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Inhaled nitric oxide (iNO) has potential anti-inflammatory, anti-microbial, and anti-viral properties for patients with lower respiratory tract infections.We compared the safety and efficacy of iNO administered in two concentrations in addition to standard supportive treatment (SST) compared to SST alone with the aim to improve clinical outcomes of infants with bronchiolitis.In this prospective, multicenter, double-blind, randomized-controlled study, 89 infants hospitalized with moderate-severe bronchiolitis were randomly assigned to three treatment groups: 150 parts per million (ppm) NO+SST(1); 85 ppm NO+SST(2); and the control treatment O2/air+SST(3). Treatment was given for 40 minutes, 4 times/day for up to 5 days. The primary endpoint was time to reach "fit for discharge". This was a composite endpoint comprised of both reaching a sustained oxygen saturation (SpO2) ≥92% in room air, and reaching a clinical score ≤5. Secondary endpoints included time to reach sustained SpO2 ≥92% in room air, time to clinical score ≤5, and time to hospital discharge. Safety was assessed by the number of treatment-related adverse-events (AEs) or serious adverse-events (SAEs). Time-to-event efficacy outcomes were analyzed by Cox proportional-hazards regression-model. Hazard ratio (HR) describes how many times more likely an individual is to experience an event, if such an individual receives the NO rather than the control treatment during the observational period.Group 1 demonstrated significant efficacy for time to reach "fit to discharge" compared to Groups 2 (HR=2.11, p=0.041) and 3 (HR=2.32, p=0.049). Group 1 also demonstrated significant efficacy for time to hospital discharge compared to Groups 2 (HR=2.01, p=0.046) and 3 (HR=2.28, p=0.043). No significant differences were observed between Groups 2 and 3 for either endpoint. There were no differences between treatment groups in time to reach clinical score ≤5. The iNO therapy was well-tolerated with no treatment-related SAEs.Treatment with high dose intermittent iNO at 150 ppm showed reduced time to clinical improvement when compared to 85 ppm or control treatment of hospitalized infants with acute bronchiolitis. The 150 ppm iNO dose is well-tolerated, with significant benefit compared to both standard therapy and 85 ppm iNO, improving respiratory outcome and reducing length of stay.

Early dropout and treatment adherence are main challenges in the treatment of children with obesity. The aim of this study was to identify factors associated with attrition and adherence to weight loss intervention program. We retrospectively reviewed the medical records of all the children who entered the program for pediatric weight loss over 5 years and retrieved demographic and clinical characteristics. Attrition and adherence were documented. Ninety-two of the 248 enrolled children (52% women, mean age 11.1 ± 3.9 years, mean body mass index 31.1 ± 7 kg/m2) dropped out (37%). Dropping out correlated with male sex, low parental education, and self-referral to the clinic ( P < .05 for all). Adherence correlated with older age and the mother’s healthy lifestyle ( P < .05 for all). Sex, parental education, and referral source may predict treatment attrition. Early recognition of children at risk of attrition may help to facilitate better care of those children.

Purpose To investigate factors associated with pediatric feeding disorders (PFD) among children of parents that reported to have had feeding disorders during their own childhood compared to children with PFD with no history of parental PFD. Methods We retrospectively reviewed the medical records of children diagnosed with PFD according to the recent WHO-based definition. Demographic and clinical characteristics of children with PFD with a parental history of PFD were compared to those of children with a PFD with no history of parental PFD. Results Included were 231 children with PFD (median [interquartile range] age 10 (5.5–29) months at diagnosis, 58% boys) of whom 133 children had parents without PFD and 98 children had parents with PFD. Unexpectedly, children of parents without PFD had a higher rate of low birth weight (28% vs. 19%, respectively, p = 0.007), more delivery complications (10% vs. 2%, p = 0.006), more hospitalizations (33% vs. 17%, p = 0.004), more prescription medications (27% vs. 18%, p = 0.05), and a higher percent of gastrostomy tube use (6% vs. 0, p = 0.02). Moreover, more parents with PFD had an academic background compared with parents without PFD (72% vs. 59%, p = 0.05). There were no significant group differences in sex, history of breastfeeding, parental marital status, or type of the child's feeding disorder. Conclusions PFD among children with a parental history of PFD comprise a distinct group of patients with unique characteristics and outcomes. Since parental feeding history may explain their child's PFD in highly differing ways, treatment should be family-based and multidisciplinary.

OBJECTIVE The etiology of anemia in premature neonates is multifactorial and may involve anemia of inflammation mediated by hepcidin. Hepcidin expression is suppressed by vitamin D. We aimed to investigate the interrelationship between hepcidin, anemia, and vitamin D status in preterm infants. STUDY DESIGN Preterm infants aged 1 to 5 weeks were prospectively recruited at the neonatal intensive care unit of the Dana Dwek Children Hospital. Blood counts and serum levels of hepcidin, ferritin, iron, 25-hydroxyvitamin D [25(OH)D] and C-reactive protein (CRP) were measured and compared between anemic and nonanemic preterm infants. RESULTS Forty-seven preterm infants (mean ± standard deviation gestational age at birth 32.8 ± 1.1 weeks, 66% males) were recruited. In total, 36% of the preterm infants were vitamin D deficient [25(OH)D

Background Tandem breastfeeding is defined as two or more offspring of different ages who are breastfed by their mother at the same time. Breastfeeding during pregnancy and tandem breastfeeding have not been widely investigated. Research Aim To determine the influence of tandem breastfeeding on the macronutrient content of human milk. Methods This longitudinal study used a prospective and a retrospective group. Human milk samples from tandem-breastfeeding participants ( n = 18) were compared to samples from non-tandem-breastfeeding participants ( n = 31). Samples were collected during the last month of pregnancy (pregnancy milk), 72 hr after birth (colostrum) and 14–60 days post-delivery (mature milk). Macronutrients were measured by mid-infrared spectroscopy. Results Fat content in pregnancy milk was lower than in mature milk ( p < .01). Protein content was higher in pregnancy milk than in colostrum and mature milk ( p < .01 and p < .001, respectively). Inversely, carbohydrate content in pregnancy milk was lower than in colostrum and mature milk ( p = .02 and p < .01, respectively). Fat and energy contents in pregnancy milk of tandem-breastfeeding participants were lower than in mature milk of non-tandem-breastfeeding participants ( p < .001 and p < .01, respectively), and protein content was higher than in mature milk ( p < .001). Carbohydrate content in colostrum and mature milk of tandem-breastfeeding participants was higher than that of non-tandem-breastfeeding participants ( p < .001 for both). Conclusion Human milk produced during pregnancy had different macronutrient content than human milk produced after delivery. Colostrum and mature milk of tandem-breastfeeding participants were similar to human milk produced by non-tandem-breastfeeding participants, with the exception of carbohydrate content.

Background The effect of biologic therapy on the incidence of inflammatory bowel disease (IBD)-related hospitalizations is controversial. The high efficacy of biologic agents is weighted against potential therapy-related adverse events, however, there are no data on the effect of biologic therapy on the indications for hospitalization in IBD. We aimed to evaluate the impact of biologic therapy on the indications and rate of hospitalization in pediatric IBD. Methods This retrospective cohort study included all children ( Results Included were 218 hospitalizations of 100 children, of whom 65 (65%) had Crohn’s disease and 35 (35%) had ulcerative colitis. The indications for hospitalization were IBD exacerbations or complications in 194 (89%) and therapy-related adverse events in 24 (11%). The patients of 56 (25.7%) hospitalizations were receiving biologic therapy. In a multivariate analysis, no correlation between therapy and indication for hospitalization was found (p = 0.829). Among children under biologic therapy, a decrease in the rate of hospitalizations from 1.09 (0.11–3.33) to 0.27 (0–0.47) per year was observed for patients that were hospitalized during 2016–2019 (p = 0.043). Conclusion Biologic therapy did not influence the indication for hospitalization, but were associated with a decrease in the rate of hospitalization during 2016–2019 in pediatric IBD.

Objectives: Commercial infant formulas attempt to imitate the unique composition of human milk, which contributes to its distinctive influence on glycemic and insulinemic responses. However, lactose-free and milk protein-free formulas are often recommended due to medical reasons or chosen due to personal preferences (e.g., veganism). The aim of this study was to determine the glycemic and insulinemic indices of a variety of infant formulas.Methods: We conducted a three-arm, randomized, double-blind, crossover study. The participants were healthy adult volunteers aged 25-40 years. Each participant randomly drank three commercially available infant formulas (cow's milk protein-based ["standard"], soy protein-based, and lactose-free). Glycemic and insulinemic responses and glucose and insulin blood levels were determined and compared between the three formulas. Results: Twenty subjects were enrolled (11 females/9 males, mean age 32.8 ± 2.9 years). No significant difference was found in the glycemic index between the three formulas (21.5, 29.1, and 21.5 for the standard, soy protein-based, and lactose-free formulas, respectively, p = 0.21). However, maximal glucose levels were significantly higher for the soy protein-based formula compared to both the standard and lactose-free formulas (111.5 mg/dL compared to 101.8 mg/dL and 105.8 mg/dL, respectively, p = 0.001).Conclusion: A cow's milk protein-based formula, a lactose-free formula, and a soy protein-based formula elicited similar glycemic index. However, soy protein-based formula produced a significantly higher increase in postprandial glucose levels. The implication and the biological significance of these results has yet to be determined.

Background Previous studies have suggested seasonal variation in macronutrient content of milk produced from animals. The influence of seasonal variation upon human milk macronutrient content has not been elucidated. This study aimed to compare the macronutrient content of HM produced by lactating mothers during the winter and the summer seasons. Methods We compiled previously generated data on macronutrient content of colostrum milk samples collected from lactating mothers of healthy term infants. The mothers were recruited during their postpartum stay at the Lis Maternity Hospital of the Tel Aviv Medical Center. Macronutrient content was measured by mid-infrared spectroscopy. Results The carbohydrate content of the colostrum was significantly higher in the summer season than in the winter season (5.9 ± 1.3 vs 5.4 ± 1.4 g/100 ml, p value

Polychlorinated Biphenyls (PCBs) are widespread environmental contaminants. PCBs have endocrine disrupting properties which raises concerns regarding their effect on the developing fetus. This study aimed to examine the association between prenatal exposure to PCBs and anogenital distance (AGD) in newborns. Serum concentrations of PCB congeners -118, -138, -153 and -180 were measured in 175 pregnant women presenting to the delivery room. AGD was measured in their newborns. Regression models were used to estimate associations between maternal PCB exposure and infant anogenital measurements, controlling for possible confounding variables. Mean maternal serum concentrations were 2.95 ± 2.18 ng/g, 4.62 ± 3.54 ng/g, 7.67 ± 6.42 ng/g and 5.10 ± 3.91 ng/g for congeners -118, -138, -153 and -180, respectively. Higher maternal concentrations of PCBs were associated with reduced AGD measures in male infants. Higher maternal concentrations of PCB-138 and PCB-153 were associated with reduced ano-scrotal distances and higher maternal concentrations of all four PCB congeners were associated with reduced ano-penile distances. No significant associations were found between any PCB congener and any AGD measure in female newborns. This study demonstrates that intrauterine exposure to PCBs may be associated with reduced AGD in male newborns. More research is needed to reveal the implications for adult reproductive health.

The clinical applicability and yield of brain magnetic resonance imaging (MRI) in the setting of an inpatient pediatric department has not been investigated. The authors performed a retrospective chart review of nontraumatic/nonneurosurgical children who underwent brain MRI during their hospitalization in a general pediatric department over a 5-year period. Of the 331 children who underwent brain MRI, 148 (45%) had abnormal findings. High-risk headaches and focal seizures were significantly correlated with findings on brain MRI. Diagnostic and therapeutic yields were most significant in acute demyelinating events, acute cerebrovascular disorders, high-risk headaches when supported by neurologic and ophthalmologic findings, focal seizures with evidence of multifocal epileptic activity on an electroencephalogram and ophthalmic complaints when accompanied by cranial nerve palsy and optic nerve impairment. Since the contributions of a brain MRI in hospitalized children is pivotal in specific clinical situations, a judicious decision-making process should be done before its scheduling, in order to optimize clinical care.

Background: Knowledge and understanding of risk mechanisms associated with pediatric feeding disorders (PFD) remain limited. We aimed to investigate causative factors associated with PFD and their relation to specific PFD types according to the recent consensus WHO-based definition. Methods: We retrospectively reviewed the medical records of children with PFD and retrieved their demographic and clinical characteristics. Healthy age- and sex-matched children served as controls. Results: Included were 254 children with PFD [median (interquartile range) age 16.4 (9.5-33) months at diagnosis] and 108 children in the control group [median age 24.85 (14.5-28.5) months]. According to the WHO-based definition, disturbances in oral intake were predominantly related to nutritional dysfunction in 118 (46.6%), feeding skill dysfunction in 83 (32.3%), medical conditions in 42 (16.7%) and psychosocial dysfunction in 11 (4.4%). In multivariate analysis, children with PFD had a higher risk for lower socioeconomic background (PPP=0.003). There were no significant differences in any of those variables between PFD types. Conclusions: Low socioeconomic status, lack of breastfeeding, and low birth weight were significantly more frequent in children with PFD. PDF manifest as multiple dysfunctions, thus highlighting the need to offer these children and their families multidisciplinary care.

Heart rate variability (HRV), a marker of the parasympathetic vagal activity, was reportedly significantly lower in patients with inflammatory bowel disease (IBD) compared to healthy controls. The aim of this study was to evaluate HRV as a predictor of clinical outcomes in pediatric IBD.This was a prospective study. Children (12-18 years of age) with IBD were prospectively recruited. Each patient underwent two 10-min HRV measurements by means of a photoplethysmograph finger sensor. The square root of the mean squared differences of successive R-R pulse intervals (RMSSD), an indirect index of vagal activity, was calculated. Clinical data, including demographic variables, disease activity and course, medications, and laboratory results were collected during a follow-up of 12 months. The relation between RMSSD and clinical outcomes was examined, adjusting for confounders.A total of 34 children with IBD were included. Patients in clinical remission had a significantly higher RMSSD compared to patients with active disease (67.72 ± 27.81 versus 45.76 ± 22.04, respectively, P = 0.022). A multivariate analysis revealed that a higher RMSSD was a significant and independent predictor of lower risk of IBD exacerbation (odds ratio = 0.941, 95% confidence interval 0.887-0.998, p = 0.044).HRV correlates with IBD activity and may also serve as an independent predictor of disease exacerbation in pediatric IBD.

Background: Aluminum exposure may originate from numerous sources, including antiperspirants. Aluminum toxicity can cause a wide range of neurological impairments. Infants are exposed to aluminum t...

Objective: Breastfeeding is considered the gold standard of infant feeding during the first year of life. However, many women experience difficulty breastfeeding and do not breastfeed to the extent...

Objective: A healthy diet during pregnancy is essential to ensure optimal fetal growth and development. Women’s awareness of dietary guidelines may assist them in following a healthy diet for themselves and their unborn babies. The Institute of Medicine and the American College of Obstetrics and Gynecology have published recommendations concerning the nutrition of pregnant/nursing women. The Israeli Ministry of Health has adopted these recommendations in revised guidelines published in 2015. The aim of this study was to describe the dietary habits among pregnant/nursing women in Israel and to assess the correlation between socioeconomic parameters and adherence to those guidelines. Methods: We performed a cross-sectional survey by interviewing pregnant/lactating women attending family health centers (FHC) in different areas of Tel Aviv, Israel. Results: One-half of the 239 recruited women reported having been informed of the guidelines for dietary changes during and after pregnancy, 30% by a professional source. Women in a lower socioeconomic status (SES) consumed more undercooked (rare) beef, raw fish, and caffeine compared to women in a higher SES (P = 0.03 and P = 0.003, respectively). The former was less compliant with the recommendation for folic acid supplementation (155 [(88.1]) vs 47 [(77]), P = 0.05) and less likely to use other dietary supplements during pregnancy, e.g., multivitamins and omega 3, than the latter (P = 0.01 and P < 0.001, respectively). Conclusion: This survey revealed deficiencies in adherence to the implementation of medical guidelines to nutrition during and after pregnancy, as well as gaps between women of different SESs, mostly in the use of dietary supplements.

Background and AimsThe role of hepcidin in inflammatory bowel disease [IBD] in children with anaemia is poorly understood. However, it has been shown that vitamin D suppresses hepcidin expression. We aimed to assess serum hepcidin levels and the effect of vitamin D treatment on those levels in newly diagnosed IBD paediatric patients.MethodsEighty-five children were prospectively recruited in the Dana-Dwek Children’s Hospital [40 newly diagnosed IBD, 45 healthy controls, 47% female, mean age 13.5 ± 3.4 years]. Blood samples for measurement of interleukin 6 [IL-6], C-reactive protein [CRP], hepcidin, iron parameters and 25-hydroxyvitamin D [25-(OH)-D] levels were obtained at baseline. Patients with mild-to-moderate signs and symptoms of IBD were treated with 4000 units of vitamin D daily for 2 weeks, after which the blood tests were repeated.ResultsBasal hepcidin, IL-6, CRP and platelet counts were significantly higher, and haemoglobin, serum iron and transferrin levels were significantly lower in the IBD children compared to controls [p < 0.001]. Eighteen patients completed 2 weeks of treatment with vitamin D. Following treatment, serum 25-(OH)-D concentrations increased by 40% [from 22.5 to 32.5 ng/mL], and serum hepcidin, CRP and ferritin levels decreased by 81%, 81% and 40% [from 33.9 to 6.7 ng/mL, from 23.9 to 4.7 mg/L, and from 27 to 16 ng/mL, respectively] [p ≤ 0.001].ConclusionSerum hepcidin levels were significantly higher in IBD paediatric patients compared to controls. Following vitamin D treatment, serum hepcidin concentration decreased significantly. These findings suggest a potential role for vitamin D in treating anaemia in IBD children.ClinicalTrials.gov numberNCT03145896

We describe the dynamics of the vaccine-specific antibody response in the breastmilk and serum in a prospective cohort of ten lactating women who received two doses of the Pfizer-BioNTech BNT162b2 COVID-19 mRNA vaccine. The antibody response was rapid and highly synchronized between breastmilk and serum, reaching stabilization 14 days after the second dose. The predominant serum antibody was IgG. The response in the breastmilk included both IgG and IgA with neutralizing capacity.

The importance of breastmilk in postnatal life lies in the strong association between breastfeeding and the reduction in the risk of infection and infection-related infant mortality. However, data regarding the induction and dynamics of breastmilk antibodies following administration of the Pfizer-BioNTech BNT162b2 COVID-19 mRNA vaccine is scarce, as pregnant and lactating women were not included in the initial vaccine clinical trials. Here, we investigate the dynamics of the vaccine-specific antibody response in breastmilk and serum in a prospective cohort of ten lactating women who received two doses of the mRNA vaccine. We show that the antibody response is rapid and highly synchronized between breastmilk and serum, reaching stabilization 14 days after the second dose. The response in breastmilk includes both IgG and IgA with neutralization capacity., Maternal antibodies can reduce risk of infection of infants. Here, the authors show induction of IgG and IgA antibodies in breastmilk and serum of ten lactating women after immunization with the Pfizer-BioNTech BNT162b2 COVID-19 mRNA vaccine.

We have recently showed that Wolfgang Amadeus Mozart's music significantly lowers resting energy expenditure (REE) in preterm infants. Whether or not this effect is specific to Mozart is unknown.To study whether familiar ("ethnic") music has the same effect on REE in preterm infants as music by Mozart.A prospective, randomized clinical trial with cross-over was conducted in 9 healthy, appropriate weights for gestational age, gavage fed, preterm infants. Infants were randomized to be exposed to a 30-minute period of Mozart music or "ethnic" music or no music over 3 consecutive days. Metabolic measurements were performed by indirect calorimetry.A total of 27 REE measurements were performed. On average REE was lower in preterm infants who were exposed to "ethnic" music compared to preterm infants who were exposed to music by Mozart (p=0.388). REE was lower in preterm infants who didn't listen to music at all compared to Mozart (p=0.014) or to "ethnic" (p=0.134).Exposure to music by Mozart significantly elevated REE in healthy preterm infants compared to preterm infants who didn't listen to music at all. Nevertheless a trend of lower REE was demonstrated when preterm infants listened to "ethnic" music compared to Mozart.We were unable to demonstrate a significant decrease in REE by exposure of preterm infants to Mozart- or "familiar" music. At this time point we cannot recommend music therapy for preterm infants in order to lower the REE. We speculate that a larger study sample might show a definite effect.

BackgroundNon-alcoholic fatty liver disease (NAFLD) can range from simple steatosis to steatohepatitis with or without fibrosis. The predictors for liver fibrosis, so as the effect of nutritional intervention on hepatic fibrosis in pediatric population are not well established. We aimed to investigate the predictors for liver fibrosis and the effects of short-term nutritional intervention on steatosis and fibrosis among obese adolescents with NAFLD.MethodsCross-sectional study among Obese adolescents. Sociodemographic and clinical data were collected. Liver fibrosis was estimated by Shearwave elastography. All participants were recommended to consume a low carbohydrate diet and were followed biweekly. Blood tests and elastography were performed upon admission and repeated after 3 months.ResultsFifty-seven pediatric patients were recruited (35 males, mean age 13.5 ± 2.9 years, mean body mass index [BMI] 38.8 ± 9.7). Liver fibrosis was diagnosed in 34 (60%) subjects, which was moderate/severe (F ≥ 2) in 24 (70%). A higher BMI Z score and moderate/severe steatosis correlated with moderate/severe fibrosis (P P = 0.001).ConclusionPediatric patients with high BMIs and severe liver steatosis are at risk for severe liver fibrosis. Nutritional intervention with minimal weight loss may improves hepatic fibrosis among pediatric population.

Currently, there are no approved treatments for infants with acute bronchiolitis, the leading cause for hospitalization of infants worldwide, and thus the recommended approach is supportive. Inhaled Nitric oxide (iNO), possesses anti-viral properties, improves oxygenation, and was shown to be safe in infants with respiratory conditions. Hospitalized infants with acute bronchiolitis were therefore recruited to a prospective double-blinded, multi-center, randomized controlled pilot study. They received intermittent high dose iNO (160 ppm) plus oxygen/air for 30 min or oxygen/air alone (control), five times/day, up to 5 days. Sixty-nine infants were enrolled. No difference was observed in frequencies of subjects with at least one Adverse Event (AE) in iNO (44.1%) vs. control (55.9%); neither was Methemoglobin7% safety threshold. No drug-related serious AEs (SAEs) were reported. Analysis of Per-Protocol population revealed that length of stay (LOS), time to SpO

Background: Sex differences in infant mortality and neonatal morbidity have been previously documented. Few studies, with conflicting results, have investigated the interaction between human milk (...

Objective: To conduct a systematic review of the effect of freezing and thawing on the macronutrients and energy composition of human milk (HM). Design: Systematic review conducted in May 2019, including all studies reporting macronutrients and energy composition of HM, according to a search of MEDLINE, EMBASE, and Google Scholar using the keywords: HM, breast milk, macronutrients, fat, lipid, protein, carbohydrates, energy, calories, freezing, thawing, and of the references in studies identified as potentially relevant. Meta-analyses were conducted in all the studies that reported one or more of the following: total energy, true protein, fat, and carbohydrates. They were reported according to following groups of freezing duration: 1-7 days, 8-30 days, 31 days-3 months, and >3 months. They were calculated and expressed as weighted averages with pooled standard deviations. Results: Eight studies remained in the final analysis. Regression analyses did not find any significant increase or decrease over time of protein content, lactose content, fat content, or energy content of milk. Conclusions: No dramatic changes in macronutrients and energy contents of milk are expected to occur within the first few months of freezing.

Objective: The impact of maternal anxiety on the macronutrients content of human milk (HM) is unknown. We hypothesized that maternal stress generated by her infant‘s hospitalization will affect the...

Background: Many obese children have at least one obese parent, and some of them have one parent who had undergone bariatric surgery (“bariatric families”). The perceptions and attitudes towards child obesity of parents in bariatric families vs. non-bariatric families have not been explored. We assessed how parents who underwent bariatric surgery for obesity perceived their child’s obesity compared to those perceptions of obese parents who did not undergo bariatric surgery.Methods: We conducted a cross-sectional survey by interviewing families in which one or both parents underwent bariatric surgery (bariatric group) and comparing their responses to those of families in which one or both parents had been treated conservatively for obesity (control group). The children of both groups were attending the Obesity Clinic of our children’s hospital. Results: Thirty-six children (median age 10.6 years, 18 in each group, matched for age and sex) were recruited. More parents in the bariatric group replied that weight plays an important role in determining self-image (pppppConclusion: Families in which one or both parents underwent bariatric surgery for obesity revealed different perceptions of their child’s obesity and different opinions about interventions for treating it compared to families with no bariatric surgery.

Objective: There are multiple health benefits associated with both breastfeeding and practicing physical activity (PA). Therefore, it is likely that many women might want to engage in both. We designed the current randomized clinical trial to examine the effect of moderate- to high-intensity PA on human milk (HM) volume and macronutrient contents. Methods and Study Design: In this prospective, randomized, crossover clinical trial, we recruited 31 healthy mothers who had been exclusively breastfeeding their infants. Mothers expressed HM twice each day on 2 consecutive days-a day with PA (1-hour before and 1-hour after PA) and a control day without PA (at the exact same hours of the day). The order of days (with/without PA) was determined randomly. Macronutrients and energy contents of HM were analyzed using the Human Milk Analyzer (Miris AB, Uppsala, Sweden). PA was graded according to the Borg Rating of Perceived Exertion scale (RPE scale). Results: A total 124 HM samples from 31 mothers were analyzed. Moderate- to high-intensity PA affected neither macronutrients (fat, carbohydrates, protein) nor energy content. Milk volume remained unaffected by PA as well. Conclusions: Maternal PA does not affect HM volume or its macronutrient contents. Lactating mothers can be reassured regarding their breast milk volume and composition while practicing PA of moderate to high intensity.

Hepcidin is a master regulator of iron metabolism. Recently, it has been shown that vitamin D suppresses hepcidin expression. Our hypothesis was that hepcidin levels inversely correlate with vitamin D levels in anemic children during acute infection. A prospective study was performed on 90 patients (45 females, 45 males, mean age 7.3 ± 5 years) who were admitted to the pediatric ward. Sixty-two patients had infectious disease (32 with coexisting anemia, 30 without anemia), and 28 patients were hospitalized for noninfectious causes. Blood samples for IL-6, hepcidin, iron status parameters, and 25-hydroxyvitamin D (25-OHD) were obtained within 72 h after admission. Serum concentrations of IL-6 and hepcidin were significantly higher and 25-OHD, iron, and transferrin were significantly lower in anemic children with infectious disease compared with controls. Children with a serum 25-OHD level 20 ng/ml (OR: 6.1, CI: 1.15–32.76). Correlation analyses found positive associations between hepcidin levels and ferritin (R2 = 0.47, P

Aim This study described outcomes following treatment for lactose intolerance, which is common in children. Methods The medical records of children aged 6-18 years who underwent lactose hydrogen breath testing at Dana-Dwek Children's Hospital, Tel Aviv, Israel, from August 2012 to August 2014 were analysed. We compared 154 children with gastrointestinal symptoms and positive lactose hydrogen breath tests to 49 children with negative test results. Results Of the 154 children in the study group, 89 (57.8%) were advised to follow a lactose-restricted diet, 32 (20.8%) were advised to avoid lactose completely, 18 (11.7%) were instructed to use substitute enzymes, and 15 (9.7%) did not receive specific recommendations. Only 11 patients (7.1%) received recommendations to add calcium-rich foods or calcium supplements to their diet. Lactose reintroduction was attempted in 119 of 154 patients (77.3%), and 65 of 154 (42.2%) experienced clinical relapses. At the final follow-up of 3.3 years, 62.3% of the study children were still observing a restricted diet. Older children and those who were symptomatic during lactose hydrogen breath testing were more likely to be on a prolonged restricted diet. Conclusion Our long-term follow-up of lactose-intolerant children showed that only a third were able to achieve a regular diet.

Helicobacter pylori, one of the most common bacterial pathogens in humans, is generally acquired during childhood. The inverse correlation between H. pylori colonization and obesity that was found in adults has not been investigated in depth in children. Our aim was to assess the correlation between overweight and obesity and H. pylori colonization in a pediatric population.H. pylori colonization in 70 symptomatic children was determined after antral biopsies during esophagogastroduodenoscopy. Data on anthropometric measurements, sociodemographic characteristics, and medical history were recorded.The participants' mean age was 12.41 ± 3.16 years, 58% were females, and 24% were obese or overweight (BMI85th percentile). The H. pylori colonization rate was 31%. There were no significant differences between the H. pylori-infected and H. pylori-noninfected groups in terms of age, gender, or clinical and sociodemographic characteristics. Nevertheless, the prevalence of overweight and obesity was significantly lower in children with H. pylori colonization compared to children with normal histology (31% in the noninfected group compared to 11% in the infected group, p = 0.04). The mean fat percentage was 24.3 ± 8.8 and 19.4 ± 6.9, respectively (p = 0.02).The findings of this prospective study are in agreement with previous studies and demonstrate an inverse relationship between H. pylori colonization and overweight or obesity among symptomatic children. A larger prospective, multiethnic investigation is warranted to more definitively determine the extent of this association.

This study is a systematic review of the macronutrient and energy composition of preterm human milk to enable the practicing neonatologist to make informed nutritional decisions in preterm infants. Meta-analyses were conducted in all the studies that reported total energy, true protein, fat, and lactose. Protein content decreased massively (by one-half) and significantly from day 1 to 3 at week 10 to 12. There was a significant linear increase in fat, lactose, and energy content during the same timeframe. Theoretic calculations on energy and macronutrient intake of preterm infants must be made according to a lactation time-specific manner.

There is evidence that multinutrient fortification of human milk increases in-hospital growth of preterm infants, but fortification has not been shown to improve long-term growth and neurodevelopmental outcome. We aimed to ascertain whether randomized controlled trials have determined the effect of early versus late introduction of fortifiers on growth and/or other outcomes, and have compared the efficacy/adverse effects of human milk-based versus cow milk-based fortifiers. We conclude that there is little evidence that early introduction of human milk fortification affects important outcomes, and limited evidence that a bovine fortifier places the infant at a higher risk of NEC.

Inflammatory bowel disease (IBD) exacerbations may lead to prolonged and complicated hospitalizations. The characteristics of exacerbation-related hospitalizations and predictors for poor outcome of pediatric patients hospitalized due to IBD have not been thoroughly described. All children who were hospitalized due to IBD exacerbation in a tertiary referral center between 2004 and 2017 were enrolled. Data on demographic and disease characteristics before and during hospitalization were retrospectively reviewed, as was the course of hospitalization, including laboratory findings, diagnostic work-up, and management. Poor outcomes were defined as prolonged hospitalization (≥ 7 days) and/or the need for surgery during hospitalization. There were 181 hospitalizations of 78 IBD children with a median (IQR) age of 14.8 (11.8-16.2) years. They included 53 (67.9%) with Crohn's disease and 25 (32.1%) with ulcerative colitis. In a multivariate analysis, severe disease activity at hospitalization (odds ratio [OR] = 3.33, P = 0.013), lower weight percentile (OR = 0.98, P = 0.009), treatment with antibiotics (OR = 5.03, P = 0.001), blood transfusion (OR = 8.03, P = 0.003), undergoing endoscopy (OR = 2.73, P = 0.027), and imaging studies during hospitalization (OR = 3.61, P = 0.001) predicted prolonged hospitalization. Surgical intervention was performed in 16 patients (8.8%), due to penetrating (OR = 7.73, P = 0.019) and stricturing disease (OR = 12.38, P < 0.001).Conclusion: We identified predictors for poor outcomes of children hospitalized due to IBD. Among the variables that can be measured at the beginning of the admission, severe disease activity was the most significant predictor recognition of these predictors that may contribute to modification of patient management.What is Known:• Inflammatory bowel disease (IBD) patients may require hospitalization due to disease exacerbation or treatment-related complications.• Hospitalizations of IBD patients constitute a heavy emotional burden on patients and families.What is New:• Lower weight percentile, severe disease activity, and a lower albumin level were predictors for prolonged hospitalization in children with IBD.• Recognition of these predictors may contribute to modification of patient management.

Long-term storage of human milk (HM) requires freezing at low temperatures, the consequences of which upon macronutrients are unclear. The conflicting results of the few studies on freezing-induced changes on HM macronutrients led to different storage recommendations. We examined differences in macronutrients content of HM after long-term storage at -20°C compared with -80°C.Mature HM samples from 25 mothers of term and preterm infants were collected. Each sample was divided into six aliquots for storage at -20°C and -80°C for 4, 12, and 24 weeks. After thawing and homogenization, energy and macronutrients content were measured using an HM infrared spectroscopy analyzer.A total of 150 HM samples were available for analysis. Thirteen samples were removed due to calibration errors. The final analysis was performed on 137 samples with validated results. Fat and energy content were consistently higher in the -80°C samples compared with the paired -20°C samples at each time point (p 0.05). Comparison of the differences in macronutrients content over time (4 versus 24 weeks) revealed a significant loss of fat (0.3 g/100 mL [7.9%], p = 0.001) and energy (2.3 kcal/100 mL [3.3%], p = 0.03) in the -20°C group. Fat and protein were also significantly decreased over time in the -80°C group (by 0.14 g/100 mL [3%], p = 0.009, and 0.06 g/100 mL [6.4%], p = 0.02, respectively).Long-term storage of HM at -80°C is associated with better fat and energy preservation compared with storage at -20°C. These results may help construct evidence-based recommendations and guidelines for optimal HM storage.

Objective: To assess the intracranial pressure in pediatric acute disseminated encephalomyelitis using spinal tap opening pressure on lumbar puncture, which is routinely performed as part of suspected acute disseminated encephalomyelitis workup. Compared to other cerebrospinal fluid parameters such as cell count, protein concentration, and presence of oligoclonal bands, cerebrospinal fluid opening pressure is infrequently recorded. Methods: A retrospective chart review of demographic, clinical, and laboratory data of children diagnosed with acute disseminated encephalomyelitis admitted to a tertiary referral hospital between 2005 and 2016. Results: Of the 36 children diagnosed with acute disseminated encephalomyelitis, 24 had the cerebrospinal fluid opening pressure documented in their records. The mean cerebrospinal fluid opening pressure was 27.6±12.6 cmH2O, range 9-55 cmH2O (95% confidence interval 21.9-33.6). Cerebrospinal fluid opening pressure in the acute disseminated encephalomyelitis group was statistically significantly higher ( P = .0013, 95% confidence interval 4.2-15.0) than the accepted upper limit in this age group (18 cmH2O). In 10 of 24 patients (42%), the opening pressure was above 28 cmH2O. Conclusions: Increased opening pressure was the most frequent cerebrospinal fluid abnormal finding in our cohort, which suggests a potential role of increased intracranial pressure in the acute disseminated encephalomyelitis pathophysiological disease mechanism. In certain cases, the opening pressure value could have monitoring and therapeutic implications, and therefore its measurement is highlighted by this study.

To test the null hypothesis that human milk (HM) macronutrients (fat, lactose, protein) and caloric content in women with gestational diabetes mellitus (GDM) is similar to that of women without GDM. Sixty-two lactating mothers (31 GDM, 31 no-GDM) were studied after confirmation by 100-g oral glucose tolerance test. Each mother contributed three manually expressed HM samples (within 72 h after labor (colostrum), after 7 days (transitional) and at 14 days (mature)). Analysis was done by infrared transmission spectroscopy. Non-GDM and GDM groups did not differ by maternal age, pre-pregnancy weight, height, diet, pregnancy weight gain, gestational age, and infant birth weight. Macronutrients content in colostrum and transitional milk did not differ between groups. Fat and energy contents in mature HM were higher in non-GDM samples than in GDM samples (p = 0.07 and p