moins 3 points du score de prurit associée à une amélioration de l’état cutané et/ou du sommeil à 3 mois ont été considérés comme répondeurs. La bilirubinémie, les acides biliaires sériques, la sertralinémie résiduelle ont été dosés pendant le suivi et les évènements indésirables rapportés. Résultats La durée médiane de traitement était de 15 mois, à la posologie moyenne de 2,2 mg/kg/j. Le score de prurit diminuait de 2,5 points en moyenne à 3 mois sur l’ensemble des patients traités et de 4,5 points chez les patients répondeurs (10 patients sur 20). Il n’a pas été retrouvé de facteurs prédictifs de réponse au traitement parmi les paramètres clinico-biologiques initiaux, l’évolution de la bilirubinémie, des acides biliaires sériques ou de la sertralinémie. Des évènements indésirables ont été rapportés chez 6 enfants. Sept patients sont toujours traités actuellement dont 5 depuis plus de deux ans avec un contrôle durable du prurit. Les causes d’interruption du traitement ont été : effet indésirable ( n = 4), arrêt du suivi ( n = 3), transplantation hépatique ( n = 3), inefficacité ( n = 2), ou décès ( n = 1). Conclusion La sertraline peut constituer un traitement de troisième ligne du prurit cholestatique de l’enfant réfractaire à l’association d’AUDC et de rifampicine. [ABSTRACT FROM AUTHOR]

Les coliques infantiles sont un problème courant mais souvent inexpliqué et multifactoriel. Le but de ce travail était de déterminer les caractéristiques à la naissance des enfants qui présentaient des coliques (Rome III). Les paramètres : anthropométriques, terme, rang de fratrie, allaitement, tabagisme, IMC et profession des parents ont été comparés entre 2 populations de nourrissons : 422 contrôles vs 100 avec coliques. Une régression logistique multiple et une analyse factorielle de correspondance multiple ont été réalisées pour rechercher les caractéristiques liées à la survenue de coliques entre 2 semaines et 3 mois d’âge. Cinq variables (p< 0,05) ont été identifiées. Les coliques étaient plus fréquentes chez les nourrissons de rang de naissance ≥ 2 (Odds ratio avec IC à 95% vs < 2, OR = 2,81 [1,77 ; 4,47]), nés d’une mère cadre ou chef d’entreprise (OR vs autres = 2,54 [1,45 ; 4,44]), d’un père en surpoids ou obèse (OR vs IMC < 25 kg/m 2 = 1,93 [1,19, 3,10]), d’une mère fumeuse (OR vs non fumeuse = 1,93 [1,06 ; 3,51]) et nés avant 40 SA (OR vs ≥ 40 = 1,91 [1,19 ; 3,07]). Ces 5 facteurs n’expliquent cependant que 9% de la variance totale (aire sous la courbe ROC =0,71). Les paramètres recueillis à la naissance ne suffisent pas à prédire le risque ultérieur de coliques. [ABSTRACT FROM AUTHOR]

Objectifs Etudier la prévalence d’endobrachyœsophage (EBO) dans une population d’adolescents opérés d’une atrésie de l’œsophage (AO). Patients et méthodes Cette étude prospective non-interventionnelle, multicentrique incluait 121 patients (15–19 ans) avec AO. Tous les patients bénéficiaient d’un protocole standardisé de biopsies œsophagiennes étagées (12 au minimum) sous anesthésie générale. Une relecture histologique centralisée était effectuée pour toutes les lames avec métaplasie. Résultats L’âge moyen était de 16,5 ans (±1,4) et 71% avaient un RGO persistant après l’âge de 2 ans. Au moment de l’étude, 41% avaient eu une chirurgie antireflux mais 42% présentaient des symptômes de RGO (26% recevaient des anti-sécrétoires). Une oesophagite modérée et/ou ulcérée était visible à l’endoscopie chez 34% et confirmée en histologie chez 66% des patients. Un EBO était suspecté à l’endoscopie chez 37%, et confirmé à l’histologie chez 43% : 50 métaplasies gastriques et une métaplasie intestinale. Il n’existait pas de relation entre EBO et symptomatologie clinique. Conclusions Les patients avec AO ont un risque important de RGO persistant et d’EBO. Un suivi endoscopique à long terme, associé à des biopsies étagées est nécessaire même chez les patients asymptomatiques. [ABSTRACT FROM AUTHOR]

A correction to the article "Nutritional Management of Children With Cerebral Palsy: A Practical Guide" that was published in a 2013 issue is presented.

Objectifs: Préciser la place du zinc dans le traitement de la maladie de Wilson (MW) chez l’enfant. Matériels et Méthodes: Les données cliniques de la MW, les modalités thérapeutiques, l’évolution clinique et biologique ont été étudiés chez 26 enfants traités par le zinc. Résultats: La découverte de la MW a été fortuite au cours d’un bilan (38 %), lors d’un dépistage dans le cas d’un bilan familial (50 %), devant une atteinte hépatique (88 %), une atteinte neurologique (4 %). La médiane d’âge était de 8 ans (0,8 – 16,1) au diagnostic et de 10,8 ans (2,3 – 19,1) au début du traitement par le zinc. Le zinc était initié dès la découverte de la MW chez 54 % des enfants. Un traitement par D-penicillamine était associé dans 69 % des cas, par trientine dans 15 % des cas, et 11 % des enfants avaient reçu les 3 thérapeutiques. Une posologie du zinc supérieure aux doses recommandées était utilisée chez 5/6 enfants de moins de 5 ans, 10/19 enfants entre 6 et 15 ans, et 1/1 enfant de plus de 16 ans. Une normalisation des transaminases et de la cupriurie était obtenue après 5 mois de traitement. Après ce délai, la cupriurie médiane est restée inférieure à 50 μg/l. Les effets secondaires étaient rares. Conclusion: Le zinc est un traitement efficace et bien toléré dans la MW chez l’enfant. [ABSTRACT FROM AUTHOR]

Several events occur during the first months of life that allow the immune system to become competent and functional. The aim of this article is to review the rationale and evidence of an influence of (n-3) long-chain PUFA (LCPUFA) on the immune system of infants. The (n-3) LCPUFA exert their immunomodulatory activities at different levels. The (n-3) LCPUFA metabolites induce eicosanoid production, alter gene expression, and modify lipid raft composition, altering T-cell signaling; all contribute to immunological functional changes. However, the roles of these mechanisms and the types of T or other immunological cells involved remain unclear at present. Moreover, the effect of (n-3) LCPUFA on the immune system of infants may vary according to dose, time of exposure, and profile of the immune system (T-helper, Th1/Th2). Most of the interventional studies in infancy have been performed for the prevention of allergy. They all confirmed influence on T-cell function and cytokine profiles, but clinically beneficial effects are more conflicting. Supplementation of the maternal diet in pregnancy or early childhood with (n-3) LCPUFA is potentially a noninvasive intervention strategy to prevent the development of allergy, infection, and possibly other immune-mediated diseases. However, any long-term in vivo effects on (n-3) LCPUFA early in life for immunomodulatory defense in infants and later on immune status and health remain to be assessed. [ABSTRACT FROM AUTHOR]

Summary: Physical activity accounts for 25–30 % of total daily energy expenditure. Total energy expenditure varies according to the physical activity, which can be voluntarily modulated. Assessment of physical activity is therefore an important factor in the promotion of health and in several childhood and adolescent pathological situations. Questionnaires are widely used for assessing physical activity patterns in youth because of their low cost and ease of use, but they systematically overestimate physical activity. Heart rate monitoring requires individual calibration in the laboratory and a number of factors other than physical activity can affect heart rate (i.e., stress, temperature, etc.). Pedometers are objective devices but give only information on the number of steps and do not assess physical activity patterns. Accelerometers seem the best compromise between feasibility and validity in the assessment of physical activity in children in free-living conditions because this is an objective and accurate method whose cost is low. The choice of the type of device depends on the objectives of the clinician or researcher. [Copyright &y& Elsevier]

Acute gastroenteritis remains a frequent illness in infants and children with still important morbidity and mortality rates. Oral rehydratation solutions (ORS) and early refeeding are the main recommendations. Indication of drugs remains limited.Objective. – To evaluate the management of acute diarrhea by private practice pediatricians of France.Methods. – A questionnaire concerning ORS, dietary formula, antidiarrheal diet, antibiotherapy, antidiarrheal drugs was sent to all 2907 private pediatricians of France.Results. – Six hundred twenty-nine questionnaires were analyzed (22%). Three hundred and ninety-seven pediatricians (63%) prescribed systematically an ORS, 294 (47%) changed formula, 412 (66%) prescribed a regimen. Antibiotic was prescribed after coproculture (81%), when glairy and bloody diarrhea (65%), associated infectious disease (63%), toxi-infectious syndrome (42%) or immunodeficiency were present (28%). Most pediatricians (97%) prescribed at least one drug: diosmectite (84%), Lactobacillus acidophilus (63%), Saccharomyces boulardii (62%), racecadotril (62%), loperamide (28%), attapulgite de Mormoiron (26%), nifuroxazide (20%). Drugs were prescribed more often for their effectiveness than for comfort.Conclusion. – This study demonstrates the discrepancies that remain between recommendations and practical care in the treatment of acute diarrhea in children. Private French pediatricians often prescribe drugs. [Copyright &y& Elsevier]

Barrett's esophagus is characterized by the replacement of squamous epithelium by columnar epithelium that is intestinal metaplasia-positive or -negative in the distal esophagus. Gastroesophageal reflux disease, which is frequent and prolonged in esophageal atresia, probably plays a major role in the development of Barrett's esophagus through repeated mucosal damage. Long-term acid exposure contributes to carcinogenesis in Barrett's esophagus of intestinal type, but its effect on gastric metaplasia is less well defined. Recent studies have suggest that metaplasia arises in about 15% of patients with esophageal atresia, with a lag time to developing metaplasia from initial surgical correction of about 10 years. Preliminary data from an ongoing multicenter study including 88 patients with esophageal atresia aged 15-19 years showed gastric metaplasia in 42% of patients (29 fundic and 7 cardial metaplasia), while one patient presented intestinal metaplasia. Esophageal mucosal abnormalities can be observed in esophageal atresia patients at endoscopy despite the absence of symptoms. Whether prolonged, aggressive, acid suppression is beneficial in these situations remains to be determined. Barrett's metaplasia can be removed by endoscopic mucosal resection or destroyed with endoscopic ablative techniques, such as photodynamic therapy, radiofrequency ablation, and cryotherapy. The risk of developing esophageal carcinoma is still a controversial issue as only a few clinical cases have been reported in young adults with esophageal atresia. As late complications of esophageal atresia, particularly esophagitis and Barrett's esophagus, are increasingly being recognized, long-time systematic follow up of the esophageal mucosa including multistage biopsies is therefore required even in asymptomatic patients. [ABSTRACT FROM AUTHOR]

Alors que le surpoids et l'obésité de l'adolescent ont été largement étudiés ces dernières années, il n'existe que peu d'information sur la prévalence et les conséquences de la maigreur chez l'adolescent en dehors des troubles des conduites alimentaires. Le but de cette étude était d'évaluer la prévalence, les caractéristiques cliniques et physiques, ainsi que les conséquences de la maigreur dans une population d'adolescents européens en bonne santé. Parmi les 3528 adolescents sains (étaient exclus grâce aux questionnaires et l'examen clinique les adolescents présentant une maladie chronique ou un trouble des conduites alimentaires), âgés de 12,5 à 17,5 ans, ayant participé à l'étude européenne HELENA, 214 (41 % de garçons) maigres définis par les courbes internationales IOTF (IMC) ont été inclus dans cette étude ancillaire, et comparés aux adolescents normopondéraux (n = 2497). Leur phénotype était étudié : examen clinique, condition physique, activité physique (AP), comportements sédentaires, et apports alimentaires. Un bilan sanguin a été réalisé dans un sous-groupe (33 % de la population). Les comparaisons entre les 2 groupes ont été réalisées grâce à des modèles de régression linéaire pour les variables continues et des modèles de régression logistique pour les variables catégorielles. Le stade pubertaire et le centre ont été inclus comme facteurs de confusion. La prévalence de la maigreur était de 7,9 % : 8,6 % chez les filles et 7,1 % chez les garçons. La pression artérielle systolique était significativement plus basse chez les adolescents minces (109,3 ± 11,3 vs 115,0 ± 12,5 ; p < 0,001). L'âge d'apparition du premier cycle menstruel était significativement plus tardif chez les adolescentes maigres que chez celles ayant un poids normal (13,1 ± 1,1 vs 12,5 ± 1,2 ; p < 0,001). La force musculaire des membres supérieurs (différence de 20 % ; p < 0,001) et le temps passé en AP d'intensité légère (160,5 ± 37,7 vs 166,7 ± 40,7 ; p < 0,05) étaient significativement plus faibles chez les adolescents minces. Les apports caloriques et protéiques étaient similaires entre les deux groupes. De même, la qualité de l'alimentation (62,0 ± 13,5 vs 62,2 ± 13,8) n'était pas significativement inférieure chez les adolescents maigres, mais le pourcentage d'adolescents qui omettaient le petit-déjeuner était plus bas chez les adolescents minces (17,1 % vs 27,7 %). La créatininémie et la résistance à l'insuline (indice HOMA) étaient plus bas chez les adolescents maigres, alors que le taux de vitamine B12 était plus élevé (p < 0,05). La maigreur affecte une proportion notable d'adolescents européens en bonne santé. Toutefois, elle n'est associée ni à un déséquilibre alimentaire, ni à des conséquences potentiellement néfastes sur la santé. [ABSTRACT FROM AUTHOR]

Objective: To report dietary sugars consumption and their different types and food sources, in European adolescents.Methods: Food consumption data of selected groups were obtained from 1630 adolescents (45.6% males, 12.5-17.5 years) from the HELENA study using two nonconsecutive 24-h recalls. Energy intake, total sugars and free sugars were assessed using the HELENA-DIAT software. Multiple regression analyses were performed adjusting for relevant confounders.Results: Total sugars intake (137.5 g/day) represented 23.6% and free sugars (110.1 g/day), 19% of energy intake. Girls had significantly lower intakes of energy, carbohydrates, total sugars and free sugars. 94% of adolescents had a consumption of free sugars above 10% of total energy intake. The main food contributor to free sugars was ‘carbonated, soft and isotonic drinks,’ followed by ‘non-chocolate confectionary’ and ‘sugar, honey, jam and syrup.’ Older boys and girls had significantly higher intakes of free sugars from ‘cakes, pies and biscuits.’ Free sugars intake was negatively associated with low socioeconomic status for ‘non-chocolate confectionary’ and ‘sugar, honey and jam’ groups; with low maternal educational level for carbonated and ‘soft drinks,’ ‘sugar, honey and jam,’ ‘cakes and pies’ and ‘breakfast cereals’ groups; and with high paternal educational level for ‘carbonated and soft drinks’ and ‘chocolates’ group.Conclusions: The majority (94%) of studied adolescents consumed free sugars above 10% of daily energy intake. Our data indicate a broad variety in foods providing free sugars. Continued efforts are required at different levels to reduce the intake of free sugars, especially in families with a low educational level. [ABSTRACT FROM AUTHOR]

Summary: Background: Socioeconomic status has been associated with obesity in children and adolescents. This association may be dependent according with where adolescents lives. Objective: The aim of this study was to evaluate the association between different socioeconomic indicators such as parental education and occupation and socioeconomic status with abdominal obesity in adolescents from two observational studies: the Healthy Lifestyle in Europe by Nutrition in Adolescence cross‐sectional study (HELENA‐CSS) and the Brazilian Cardiovascular Adolescent Health (BRACAH) study. Methods: European (n = 3192, aged 12.5–17.5 years, with 53.1% girls from HELENA‐CSS) and Brazilian (n = 991, aged 14–18 years, with 54.5% girls from BRACAH study) adolescents from two cross‐sectional studies were included in this analysis. Complete data on waist circumference (WC), height, socioeconomic status indicators and several confounders were collected. Socioeconomic indicators were measured using a self‐reported questionnaire in order to assess the family social status of the adolescents. Multilevel linear regression models were used to examine associations, and results were adjusted for potential confounders. Results: Adjusted results showed inverse associations between mother's and father's education levels (p < 0.001) and father's occupation level (p < 0.001) with waist‐to‐height ratio (WHtR) and WC in HELENA‐CSS girls. Similarly in European girls, socioeconomic indicators by socioeconomic status and maternal occupation level were associated with WHtR. In HELENA‐CSS boys, the same significant association was found between WHtR and WC with maternal occupation level. Moreover, in European boys WHtR was also associated with parental education. In Brazilian adolescents, both indicators of abdominal obesity did not remain associated with the independents variables, after adjustment for potential confounders. Conclusions: Abdominal obesity was associated with socioeconomic indicators in higher‐income countries, but this association was not observed in a lower‐middle‐income country. [ABSTRACT FROM AUTHOR]

La période des 1000 premiers jours de vie est reconnue comme étant une fenêtre de vulnérabilité pouvant avoir un impact à long terme sur la santé des individus. La cohorte PENSINE (Périnatalité, environnement, santé intestinale et nutrition de l'enfant) vise à évaluer l'impact de l'allaitement sur la santé intestinale de l'enfant. L'objectif principal de ce travail est de caractériser la cohorte PENSINE et la comparer à la population générale ayant accouché dans la maternité (groupe MAT) réalisant l'étude. La cohorte prospective PENSINE vise à déterminer l'impact de l'allaitement sur la santé intestinale des enfants à l'âge de 4 ans à partir de couples mère/enfant inclus à la maternité participant à l'étude. Les 180 premiers couples mère/enfant inclus ont été caractérisés et comparés à la population de la même maternité (groupe MAT) n'ayant pas participé à l'étude sur des variables d'intérêt de façon à identifier les spécificités de la cohorte. En réponse au critère d'évaluation principal, le groupe d'enfants allaités exclusivement pendant au moins 3 mois (AM) a été comparé au groupe d'enfants ayant reçu un allaitement artificiel et/ou mixte (AAm) selon ces mêmes variables d'intérêt afin d'évaluer l'homogénéité de la cohorte. Comparativement au groupe MAT, l'âge maternel moyen à l'accouchement (32,2 ± 4,3 vs 31,3 ± 5,3 ans ; p < 0,01), le terme moyen (40 + 1 ± 1,0 vs 39 + 2 ± 1,2 SA ; p < 0,001) et le taux d'allaitement exclusif pendant le séjour à la maternité (78,5 vs 60,0 % ; p < 0,001), étaient plus élevés dans la cohorte PENSINE, alors que le taux de prématurité était plus faible (1,6 vs 7,1 % ; p < 0,01). Le taux d'accouchement par voie basse (83,3 vs 81,2 % ; p = 0,47), le poids moyen de l'enfant à la naissance (3431 ± 416 vs 3363 ± 468 g ; p = 0,06) et la proportion de filles (57,6 vs 50,3 % ; p = 0,09) n'étaient pas différents entre les deux groupes. Excepté le taux d'allaitement exclusif pendant le séjour à la maternité, aucune différence significative n'était retrouvée pour ces mêmes variables entre les sous-groupes AM et AAm de la cohorte PENSINE. Cette analyse préliminaire montre que la cohorte PENSINE possède des spécificités par rapport à la population totale de la maternité. Il existe toutefois une homogénéité des données de naissance entre les enfants ayant été allaité exclusivement ou non lors des 3 premiers mois de vie. Ces informations seront à prendre en considération lors des analyses des variables cliniques, anthropométriques et biologiques afin d'évaluer leur impact sur la santé intestinale de l'enfant sain. [ABSTRACT FROM AUTHOR]

Objectives This study aimed to explore the associations of liver biomarkers with cardiometabolic risk factors and their clustering, and to provide reference values (percentiles) and cut-off points for liver biomarkers associated with high cardiometabolic risk in European adolescents. Methods Alanine aminotransferase ( ALT), gamma-glutamyltransferase ( GGT), aspartate aminotransferase to ALT ratio ( AST/ ALT), waist circumference, blood pressure, triglycerides, high-density lipoprotein cholesterol and insulin were measured in 1084 adolescents. We computed a continuous cardiometabolic risk score and defined the high cardiometabolic risk. Results Higher ALT and GGT and lower AST/ ALT were associated with adiposity and with the number of adverse cardiometabolic risk factors ( Ps < 0.05). Higher GGT and lower AST/ ALT were associated with higher cardiometabolic risk score ( Ps < 0.001) in males and females, and ALT only in males ( Ps < 0.001). Gender- and age-specific percentiles for liver biomarkers were provided. Receiver operating characteristic analyses showed a significant discriminatory accuracy of AST/ ALT in identifying the low/high cardiometabolic risk ( Ps < 0.01) and thresholds were provided. Conclusions Higher GGT and lower AST/ ALT are associated with higher cardiometabolic risk factors and their clustering in male and female European adolescents, whereas the associations of ALT were gender dependent. Our results suggest the usefulness of AST/ ALT as a screening test in the assessment of adolescents with high cardiometabolic risk and provide gender- and age-specific thresholds that might be of clinical interest. [ABSTRACT FROM AUTHOR]

Background Post-transplant food allergy (LTFA) is increasingly observed after paediatric liver transplantation (LT). Although the immunopathology of LTFA remains unclear, immunoglobulin (Ig) E seems to be implicated. Objective To study humoral and cellular immunity in paediatric LT patients in search for factors associated with LTFA, and compare with healthy controls (HC) and non-transplant food-allergic children (FA). Methods We studied serum Ig levels in 29 LTFA, 43 non-food-allergic LT patients (LTnoFA), 21 FA patients and 36 HC. Serum-specific IgA and IgE against common food allergens in LTFA, IgA1, IgA2 and joining-chain-containing polymeric IgA (pIgA) were measured. Peripheral blood mononuclear cells were analysed by flow cytometry for B and T cell populations of interest. Results Serum IgA and specific IgA were higher in LTFA compared to LTnoFA. LTFA patients had the highest proportion of circulating T follicular helper cells (cTfh). The percentage of cTfh correlated positively with serum IgA. Unique in LTFA was also the significant increase in serum markers of mucosal IgA and the decrease in the Th17 subset of CXCR5- CD4+ cells compared to HC. Both LT patients exhibited a rise in IgA+ memory B cells and plasmablasts compared to HC and FA. Conclusions LT has an impact on humoral immunity, remarkably in those patients developing FA. The increase in serum markers of mucosal IgA, food allergen-specific IgA and cTfh cells observed in LTFA, point towards a disturbance in intestinal immune homoeostasis in this patient group. [ABSTRACT FROM AUTHOR]

Congenital esophageal stenosis ( CES) is a rare clinical condition but is frequently associated with esophageal atresia ( EA). The aim of this study is to report the diagnosis, management, and outcome of CES associated with EA. Medical charts of CES- EA patients from Lille University Hospital, Sainte- Justine Hospital, and Montreal Children's Hospital were retrospectively reviewed. Seventeen patients (13 boys) were included. The incidence of CES in patients with EA was 3.6%. Fifteen patients had a type C EA, one had a type A EA, and one had an isolated tracheoesophageal fistula. Seven patients had associated additional malformations. The mean age at diagnosis was 11.6 months. All but two patients had non-specific symptoms such as regurgitations or dysphagia. One CES was diagnosed at the time of surgical repair of EA. In 12 patients, CES was suspected based on abnormal barium swallow. In the remaining four, the diagnostic was confirmed by esophagoscopy. Eleven patients were treated by dilation only (1-3 dilations/patient). Six patients underwent surgery (resection and anastomosis) because of failure of attempted dilations (1-7 dilations/patient). Esophageal perforation was encountered in three patients (18%). Three patients had histologically proven tracheobronchial remnants. CES associated with EA is frequent. A high index of suspicion for CES must remain in the presence of EA. Dilatation may be effective to treat some of them, but perforation is frequent. Surgery may be required, especially in CES secondary to ectopic tracheobronchial remnants. [ABSTRACT FROM AUTHOR]

Focuses on the clinical case of extreme hyperbilirubinaemia in a male infant with hepatic haemangio-endothelioma. Results of the physical examination; Explanation for the intensity of cholestasis in the patient; Effect of corticosteroids on both haemangio-endothelioma and cholestasis.

Objectifs Etudier rétrospectivement les cavernomes porte suivi en gastroentérologie pédiatrique de 1975 à 2013 Sujet/matériels et méthodes Avec un âge moyen de découverte de 4.2 ans, 34 patients étaient suivis en gastroentérologie pour cavernome porte. On analysait sur dossier:l’étiologie, le diagnostic, le traitement et les complications. Résultats principaux La population comptait 55.8% de cas liés à un cathéter ombilical (KTO) (n=19). Une hémorragie digestive (HD) permettait le diagnostic dans 47.1% des cas (n=16). On opérait 18 enfants pour extension de varices oesophagiennes (VO) avec HD dont 15 d’une dérivation mésentérico-cave par greffon jugulaire(83.3%). Le succès opératoire était défini par la non extension des VO sans béta bloquants après une opération avec perméabilité du greffon. Parmi les 18 opérés,13 cas(72.2%) étaient un succès(suivi post opératoire moyen de 9.8 ans). L’analyse comparative opérés/non opérés par χ2 montrait une différence significative sur le mode de découverte, les HD semblent plus fréquentes chez les opérés (p<0.01; 83.33%vs 6.25%). Conclusion Les cavernomes semblent être principalement d’origine iatrogène. La dérivation mésenterico-cave reste encore efficace malgré l’essor actuel des techniques de reperméabilisation du récessus de rex. [ABSTRACT FROM AUTHOR]

What is already known about this subject Although there is no clear evidence of the role of dairy consumption on cardiovascular disease ( CVD) risk development in adults, several studies have suggested dairy consumption to have a protective effect., Limited evidence on the relationship between milk and dairy products consumption and CVD risk factors among adolescents., What this study adds Dairy consumption was inversely associated with CVD risk in European adolescent girls., Higher dairy consumption was associated with lower adiposity and higher cardiorespiratory fitness in both genders., Objective To identify those food groups best discriminating individuals at high/low cardiovascular disease ( CVD) risk and to investigate the relationship between dairy consumption and CVD risk factors (individual and scores) in adolescents (12.5-17.5 years) from eight European cities participating in the cross-sectional (2006-2007) HELENA (Healthy Lifestyle in Europe by Nutrition in Adolescence) project. Methods Diet, waist circumference, skin-folds thickness, systolic blood pressure, insulin resistance, triglycerides, total cholesterol/high-density lipoprotein ratio and cardiorespiratory fitness ( CRF) were assessed in 511 (49.9% boys) adolescents. Individual z-scores of CVD risk factors were summed to compute sex-specific clustered CVD risk scores. Results Dairy emerged as the food group best discriminating adolescents at low/high CVD risk. In both genders, waist circumference and sum of skin-folds were inversely associated with consumption of milk and yogurt, and milk- and yogurt-based beverages, whereas a positive association was observed with CRF. Moreover, CVD risk score (β = −0.230, P = 0.001) was also inversely associated with overall dairy consumption only in girls. Discussion Dairy consumption is associated with lower adiposity and higher CRF in these adolescents. An inverse association between CVD risk score and dairy consumption is also depicted in girls. The study adds further evidence to the scarce literature on the influence of milk and dairy products on adolescents' cardiovascular health. [ABSTRACT FROM AUTHOR]

To investigate the combined influence of diet quality and physical activity on cardiovascular disease ( CVD) risk factors in adolescents, adolescents ( n = 1513; 12.5-17.5 years) participating in the Healthy Lifestyle in Europe by Nutrition in Adolescence study were studied. Dietary intake was registered using a 24-h recall and a diet quality index was calculated. Physical activity was assessed by accelerometry. Lifestyle groups were computed as: healthy diet and active, unhealthy diet but active, healthy diet but inactive, and unhealthy diet and inactive. CVD risk factor measurements included cardiorespiratory fitness, adiposity indicators, blood lipid profile, blood pressure, and insulin resistance. A CVD risk score was computed. The healthy diet and active group had a healthier cardiorespiratory profile, fat mass index ( FMI), triglycerides, and high-density lipoprotein cholesterol ( HDL- C) levels and total cholesterol ( TC)/ HDL- C ratio (all P ≤ 0.05). Overall, active adolescents showed higher cardiorespiratory fitness, lower FMI, TC/ HDL- C ratio, and homeostasis model assessment index and healthier blood pressure than their inactive peers with either healthy or unhealthy diet (all P ≤ 0.05). Healthy diet and active group had healthier CVD risk score compared with the inactive groups (all P ≤ 0.02). Thus, a combination of healthy diet and active lifestyle is associated with decreased CVD risk in adolescents. Moreover, an active lifestyle may reduce the adverse consequences of an unhealthy diet. [ABSTRACT FROM AUTHOR]

Background/objectives:The objective of this study was to examine the relationship between amino acid (AA) intake and serum lipid profile in European adolescents from eight European cities participating in the cross-sectional (2006-2007) HELENA (Healthy Lifestyle in Europe by Nutrition in Adolescence) study, and to assess whether this association was independent of total fat intake.Subjects/methods:Diet, skinfold thickness, triglycerides (TG), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-c), TC/HDL-c ratio, low-density lipoprotein cholesterol (LDL-c), apolipoprotein B (Apo B), apolipoprotein A1 (Apo A1) and Apo B/Apo A1 ratio were measured in 454 12.5- to 17.5-year-old adolescents (44% boys). Intake was assessed via two non-consecutive 24-h dietary recalls. Data on maternal education and sedentary behaviors were obtained via questionnaires. Physical activity was objectively measured by accelerometry.Results:Alanine, arginine, asparaginic acid, glycine, histidine, lysine and serine intakes were inversely associated with serum TG concentrations in both boys and girls. Intake of other AA like alanine and/or arginine was also inversely associated with serum TC, LDL-c and Apo B/Apo A1 ratio only in girls. An inverse association was observed between intakes of alanine, isoleucine, leucine, methionine, serine, tryptophan, tyrosine and valine and TC/HDL-c ratio among female adolescents. Similar results were found in males for serine and tryptophan intakes. It is noteworthy, however, that associations were no longer significant in both genders when total fat intake was considered as a confounding factor.Conclusions:In this sample of adolescents, the association between AA intakes and serum lipid profile did not persist when dietary fat was considered. Therefore, dietary interventions and health promotion activities should focus on fat intake to improve lipid profile and potentially prevent cardiovascular disease. [ABSTRACT FROM AUTHOR]

Highlights: [•] Adolescents’ sleep time was not associated with cardiometabolic risk factors. [•] European adolescents reported a sleep time of 8h per day (median). [•] Beyond sleep duration, other dimensions of sleep may be more important for health. [•] Future epidemiologic studies should be rigorous with the election of confounders. [ABSTRACT FROM AUTHOR]

Background and Aims: The aim of this study was to assess the micronutrient status of children receiving prolonged enteral nutrition. Methods: This cross-sectional single-center study included all 64 children (median age 6.8 years) receiving enteral nutrition providing >50% of daily energy intake for more than 6 months (median duration of enteral nutrition 43 months). The characteristics of the patients and mode of enteral nutrition were recorded. The concentrations of iron, zinc, copper, selenium and vitamins A, D, E and C were measured in plasma. Results: Twelve children (19%) had iron deficiency. A high 25-hydroxyvitamin D concentration was recorded in 20% of the children, but none had associated hypercalcemia. Fifty-two children (81%) had low zinc concentrations in both plasma and erythrocytes. Plasma zinc, calcium, phosphorus and vitamin D concentrations were significantly lower in children receiving fiber supplementation. Abnormal micronutrient concentrations were found more frequently in the children receiving fiber supplementation. No other predisposing factors were associated with micronutrient deficiencies. Conclusion: Long-term enteral nutrition can lead to micronutrient deficiencies in children, whose micronutrient concentrations may require regular checking. Fiber supplementation might reduce the bioavailability of zinc, calcium, phosphorus and vitamin D. Copyright © 2013 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Background: High prevalence of vitamin D insufficiency (<75 nmol/l) has been previously reported in European adolescents. Vitamin D deficiency has been related to physical fitness and adiposity but it is not clearly known whether this relationship applies to growing children and adolescents.Aim: To determine how body composition and physical fitness are related to 25-hydroxyvitamin D [25(OH)D] concentrations in European adolescents.Design: The HEalthy Lifestyle in Europe by Nutrition in Adolescence-CSS study was a multi-centre cross-sectional study.Methods: Plasma 25(OH)D, body composition and physical fitness measures were obtained in 1006 European adolescents (470 males) aged 12.5–17.5 years. Stepwise regression and ANCOVA were performed by gender using 25(OH)D as dependent variable, with body composition, physical fitness as independent variables controlling for age, seasonality and latitude.Results: For males, maximum oxygen consumption (VO2max) (B = 0.189) and body mass index (BMI) (B = −0.124) were independently associated with 25(OH)D concentrations (both P < 0.05). For females, handgrip strength (B = 0.168; P < 0.01) was independently associated with 25(OH)D concentrations. Those adolescents at lower BMI and high fitness score presented significant higher 25(OH)D concentrations than those at lower fitness score in the other BMI groups (P < 0.05).Conclusions: Cardiorespiratory fitness and upper limbs muscular strength are positively associated with 25(OH)D concentrations in male and female adolescents, respectively. Adiposity in males and low fat free mass in females are related to hypovitaminosis D. The interaction between fitness and BMI has a positive effect on 25(OH)D concentrations. Therapeutic interventions to correct the high rates of vitamin D deficiency in adolescents should consider physical fitness. [ABSTRACT FROM AUTHOR]