Search

There is no concordance between current diagnostic criteria for failure to thrive (FTT). We analyzed validity of the Semi-Objective Failure to Thrive (SOFTT) diagnosis tool, which uses a combination of subjective and objective components to make the diagnosis of FTT. The tool was used to diagnose FTT in 94 patients who met 1 of 7 accepted criteria for FTT. Concurrent and predictive validity were demonstrated using anthropometric z-scores and change in anthropometric z-scores, respectively. SOFTT results correlated with differences in anthropometric z-scores for length ( P = .011), weight, weight-for-length, body mass index, mid-upper arm circumference, and triceps skinfold thickness ( P < .0001) between those diagnosed as normal and those with FTT. At follow-up, children with FTT compared with children rated as normal had significantly higher change in weight ( P ≤ .001) and body mass index ( P = .026) z-scores. The SOFTT tool leads to the accurate diagnosis of FTT demonstrated by concurrent and predictive validity.

Context— Solid-organ transplant is the treatment of choice for end-stage organ failure and requires a transition from management of a life-threatening condition to a chronic illness. Despite research focusing on quality of life after transplant, there is a gap addressing the role of managing a chronic illness focusing on vulnerability and impact on family. Objective— Identify patient and family patterns of adaptation among kidney and liver transplant recipients in regard to (1) vulnerability, (2) impact of illness on the family, (3) family functioning, and (4) quality of life (parent and child report). Design— Cross-sectional study enrolling children 5 to 18 years old and their parent at a single time point after kidney or liver transplant. Validated self-report tools were completed. Results— In all, 47 participants (24 kidney and 23 liver) were recruited. Mean age at transplant was 4.0 (kidney) and 2.1 (liver) years. Mean age at report was 12.1 (kidney) and 7.1 (liver) years. Child vulnerability correlated negatively with (1) family impact in the kidney ( P < .05) and liver ( P < .05) transplant groups, (2) PedsQL subscales including Parent Emotional ( P < .05), Parent Social ( P < .01), Parent Psychosocial ( P < .01), Parent Physical ( P < .05), Parent School ( P < .05), and Child Social ( P < .01) in the kidney transplant group, (3) PedsQL Parent Emotional subscale ( P < .01) in the liver transplant group, and (4) Functional status ( P < .01) in the liver transplant group. Conclusions— Child vulnerability provides insight into quality of life and the impact of illness on the family and family functioning.

Background Phytosterols in soybean oil (SO) lipids likely contribute to parenteral nutrition-associated liver disease (PNALD) in infants. No characterization of phytosterol metabolism has been done in infants receiving SO lipids. Methods In a prospective cohort study, 45 neonates (36 SO lipid vs 9 control) underwent serial blood sample measurements of sitosterol, campesterol, and stigmasterol. Mathematical modeling was used to determine pharmacokinetic parameters of phytosterol metabolism and phytosterol exposure. Results Compared to controls, SO lipid-exposed infants had significantly higher levels of sitosterol and campesterol (p

The aims of the study were to describe infliximab adherence in a pediatric inflammatory bowel disease cohort, to identify demographic and disease factors associated with adherence, and to examine differences in acute care use among adherent and nonadherent patients. Charts of patients who received infliximab at the Children's Hospital of Wisconsin (CHW) between October 2010 and October 2012 were retrospectively reviewed. A total of 151 patients met the inclusion criteria; 91.4% of the patients were adherent. Nonadherent patients had more emergency room visits and hospitalizations than adherent patients. The study is the first to show high adherence rates to infliximab in a pediatric cohort.

After intestinal digestion and absorption of lipids, the enterocyte needs to package these in a form that can permit transit of these lipids in a high concentration in an aqueous environment, to deliver dietary lipids to the relevant tissues for use. To achieve this, lipids are packaged into lipoproteins, spherical particles that can allow hydrophobic lipids, charged lipids, fat-soluble vitamins to interact with special proteins that allow them to travel in the blood. The enterocyte secretes dietary lipids in massively large particles called chylomicrons (literally micron-sized milky particles) that contain dietary lipids and fat-soluble vitamins. These very large particles are rich in triglycerides, are secreted into the lymphatic system and enter the systemic circulation, where the triglycerides are removed by the action of lipases in the capillary beds of all vasculature, allowing the energy-rich triglycerides to be delivered to the tissues. As the chylomicron particle travels through the circulation, it looses the triglyceride, becomes relatively more concentrated in cholesterol ester (CE), and becomes smaller. This remnant particle becomes recognizable by receptors in the liver, where it is taken up via endocytosis and all of the lipid content is remetabolized by the liver. The liver can resecrete the lipid via secretion of a lipoprotein, the very low density lipoprotein (VLDL) that can further allow delivery of lipids to the circulation. As lipids are off loaded, as well as exchanged with other lipoprotein particles in the blood, the VLDL is reduced in size, and becomes recognizable by receptors in the liver to be cleared. A small number of VLDL particles become small enough in the circulation and are relatively triglyceride-poor, but CE-rich termed, low density lipoproteins (LDL), and these are cleared by the liver at a much lower rate, although clearance is also receptor mediated. All tissues also have the ability to synthesize cholesterol, but any excess needs to be removed. To achieve this, tissues use the high density lipoprotein pathway in which these lipoprotein particles can accept cholesterol from cells and tissues and exchange these with VLDL and LDL, or are taken up by the liver. The liver is the major organ that can dispose of excess body cholesterol, either by direct secretion into bile or by converting cholesterol to bile salts and then excreting bile salts into bile. This article describes these pathways in detail, as well as some of the human genetic disorders that are caused when these pathways are disrupted.

Respiratory syncytial virus (RSV) is a ubiquitous virus responsible for acute infections of the respiratory tract in patients of all ages. RSV presents significant health risks to immunocompromised patients. Two patients, 1 before a liver transplant and 1 after a liver transplant, died of a severe RSV infection. Because of the high risk of death, we recommend expanding the criteria for palivizumab prophylaxis to 2 types of patients: (1) patients with chronic liver disease or who have received a liver transplant and are 24 months old or less and (2) transplant recipients with underlying pulmonary conditions who are less than 36 months old. Further research is indicated in pediatric solid-organ transplant centers to evaluate the effective management of RSV infection to prevent morbidity.

Aminosalicylates are a class of medications commonly used as first-line therapy for induction and maintenance of remission in mild to moderate inflammatory bowel disease (IBD) [1]. Although their use in ulcerative colitis (UC) is well established, their role in Crohn’s disease (CD) remains controversial. Aminosalicylates were derived from sulfasalazine (SASP), comprised by two moieties with antimicrobial and anti-inflammatory properties, sulfapyridine and 5-aminosalicylic acid (5-ASA), respectively [2, 3]. In the colonic lumen, bacteria metabolize the azo bond that joins the subunits thereby releasing the therapeutically active 5-ASA and the inactive sulfapyridine [4]. Although effective for the treatment of IBD, the dose-related adverse effects and hypersensitivity reactions associated with sulfapyridine led to the development nonsulfa aminosalicylates. The use of 5-ASAs in adults with IBD is well established; however, there is limited evidence for their safety and efficacy in the pediatric IBD population. This shortcoming is further accentuated by mounting evidence that suggests important differences between adult and pediatric IBD. Nonetheless, 5-ASAs are commonly used in pediatric IBD patients and their use in this population remains mainly guided by the adult literature.