Search

Objective to investigate the reliability of laryngeal reflux finding score (RFS) and symptom index (RSI) in assessing gastroesophageal reflux (GER) in children and infants. Methods patients with laryngeal or respiratory symptoms, who underwent laryngoscopy and esophageal pH-impedance (MII-pH) were recruited. RSI and RFS were correlated to MII-pH results. A RSI>13, RFS>7, acid exposure index>7%, total reflux episodes>100/24 h in infants or>70/24 h in children, or a positive symptom index or association probability, were considered pathological. Analysis considering age ( 12 months) was performed. Sensitivity, specificity, positive (PPV) and negative predictive values (NPV) of the laryngeal scores were calculated. Results 197 children (median 53 months, 61 infants) were enrolled. MII-pH was pathological in 5/10 patients with RFS>7, and in 17/31 with RSI>13. RFS>7 had 3.9% sensitivity, 93% specificity, a PPV of 50 and a NPV of 34 in predicting GER disease. RFS was inversely associated to weakly acidic and proximal GER. RSI>13 had 13% sensitivity, 83% specificity, and a PPV and NPV similar to RFS. RSI was significantly associated with the number of acid reflux episodes, and, in infants, with bolus exposure index. Conclusions RSI and RFS aren't accurate in predicting GER in infants and children. Acid reflux relates to laryngeal symptoms, but neither acid, nor proximal and weakly acidic GER relate to laryngeal alterations.

Objective: To assess the accuracy of noninvasive parameters, fecal calprotectin (FC), increased bowel wall thickening (BWT) at intestinal ultrasound (IUS) and blood inflammatory indexes (BII), alone or in combination, as diagnostic tools for inflammatory bowel disease (IBD) in pediatric patients. Methods: Retrospective data were collected on consecutive children (age 2–18 years) referred to our pediatric gastroenterology clinic, for recurrent abdominal pain and/or altered bowel habit from 2007 to 2013. Subjects who had diagnostic workup: laboratory tests (FC, BII, white blood cell (WBC), C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR)) and IUS as initial assessment were eligible. Subjects with known gastrointestinal (GI) diseases, or signs or symptoms highly suggestive for organic diseases necessitating prompt endoscopy (e.g., perianal disease or rectal bleeding), or who had recently performed endoscopy were excluded. The accuracy of noninvasive tests for detecting IBD was assessed using endoscopic and/or radiological investigations, performed in subsequent clinical follow up, as reference gold standard. Results: Seventy-seven patients (mean age 11.3, 44 males) were included, 23 (29.9%) with a final diagnosis of IBD. As single tests, FC gave the highest sensitivity (96%) but lower specificity (72%) and IUS highest specificity (96%) with lower sensitivity (70%). The combination of FC + IUS showed excellent accuracy for detecting children with IBD with positive predictive value: 100%; negative predictive value: 88.5%. The probability of IBD in children with normal FC, BII and IUS was 0.09%. Conclusions: FC and increased BWT at IUS are accurate to guide reassurance or proceeding with further invasive procedures for detecting IBD in children with mild GI symptoms.

Background: Neonatal hypoglycemia is a common disorder especially in at-risk infants and it can be associated with poor long-term neurological outcomes. Several therapeutic interventions are suggested, from the implementation of breastfeeding to the glucose intravenous administration. Oral dextrose gel massaged into the infant’s inner cheek is a recent treatment option of asymptomatic hypoglycemia, after which oral feeding is encouraged. This approach seems to reduce the admission of infants to neonatal intensive care unit (NICU) so favouring maternal bonding and breastfeeding success at discharge. Methods: In our unit we recently implemented the protocol for the management of asymptomatic hypoglycemia with the introduction of dextrose oral gel at 40%. Therefore we compared two cohorts of near term at-risk infants with asymptomatic hypoglycemia: a historical group managed with our old protocol and the second one prospectively followed after the introduction of dextrose gel at 40%. Results: Primary outcome was occurrence of NICU admission and glucose intravenous needs; breastfeeding success was the secondary outcome. Infants in the dextrose oral gel group showed statistically lower need of NICU admission and higher prevalence of exclusive breastfeeding at discharge compared with infants of the historical group. Conclusions: In our population the introduction of dextrose oral gel at 40% to the protocol, helped in the safe management of asymptomatic hypoglycemia in near term infants and, at the same time, implemented breastfeeding.

Lung ultrasound imaging is reaching growing interest from the scientific community. On one side, thanks to its harmlessness and high descriptive power, this kind of diagnostic imaging has been largely adopted in sensitive applications, like the diagnosis and follow-up of preterm newborns in neonatal intensive care units. On the other side, state-of-the-art image analysis and pattern recognition approaches have recently proven their ability to fully exploit the rich information contained in these data, making them attractive for the research community. In this work, we present a thorough analysis of recent deep learning networks and training strategies carried out on a vast and challenging multicenter dataset comprising 87 patients with different diseases and gestational ages. These approaches are employed to assess the lung respiratory status from ultrasound images and are evaluated against a reference marker. The conducted analysis sheds some light on this problem by showing the critical points that can mislead the training procedure and proposes some adaptations to the specific data and task. The achieved results sensibly outperform those obtained by a previous work, which is based on textural features, and narrow the gap with the visual score predicted by the human experts., Comment: 7 pages

The development of a proper neonatal microbiota is of great importance, especially for the effects that dysbiosis has in acute and chronic diseases’ onset. The microbiota, particularly the intestinal one, plays a crucial role in maintaining the health of the host, preventing colonization by pathogenic bacteria and significantly influencing the development and maturation of a normal gastrointestinal mucosal immunity. Several factors may interfere with the physiological development of microbiota, such as diseases during pregnancy, type of delivery, maternal nutrition, type of neonatal feeding, use of antibiotics, exposition to hospital environment (e.g., neonatal intensive care unit) and genetic factors. Thanks to a proper maternal and neonatal supplementation with specific functional nutrients, it is now possible to correct dysbiosis, thus reducing the risks for the newborn’s health. In this review of the literature, we give an overview of the studies highlighting the composition of the maternal, fetal and neonatal microbiota, the factors potentially responsible for dysbiosis and the use of functional nutrients to prevent diseases’ onset.

The last decades have seen significant improvements in the care of premature infants. The introduction of new approaches, especially in the ventilatory management, have led to significant increase of survival rate of low and extremely low gestational age infants. These populations of neonates, however, often experience prolonged mechanical ventilation, which is widely recognized to be closely related to bronchopulmonary dysplasia (BPD) development. The management of BPD, which is a multifactorial disease, requires a multidisciplinary approach and remains challenging for all the physicians involved. In fact, short and long-term sequelae are not only related to pulmonary performances but include neurological impairment and growth deficiency. A proper nutrition management since the very first days has shown to significantly contribute to the optimal maturation and functionality of the lung. In this paper, we aim to give an overall of the main principles of nutrition in infants born prematurely, with specific regard to the interventions, which could be relevant in infants affected by BPD.

Growing evidence underlines the pivotal role of infant gut colonization in the development of the immune system. The possibility to modify gut colonization through probiotic supplementation in childhood might prevent atopic diseases. The aim of the present systematic review and meta-analysis was to evaluate the effect of probiotic supplementation during pregnancy and early infancy in preventing atopic diseases. PubMed, Embase and Cochrane Library were searched for randomized controlled trials evaluating the use of probiotics during pregnancy or early infancy for prevention of allergic diseases. Fixed-effect models were used, and random-effects models where significant heterogeneity was present. Results were expressed as risk ratio (RR) with 95% confidence interval (CI). Seventeen studies, reporting data from 4755 children (2381 in the probiotic group and 2374 in the control group), were included in the meta-analysis. Infants treated with probiotics had a significantly lower RR for eczema compared to controls (RR 0.78 [95% CI: 0.69-0.89], P = 0.0003), especially those supplemented with a mixture of probiotics (RR 0.54 [95% CI: 0.43-0.68], P

Esophageal multiple intraluminal impedance baseline is an additional impedance parameter that was recently related to esophageal integrity. The aim of this study was to assess the relationship between mean esophageal impedance value and endoscopic findings in a large group of children. Children with symptoms of gastroesophageal reflux submitted to both endoscopy and impedance were included. Esophagitis was graded according to the Los Angeles classification. Mean impedance value was automatically calculated over 24-hour tracings. Data were adjusted for age through z-score transformation using percentiles normalized by the LMS (Lambda for the skew, Mu for the median, and Sigma for the generalized coefficient of variation) method. Nonparametric Mann-Whitney and Kruskal-Wallis tests, multiple, and stepwise regression were used. P-value

Gluten-free diet (GFD) is the cornerstone treatment for celiac disease (CD). GFD implies a strict and lifelong elimination from the diet of gluten, the storage protein found in wheat, barley, rye and hybrids of these grains, such as kamut and triticale. The absence of gluten in natural and processed foods, despite being the key aspect of GFD, may lead to nutritional consequences, such as deficits and imbalances. The nutritional adequacy of GFD is particularly important in children, this the age being of maximal energy and nutrient requirements for growth, development and activity. In recent years, attention has focused on the nutritional quality of gluten-free products (GFPs) available in the market. It is well recognized that GFPs are considered of lower quality and poorer nutritional value compared to the gluten-containing counterparts. The present review focuses on the nutritional adequacy of GFD at the pediatric age, with the aim being to increase awareness of the potential complications associated with this diet, to identify strategies in order to avoid them and to promote a healthier diet and lifestyle in children with CD.

Probiotics have been linked to a reduction in the incidence of necrotizing enterocolitis and late-onset sepsis in preterm infants. Recently, probiotics have also proved to reduce time to achieve full enteral feeding (FEF). However, the relationship between FEF achievement and type of feeding in infants treated with probiotics has not been explored yet. The aim of this systematic review and meta-analysis was to evaluate the effect of probiotics in reducing time to achieve FEF in preterm infants, according to type of feeding (exclusive human milk (HM) vs. formula). Randomized-controlled trials involving preterm infants receiving probiotics, and reporting on time to reach FEF were included in the systematic review. Trials reporting on outcome according to type of feeding (exclusive HM vs. formula) were included in the meta-analysis. Fixed-effect or random-effects models were used as appropriate. Results were expressed as mean difference (MD) with 95% confidence interval (CI). Twenty-five studies were included in the systematic review. In the five studies recruiting exclusively HM-fed preterm infants, those treated with probiotics reached FEF approximately 3 days before controls (MD -3.15 days (95% CI -5.25/-1.05), p = 0.003). None of the two studies reporting on exclusively formula-fed infants showed any difference between infants receiving probiotics and controls in terms of FEF achievement. The limited number of included studies did not allow testing for other subgroup differences between HM and formula-fed infants. However, if confirmed in further studies, the 3-days reduction in time to achieve FEF in exclusively HM-fed preterm infants might have significant implications for their clinical management.

There is increasing interest in the potential beneficial role of probiotic supplementation in the prevention and treatment of atopic diseases in children. Probiotics are defined as ingested live microorganisms that, when administered in an adequate amount, confer a health benefit to the host. They are mainly represented by Lactobacilli and Bifidobacteria. Several epidemiological data demonstrate that intestinal microflora of atopic children is different from the one of healthy children. Many literature data show that probiotics may modulate the intestinal microflora composition and may have immunomodulatory effect. Based on this hypothesis, probiotics are supposed to confer benefits to allergic diseases. Administration of probiotics when a natural population of indigenous intestinal bacteria is still developing could theoretically influence immune development by favoring the balance between Th1 and Th2 inflammatory responses. For this reason, some studies have evaluated the potential impact of probiotics supplementation in the prevention of atopic dermatitis, with contrasting results. Clinical improvement in immunoglobulin (Ig)E-sensitized (atopic) eczema following probiotic supplementation has been reported in some published studies and the therapeutic effects of probiotics on atopic dermatitis seemed to be encouraging. However, as far as the usefulness of probiotics as a prevention strategy is concerned, results are still inconclusive. In fact, the clinical benefits of probiotic therapy depend upon numerous factors, such as the type of bacteria, dosing regimen, delivery method and other underlying host factors, such as age and diet. More studies are still needed to definitively prove the role of probiotics in the treatment of allergic eczema.

A 34-week infant born from a mother with a history of drug abuse developed neonatal abstinence syndrome (NAS) in the first hours of life. Urine drug screening was positive for cocaine and heroin. The infant developed acute kidney injury and bilateral hydronephrosis while receiving oral morphine for control of NAS. Cessation of morphine therapy and urinary catheterization resulted in a rapid and complete resolution of the symptoms. Our patient was homozygous for the C3435T polymorphism in the ABCB1 gene, a polymorphism previously associated with impaired P-glycoprotein activity. We hypothesize that acute renal toxicity was related to accumulation of morphine within urothelial cells due to genetically determined impaired P-glycoprotein activity.

Probiotics are viable microorganisms that can exert potential benefit to health. They have been administered in several clinical conditions with conflicting results. Infantile colic is a recurring condition in the first months of life, defined by Rome III criteria such as paroxysms of irritability, fussing or crying that start and stop without obvious cause, lasting >3 hours per day and occurring >3 days each week and without a failure to thrive. Laboratory tests and radiological examinations are unnecessary if the infant is gaining weight normally and has a normal physical examination. Despite the fact that these symptoms are spontaneously self-limited after the age of 3 months, infantile colic may lead to a significant parental strife. Currently aetiopathogenesis is not yet understood but different treatments have been proposed to mitigate symptoms. Several studies showed that colicky infants had an inadequate balance of Lactobacilli in gut microflora and probiotics have been studied as a potential therapy due to their role in the modulation of intestinal microbiota. We performed a review of literature regarding this topic to evaluate if there was sufficient evidence to support a probiotic supplementation approach for colicky infants.

Studies of adults and children with celiac disease (CD) performed mostly in tertiary care centers have reported an increased risk of overweight during gluten-free diet (GFD). We measured body mass index (BMI) of CD children followed by family pediatricians in order to estimate prevalence of underweight and overweight at diagnosis and to describe BMI changes during GFD.We compared 150 CD children (age range 2-16 yrs) under GFD from a median (IQR) time of 4.4 (4.2) years with 288 healthy children matched for gender and age. We also evaluated retrospectively BMI changes between CD diagnosis and the current evaluation. The median (IQR) BMI of CD patients was significantly lower than that of controls [-0.38 (1.46) vs. 0.09 (1.18) SDS, p0.0001, Italian reference data]. Using the International Obesity Task Force classifications, CD children were less frequently overweight or obese (12% vs. 23.3%, p = 0.014) and more frequently underweight (16% vs. 4.5%, p0.001) than controls. During GFD, there was a marked decrease of number of underweight subjects (13 vs. 27) and a minimal increase of number of overweight subjects (9 vs. 6) (p0.001).The frequency of overweight and obesity at diagnosis of CD and during GFD in children followed by family pediatricians is substantially lower than that reported in tertiary care centers. On the other hand, the high frequency of underweight at diagnosis confirms the need of careful personalized nutritional management.

Background Rotavirus is the major cause of acute gastroenteritis and severe dehydrating diarrhea in young children. Methods To estimate the proportion of hospital admissions for rotavirus acute gastroenteritis and identify the circulating G and P genotypes among children under five years of age, we conducted a prospective observational study from January to December 2008, recruiting children consecutively admitted to six hospitals in Milan and nearby towns in northern Italy. Typing was done on stool samples by reverse transcriptase polymerase chain reaction amplification. Results Of the 521 stool samples from children with acute gastroenteritis, 34.9% (95%CI, 30.8 to 39.2%) were rotavirus-positive. Two thirds (67.6%) were under two years of age, and 13.2% were under six months. The predominant G type was G1 (40.7%), followed by G9 (22.5%), G2 (13.2%), G3 (5.5%), G4 (3.8%) and G10 (1.6%). Twenty-one (11.7%) mixed-G infections were identified: G1+G10 (8.8%); G1+G9 (1.6%); and G2+G10 (1.2%). Only P[8] (67.6%) and P[4] (12.6%) types were P genotyped. The predominant single G/P combination was G1P[8] (39.7%), followed by G9P[8] (25.3%), G2P[4] (14.3%), and G3P[8] (4.1%). All G-mixed types combined with P[8]. Conclusions These findings show an high prevalence of rotavirus infections among children admitted to hospital for acute gastroenteritis caused by different rotavirus strains circulating in the area studied.

Background Nosocomial infections are among the leading causes of mortality and morbidity especially in neonatal intensive care unit (NICU) [1]. The intestinal microbiota of the gut is nowadays considered to play an important functional role in the host’s health through nutritional, physiological and immunological processes. For these reasons, probiotics may exert actions of prevention and therapy of infectious diseases.

Dario Dilillo1,∗, Francesca Penagini1, Giovanni Maconi2, Giulia Rendo1, Massimo Tonolini3, Fabio Meneghin1, Federica Furfaro2, Gian Vincenzo Zuccotti 1 1 Clinica Pediatrica, Ospedale Luigi Sacco, Universita degli Studi di Milano, Milano, Italy 2 Italia Dipartimento di Gastroenterologia, Ospedale Luigi Sacco, Universita degli Studi di Milano, Milano, Italy 3 Dipartimento di Radiologia, Ospedale Luigi Sacco, Universita degli Studi di Milano, Milano, Italy

s / Digestive and Liver Disease 45 (2013) e263–e311 e283 ter >8mm); this data correlated with high HIV viral load (p: 0.001) and low CD4+ T cell percentage (p: 0.012) but not with faecal calprotectin and CD4+ T absolute count. Conclusion: HIV-infected children, either naive and on HAART, did not have significant biochemical or ultrasonoghraphic signs of mucosal inflammation. A proportion of patients showed enlarged mesenteric lymphnodes,which correlatedwith highHIV viral load, and low CD4 percentage. This data may suggest a role of bowel ultrasound as a noninvasivemethod to differentiate controlled and uncontrolled HIV infection.

in 1/2000–1/2500 phenotypic females, the syndrome manifests itself in a number of ways. Concurrent health concerns may also be present, including many autoimmune diseases, in particular hypothyroidismandceliacdisease,which cancausemalabsorption. However, not all cases of malabsorption in patients with Turner syndrome are caused by celiac disease. Materials and methods: We report the case of T.G. with a Turner’s syndrome diagnosed at birth, that from the first days of life presented poor growth height-weight (in relation to specific curves); was fuelled with adapted milk and then had followed a program of weaning gluten-free. At 7 months of age she was hospitalized for persistent fever and diarrhea, and discharged with a diagnosis of acute enteritis. But severe diarrhea persists and T.G. stunted, so she came at our observation for severe dystrophy secondary tomalabsorption at 8months old; the little girl was dystrophic, hypotonic and lethargic, with little subcutaneous fat and dehydrationof the skin andmucousmembranes,weight of 4.060kg (≪3 ◦C), length of 59 cm ( 3 ◦C), head circumference of 42 cm. We started intravenous rehydration and oral administration of a cow’s milk whey protein hydrolysate. The glycemic profile documented hypoglycemia after prolonged fasting (at night), so it was undertaken exclusive and continues enteral nutrition with nasogastric probe, obtaining euglycemia and progressive improvement of the evacuations. Adding MCT oil, we have increase caloric intake up to 150kcal/kg/die, obtaining also weight increase of the child. Results: Enteral nutrition was withdrawn gradually, but the administration of a cow’s milk whey protein hydrolysate was required for about 13 months. The tests carried out showed a protein-losing enteropathy; sweat test, hemogas-analysys, ammonia test, specific IgE level versus cow’s milk, aminoaciduria and aminoacidemia, thyroid function, HLA celiac disease testing, coproculture and urineculture, heart and abdomen ultrasound, and thorax radiography were normal. The array-CGH confirmed the mosaicism of chromosome X and the SHOX-gene analysis documented a heterozygous deletion encompassing all exons and enhancer region of SHOX-gene and X-linked genes, compatible with Leri Weill syndrome. Conclusions: This clinical case highlights the primary importance of nutrition in the treatment of a patient with a clinical condition of malabsorption. The choice of elemental diet (cow’s milk whey protein hydrolysate +MCT oil) and the use of the exclusive and continues enteral nutrition with naso-gastric probe, are results highly effective for overcoming the feeding difficulties of the patient and reach an adequate growth.

acute diarrhea. The initial clinical evaluation of the patients should focus on identifying likely causes on the basis of history and clinical findings. Blood routine analyses were performed upon admission in the hospital. Stool samples were obtained from all the children affected by gastroenteritis. All the specimens were tested for the presence of rotavirus antigens using validated ELISA test. Rectal swabs were cultured for Salmonella, Campylobacter and Shigella. We used Bayes’ theorem to establish ESR threshold level that could distinguish the two group of different causative agents of acute diarrhea. Results: Salmonella spp. grew in 27 samples, Rotavirus antigens were detected in 31 specimens. All the Children were culture-negative for Shigella and Campylobacter. 53% of patients with ID had ESR levels greater than mm. 29, 46% had levels lower. Only 5% of patients with NID had ESR values greater than mm 29. Using Bayes’ theorem, if ESR level is greater than mm 29, the probability that a patient with acute diarrhea has salmonellosis is 0.88. Conclusions: In our country the children admitted in hospital for AD with ESR levels higher than mm 29 have likely contracted salmonellosis.

The observation that intestinal bacterial microflora might be able to influence immune system surveillance through changed nutritional habits has raised awareness of the role of probiotics. These are live microorganisms that are able to reach the gastrointestinal tract and alter its microfloral composition, producing beneficial health effects when consumed in adequate amounts. Recent clinical trials have evaluated the clinical effectiveness of probiotics in the treatment and prevention of a wide range of acute and chronic gastrointestinal diseases, and also non-gastrointestinal diseases, such as atopy, respiratory infections, vaginitis and hypercholesterolaemia. Probiotic supplements are generally regarded as safe because the microorganisms they contain are identical to those found in human gastrointestinal and vaginal microflora. Guidelines on the use of probiotics in the clinical setting require periodical updates for the latest data to be included in clinical applications. The purpose of this clinical report is to review current evidence on the use of probiotics in a variety of gastrointestinal and non-gastrointestinal conditions.