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OBJECTIVES/BACKGROUND: Disease-related malnutrition is common in patients with chronic diseases and has detrimental effects, therefore, skills in nutrition care are essential core competencies for paediatric digestive medicine. The aim of this survey, conducted as part of a global survey of paediatric gastroenterology, hepatology and nutrition (PGHN) training in Europe, was to assess nutrition care-related infrastructure, staff, and patient volumes in European PGHN training centres. METHODS: Standardized questionnaires related to clinical nutrition (CN) care were completed by representatives of European PGHN training centres between June 2016 and December 2019. RESULTS: One hundred training centres from 17 European countries, Turkey, and Israel participated in the survey. Dedicated CN clinics exist in 66% of the centres, with fulltime and part-time CN specialists in 66% and 42%, respectively. Home tube feeding (HTF) and home parenteral nutrition (HPN) programmes are in place in 95% and 77% of centres, respectively. Twenty-four percent of centres do not have a dedicated dietitian and 55% do not have a dedicated pharmacist attached to the training centre. Even the largest centres with >5000 outpatients reported that 25% and 50%, respectively do not have a dedicated dietitian or pharmacist. Low patient numbers on HTF and HPN of

Primary health care is the foundation of a health system and has a strong influence on the efficiency of the health system as a whole. For children in Europe, it is defined by three primary health care models: paediatric; mixed paediatrician and family physician; and family physician. There is much debate in Europe about which model is most appropriate for children. The Lithuanian model is mixed, although health policy is geared towards the promotion of family physicians, with a decline in the number of primary paediatricians in clinical practice.To review the children's primary health care system in Lithuania, compare the indicators of primary care by family physicians and paediatricians in Lithuania, and identify parents' perceptions of the primary health care model for children.A retrospective longitudinal study was performed of children's primary health care indicators for quantity and quality in 2014-2018. A representative opinion survey of 1000 adult respondents was conducted.A total of 3.5 million children's visits to primary care physicians (6.7 ± 3 visits for each child) were registered in Lithuania in 2018. During a recent 5-year period (2014-2018), the number of visits did not change significantly. Visits to paediatricians accounted for 41% of all children's visits to primary care physicians in 2018. Visits to Emergency Departments increased by 20%. The results of the survey showed that 72.3% of the respondents would prefer their children be treated by a primary care paediatrician.The mixed paediatrician and family physician health care model gives parents the right to choose. The results showed a decreased number of paediatricians in primary care; paediatric primary care is more frequent than family physician care; and parents tend to trust paediatricians more. The study also showed differences in the models of service used and patterns between regions in Lithuania.

The EuroPedHp-registry aims to monitor guideline-conform management, antibiotic resistance, and eradication success of 2-week triple therapy tailored to antibiotic susceptibility (TTT) in Helicobacter pylori-infected children.From 2017 to 2020, 30 centres from 17 European countries reported anonymized demographic, clinical, antibiotic susceptibility, treatment, and follow-up data. Multivariable logistic regression identified factors associated with treatment failure.Of 1605 patients, 873 had follow-up data (53.2% female, median age 13.0 years, 7.5% with ulcer), thereof 741 (85%) treatment naïve (group A) and 132 (15%) after failed therapy (group B). Resistance to metronidazole was present in 21% (A: 17.7%, B: 40.2%), clarithromycin in 28.8% (A: 25%, B: 51.4%), and both in 7.1% (A: 3.8%, B: 26.5%). The majority received 2-week tailored triple therapy combining proton pump inhibitor (PPI), amoxicillin with clarithromycin (PAC) or metronidazole (PAM). Dosing was lower than recommended for PPI (A: 49%, B: 41%) and amoxicillin (A: 6%, B: 56%). In treatment naïve patients, eradication reached 90% (n = 503, 95% CI 87-93%) and 93% in compliant children (n = 447, 95% CI 90-95%). Tailored triple therapy cured 59% patients after failed therapy (n = 69, 95% CI 48-71%). Treatment failure was associated with PAM in single clarithromycin resistance (OR = 2.47, 95% CI 1.10-5.53), with PAC in single metronidazole resistance (OR = 3.44, 95% CI 1.47-8.08), and with low compliance (OR = 5.89, 95% CI 2.49-13.95).Guideline-conform 2-weeks therapy with PPI, amoxicillin, clarithromycin or metronidazole tailored to antibiotic susceptibility achieves primary eradication of ≥ 90%. Higher failure rates in single-resistant strains despite tailored treatment indicate missed resistance by sampling error.

OBJECTIVES: Recommendations for diagnosing and treating eosinophilic esophagitis (EoE) are evolving; however, information on real world clinical practice is lacking. To assess the practices of pediatric gastroenterologists diagnosing and treating EoE and to identify the triggering allergens in European children. METHODS: Retrospective anonymized data were collected from 26 European pediatric gastroenterology centers in 13 countries. Inclusion criteria were: Patients diagnosis with EoE, completed investigations prescribed by the treating physician, and were on stable medical or dietary interventions. RESULTS: In total, 410 patients diagnosed between December 1999 and June 2016 were analyzed, 76.3% boys. The time from symptoms to diagnosis was 12 ± 33.5 months and age at diagnosis was 8.9 ± 4.75 years. The most frequent indications for endoscopy were: dysphagia (38%), gastroesophageal reflux (31.2%), bolus impaction (24.4%), and failure to thrive (10.5%). Approximately 70.3% had failed proton pump inhibitor treatment. The foods found to be causative of EoE by elimination and rechallenge were milk (42%), egg (21.5%), wheat/gluten (10.9%), and peanut (9.9%). Elimination diets were used exclusively in 154 of 410 (37.5%), topical steroids without elimination diets in 52 of 410 (12.6%), both diet and steroids in 183 of 410 (44.6%), systemic steroids in 22 of 410 (5.3%), and esophageal dilation in 7 of 410 (1.7%). Patient refusal, shortage of endoscopy time, and reluctance to perform multiple endoscopies per patient were noted as factors justifying deviation from guidelines. CONCLUSIONS: In this "real world" pediatric European cohort, milk and egg were the most common allergens triggering EoE. Although high-dose proton pump inhibitor trials have increased, attempted PPI treatment is not universal.

As a result of the outbreak of SARS-CoV-2 and consequent restrictions in spring 2020, children in many countries might be engaged in more sedentary behavior and have limited possibilities to access the necessary level of physical activity to maintain their physical and mental health. The aim of this study was to explore the relationships between child sedentary behavior, physical activity, mental and physical health, and parental distress in a sample of Lithuanian children aged 6–14 years during the COVID-19 pandemic lockdown in March–June 2020. Parents of 306 children (52.9% female) completed an online survey in May–June 2020 and reported on their children’s screen time for educational and recreational (leisure) purposes, the level of physical activity and time outdoors, somatic symptoms, and emotional well-being and behavior. Parents also reported on stressful life events in the family and personal distress. The results revealed that 57.5% of children exceeded the recommended maximum of 2 h of recreational screen time per day, and 33.6% of the children did not meet the recommended guidelines of 60 min of physical activity per day. Longer screen time for educational purposes and parental distress significantly predicted a higher prevalence of somatic symptoms in children and parental distress also served as a significant predictor of children’s decreased emotional well-being and behavior. These results highlight the importance of psychosocial support interventions for parents who experience distress when raising children at a stressful time, such as during a pandemic.

Infection is a serious concern in the short and long term after pediatric liver transplantation. Vaccination represents an easy and cheap opportunity to reduce morbidity and mortality due to vaccine-preventable infection. This retrospective, observational, multi-center study examines the immunization status in pediatric liver transplant candidates at the time of transplantation and compares it to a control group of children with acute liver disease. Findings show only 80% were vaccinated age-appropriately, defined as having received the recommended number of vaccination doses for their age prior to transplantation, for DTP-PV-Hib, less than 75% for Hepatitis B and two-thirds for pneumococcal conjugate vaccine in children with chronic liver disease. Vaccination coverage for live vaccines is better compared to the acute control group with 81% versus 62% for measles, mumps and rubella (p = 0.003) and 65% versus 55% for varicella (p = 0.171). Nevertheless, a country-specific comparison with national reference data suggests a lower vaccination coverage in children with chronic liver disease. Our study reveals an under-vaccination in this high-risk group prior to transplantation and underlines the need to improve vaccination.

Objectives: A descriptive and comparative study of gastric histological aspects according to the updated Sydney classification (USC), obtained from Helicobacter pylori-positive versus H pylori-negative children referred for upper gastrointestinal endoscopy. Methods: The Prisma method was used to perform a systematic review and meta-analysis. Selection criteria were based on following key words USC, H pylori, children, endoscopy, or biopsy. Publication biases were assessed according to the Newcastle-Ottawa Scale, and a meta-regression analysis was done. The study was registered on the PROSPERO platform. Results: Between 1994 and 2017, 1238 references were found; 97 studies were retained for the systematic review with a total number of 25,867 children; 75 studies were selected for the meta-analysis concerning 5990 H pylori-infected and 17,782 uninfected children.H pylori-positive versus H pylori-negative children, according to the USC, showed significantly higher relative risk for gastric antral and corpus chronic inflammation, presence of neutrophils, and of lymphoid follicles, and gastric mucosa atrophy, whereas, intestinal metaplasia showed a significantly higher RR only in antral biopsies. The meta-regression analysis showed that H pylori-positive versus H pylori-negative children had significantly higher risk only for corpus activity according to age, recurrent abdominal pain, and geographical area of low H pylori prevalence. Conclusions: H pylori infection in children was associated with higher relative risk for gastric antral and corpus chronic inflammation, presence of neutrophils, lymphoid follicles, and rare gastric mucosa atrophy, whereas, rare intestinal metaplasia was only significantly higher in the antral area.

Dėl COVID-19 pandemijos paskelbus karantiną, per trumpą laiką turėjo persiorientuoti ir persiorganizuoti visa švietimo sistema, kai vaikų ugdymo (dalykinio, socialinio, net fizinio) forma pakeista iš tiesioginės į nuotolinio ugdymo formą. Šis nenumatytų sąlygų sukeltas staigus pokytis paveikė ugdymo proceso dalyvių (vaikų, tėvų, mokytojų) sąveiką, įsitraukimą ir vaidmenis ugdymo procese; ugdymo aplinką, turinį ir pobūdį. Tai analogų neturinti patirtis, kurią būtina tirti idant būtų geriau pasirengta galimoms ateities krizėms. Todėl įvairių sričių ir krypčių - edukologijos, psichologijos, socialinio darbo, sociologijos ir medicinos mokslininkai susijungė bendram tyrimo projektui „Nuotolinis vaikų ugdymas pandemijos dėl COVID-19 metu: grėsmės bei galimybės ekosisteminiu požiūriu“, kurį 2020 m. birželio – gruodžio mėnesiais finansavo Lietuvos mokslo taryba (sutarties Nr. S-COV-20-11). Pagrindinis šio projekto tikslas - visapusiškai analizuoti privalomo nuotolinio ugdymo(si) iššūkius ugdymo procesui ir jo dalyviams (vaikams, tėvams, ugdytojams), grėsmes ir galimybes priešmokyklinių ir pirmų - aštuntų klasių vaikų fizinei ir psichikos sveikatai, saugumui ir mokymosi sėkmei bei parengti rekomendacijas švietimo, socialinės politikos formuotojams ir vykdytojams, mokyklų vadovams, mokytojams ir tėvams. Ši mokslo studija - tai labai intensyvaus plataus tyrimo, atlikto per trumpą laiką daugiadisciplininės mokslininkų komandos, rezultatas.

OBJECTIVES The aim of the study was to assess differences in the diagnosis and management of eosinophilic esophagitis (EoE) by European pediatric (PG) and adult gastroenterologists (AG), and their self-reported adherence to guidelines. METHODS A multiple-choice questionnaire gauged the diagnostic and management strategies of gastroenterologists treating children or adults in 14 European countries and the United Arab Emirates (UAE). RESULTS Questionnaires were completed by 465 PG and 743 AG. PG were significantly more likely to take biopsies in patients with symptoms of esophageal dysfunction (86.2% PG vs 75.4% AG, P

Background and Aims An expanding number of monogenic defects have been identified as causative of severe forms of very early-onset inflammatory bowel diseases [VEO-IBD]. The present study aimed at defining how next-generation sequencing [NGS] methods can be used to improve identification of known molecular diagnosis and to adapt treatment. Methods A total of 207 children were recruited in 45 paediatric centres through an international collaborative network [ESPGHAN GENIUS working group] with a clinical presentation of severe VEO-IBD [n = 185] or an anamnesis suggestive of a monogenic disorder [n = 22]. Patients were divided at inclusion into three phenotypic subsets: predominantly small bowel inflammation, colitis with perianal lesions, and colitis only. Methods to obtain molecular diagnosis included functional tests followed by specific Sanger sequencing, custom-made targeted NGS, and in selected cases whole exome sequencing [WES] of parents-child trios. Genetic findings were validated clinically and/or functionally. Results Molecular diagnosis was achieved in 66/207 children [32%]: 61% with small bowel inflammation, 39% with colitis and perianal lesions, and 18% with colitis only. Targeted NGS pinpointed gene mutations causative of atypical presentations, and identified large exonic copy number variations previously missed by WES. Conclusions Our results lead us to propose an optimised diagnostic strategy to identify known monogenic causes of severe IBD.

Inflammatory bowel diseases (IBDs) are complex inflammatory disorders of the gastrointestinal tract which could involve multiple organ systems and present with various extraintestinal manifestations. Almost every organ system may be affected in IBD including the musculoskeletal system, skin, eyes, liver, lungs, kidneys, immune system, hematologic system, and cardiovascular system. Certain extraintestinal manifestations are frequently related to the activity of the IBD (peripheral arthritis, oral ulcers, erythema nodosum, episcleritis), while others develop independently of the intestinal inflammation (axial arthropathies, hepatobiliary disorders). The etiopathogenesis of IBD is complex and includes interaction between environmental factors and immune system in genetically susceptible individuals. Autoinflammation is becoming increasingly recognized as an important component in the pathogenesis of IBD, especially Crohn’s disease. Genetic loci specifically associated with Crohn’s disease consistently implicate involvement of innate immunity (CARD15/NOD2, IRGM, IL23R, LRRK2, and ATG16L1) and de-regulated adaptive immune responses, namely, the interleukin-23 and T helper 17 cell pathways. This chapter provides comprehensive review of various extraintestinal manifestations associated with IBD with specific focus on autoinflammation.

Background and Objectives: There is evidence that eating meals or snacks while watching TV is an obesogenic factor. Moreover, the patterns of TV and other screen use during meals begin early and persist. However, there are only a few studies to date which address the prevalence and predictors of young children&rsquo, s exposure to screen during mealtimes. Thus, the present study aimed to investigate the prevalence and the associated factors of screen use during meals in early childhood. Materials and Methods: A cross sectional survey was conducted in Lithuania. Data of 847 children aged 2 to 5 years old (51.5% boys) were analyzed in this study. Parents completed the Child Behavior Checklist (CBCL/1&frac12, 5) and reported their children&rsquo, s daily screen time, exposure to background TV, screen use during child&rsquo, s meals, child and parental height and weight, and sociodemographic data. Results: More than half of children were exposed to screen during meals: 33.7% occasionally, several times per week or per month, and 22%&mdash, daily or during every meal. Overall daily screen time, background TV, consumption of junk food, child age, and emotional and behavioral problems were related to mealtime screen use (all associations significant at p &lt, 0.01). Longer daily screen time (OR 1.01, 95% CI 1.00&ndash, 1.01), more background TV (OR 1.26, 95% CI 1.10&ndash, 1.45), and elder child age (OR 1.02, 1.03) were significant predictors of occasional use of screen during meals. Also, longer daily screen time (OR 0.99, 95% CI 0.98&ndash, 0.99), background TV (OR 0.78, 95% CI 0.66&ndash, 0.91) together with no siblings&rsquo, status of a child (OR 0.42, 95% CI 0.25&ndash, 0.69) increased the probability that children were fed in front of screens daily. Conclusions: This study confirmed the unfavorable associations among screen use during meals, daily screen time and junk food consumption in early childhood. In addition, first-time parents should get particular health providers&rsquo, attention as they are more likely to use screens during child&rsquo, s mealtime.

BackgroundVaccine-preventable diseases and opportunistic infections in pediatric inflammatory bowel disease (IBD) are increasingly recognized issues. The aims of this study were to evaluate vaccinations, immunization status, and consequent therapeutic management in children with IBD and to analyze the differences among patients diagnosed before (Group 1) and after June 2012 (Group 2).MethodsThis was a multicenter, retrospective cohort investigation. Between July 2016 and July 2017, 430 children with IBD were enrolled in 13 centers. Diagnosis, therapeutic history, vaccinations, and immunization status screening at diagnosis and at immunosuppressant (IM)/biologic initiation and reasons for incomplete immunization were retrieved.ResultsVaccination rates at diagnosis were unsatisfactory for measles, mumps, and rubella (89.3%), Haemophilus influenzae (81.9%), meningococcus C (23.5%), chickenpox (18.4%), pneumococcus (18.6%), papillomavirus (5.9%), and rotavirus (1.9%). Complete immunization was recorded in 38/430 (8.8%) children, but specific vaccines were recommended in 79/430 patients (18.6%), without differences between the 2 groups. At IM start, 22% of children were tested for Epstein-Barr virus (EBV) status, with 96.2% of EBV-naïve patients starting azathioprine, without differences between Groups 1 and 2. Screening for latent tuberculosis (TB) before start of biologics was performed in 175/190 (92.1%), with up to 9 different screening strategies and numerous inconsistencies.ConclusionsWe demonstrated a poor immunization status at diagnosis in children with IBD, which was not followed by proper vaccination catch-up. EBV status before IM initiation and latent TB before biologics were not adequately assessed. Thus, the overall impact of the current guidelines seems unsatisfactory.

Reikšminiai žodžiai: vaikai, parenterinis maitinimas namuose, indikacijos, komplikacijos. Parenterinis maitinimas (PM) – tai specialių mitybos mišinių lašinimas į veną. Jis skiriamas, kai yra žarnyno nepakankamumas arba kaip papildomas maitinimas ligoniui, nesugebančiam gauti reikiamo energijos kiekio. Šiuo metu dažniausiai naudojami „viskas viename“ parenterinės mitybos mišiniai į atskirą centrinės venos kateterio kanalą. Šiame mišinyje yra visos pagrindinės maisto medžiagos: gliukozė, aminorūgštys, riebalų rūgštys. Parenterinė mityba gali sukelti infekcinių, mechaninių, metabolinių komplikacijų. Parenterinis maitinimas dažniausiai naudojamas stacionare, bet gali būti taikomas ir namų sąlygomis. Šiame straipsnyje aprašomas pirmas ilgalaikės (daugiau nei 6 metai) parenterinės mitybos namuose atvejis Lietuvoje. Mergaitei, sergančiai lėtiniu žarnyno pseudoobstrukcijos sindromu, septynerių metų (2009 m.) Vaikų ligoninėje, Vilniaus universiteto ligoninės Santariškių klinikų filiale, pradėtas visiškas parenterinis maitinimas, o po mėnesio pratęstas namuose. Per daugiau nei šešerius metus pakeisti 5 kateteriai ir šiuo metu 820 parų funkcionuoja šeštas. Vidutinė kateterio funkcionavimo trukmė 373,6 paros. Kateteriai du kartus pakeisti dėl infekcijos ir tris kartus dėl kateterio nepraeinamumo. Ligonei išsivystė parenterinio maitinimo komplikacijos: du kartus sirgo sepsiu, buvo ryškūs elektrolitų balanso sutrikimai, nustatyta ir iki šiol išlieka v. brachiocephalica ir v. cava superior trombozė, PM sukeltas hepatitas.

Reikšminiai žodžiai: H. pylori, atsparumas antibiotikams, vaikai. Daugelyje šalių pastebimas didėjantis Helicobacter pylori (H. pylori) atsparumas antibiotikams, ypač vaikų amžiuje. Tai nulemta augančio antibiotikų vartojimo. Darbo tikslas. Nustatyti Helicobacter pylori pirminį atsparumą antibiotikams Lietuvoje, gautus rezultatus palyginti su seniau atliktais tyrimais. Tyrimo medžiaga ir metodai. Į tyrimą įtraukti nuo 2013 metų rugsėjo iki 2015 metų balandžio Vaikų ligoninėje, VšĮ Vilniaus universiteto ligoninės Santariškių klinikų filiale (toliau – Vaikų ligoninė) gydyti vaikai. Atrankos kriterijai: vaikai, besiskundžiantys pilvo skausmu, dispepsija ar nustatyta neaiškios kilmės anemija; atlikta fibrogastroskopija ir gautas teigiamas ureazės testas, anksčiau netaikyta H.pylori eradikacija. Biopsijos buvo paimtos iš 137 pacientų (80 mergaičių ir 57 berniukų). Biopsijos medžiaga buvo išsėta į arklio kraujo agaro terpę ir auginama 35–37°C mikroaerobinėmis sąlygomis 4–7 dienas. Atlikti E-testai amoksicilinui (minimali slopinanti koncentracija (MIC) ≥0,125 mg/l), klaritromicinui (MIC ≥ 0,5 mg/l), metronidazoliui (MIC ≥ 8 mg/l) ir levofloksacinui (MIC ≥1 mg/l). Rezultatai. Iš 137 pasėlių augimas buvo stebimas 82 atvejais (60,4 proc.). Atsparumas vienam ar keliems antibiotikams nustatytas 41 pasėlyje. Atsparumas klaritromicinui buvo 33 (40,2 proc., metronidazoliui – 18 (22 proc.), levofloksacinui 2 (2,4 proc.), klaritromicino ir metronidazolio deriniui – 11 (13,4 proc.) atvejų. Amoksicilinui atsparumo nebuvo pastebėta. Rezultatai palyginti su 2007–2008 m. Lietuvoje atliktu tyrimu [4]: atsparumas klaritromicinui padidėjo nuo 16,8 proc. iki 40,2 proc. (p

Informacinėms technologijoms vis labiau skverbiantis į kiekvienos šeimos kasdienybę įvairių šalių tyrėjai jau kurį laiką aktyviai domisi galimu jų naudojimo poveikiu vaikų sveikatai; vis dėlto itin nedaug tyrimų, kuriuose būtų kompleksiškai tiriama ir psichikos, ir fizinė sveikata, jos sąsajos su vaikų aktyviu bei pasyviu buvimu prie įvairių ekranų. Tyrimo tikslas – nustatyti, kokios yra pusantrų – penkerių metų amžiaus vaikų aktyvaus ir pasyvaus informacinių technologijų (televizoriaus, kompiuterio, planšetinio kompiuterio, išmaniojo telefono ir žaidimų konsolės) naudojimo apimtys bei kaip jos siejasi su šių vaikų psichologinės ir fizinės sveikatos aspektais. Siekiant šio tikslo, ikimokyklinio amžiaus vaikų iš įvairių Lietuvos vietovių tėvų buvo paprašyta užpildyti anketas apie jų vaikų psichikos ir fizinę sveikatą bei informacinių technologijų naudojimą (tiek aktyvų, tiek pasyvų). 2017m. balandžio – spalio mėnesiais buvo surinkti duomenys apie 769 vaikus nuo 18 iki 72 mėn. amžiaus (M = 42,42, SD = 15,5). Tyrimo rezultatai atskleidė, kad trečdalis vaikų darbo dienomis praleidžia prie ekranų nuo 30 min. iki valandos, o savaitgaliais – nuo 1 iki 2 valandų, tačiau nemaža dalis (11 proc. darbo dienomis ir 22 proc. laisvadieniais) naudojasi informacinėmis technologijomis 2-3 val. ir daugiau; ilgiau prie ekranų būna vyresni vaikai, taip pat tie, kurių tėvų išsilavinimas yra vidurinis arba žemesnis. Dažniausiai ikimokyklinio amžiaus vaikai žiūri televizorių, rečiau naudojasi išmaniuoju telefonu ar planšetiniu kompiuteriu, dar rečiau– kompiuteriu, o žaidimų konsole šio amžiaus vaikai beveik nesinaudoja. Tėvai būdami šalia vaiko dažniausiai žiūri TV ar naudojasi išmaniuoju telefonu, TV kaip “fonas” dažnai ar beveik visada būna naudojamas 29 proc. tirtų vaikų šeimose. Rasta reikšmingų sąsajų tarp informacinių technologijų naudojimo ir sveikatos rodiklių: ilgesnė buvimo prie ekrano trukmė yra susijusi su didesniais vaikų emocinių, elgesio problemų, somatinių skundų ir bendrai somatinių simptomų įverčiais, taip pat dažnesniu sergamumu ūminėmis ligomis ir trumpesne miego trukme, net ir kontroliuojant vaikų amžių. Formuluojant ikimokyklinio amžiaus vaikų informacinių technologijų naudojimo rekomendacijas svarbu turėti omenyje, kad reikšmingai didesnei somatinės simptomatikos raiškai atsirasti svarbi jau 1-2 val. buvimo prie ekranų trukmė, o elgesio ir emocijų sunkumų didesnei raiškai – 2-3 val. ir ilgesnė buvimo prie ekranų trukmė. While information technologies are invading everyday life of each family more and more, researchers around the world are increasingly interested in possible consequences for children’s health. However, few studies analyse the relations between interactive and background screen time with both mental and physical health of children. The objective of this study is to determine the extent of foreground and background information technology (television, PC, tablet, smart phone and gaming console) use among children from one year and a half to five years old and to find out how it relates to the psychological and physical health aspects of the children. To this end, parents of pre-school children from different regions of Lithuania were asked to fill in questionnaires about their children‘s mental and physical health and the use of information technologies (both foreground and background use). From April to October 2017, data was collected on 769 children, whose age was between 18 and 72 months (M = 42.42, SD = 15.5). The results of the study revealed that one third of the children have 30 minutes to an hour of screen time on workdays and 1 to 2 hours of screen time on weekends, but a significant proportion (11% on weekdays and 22% on weekends) use information technology for 2-3 hours and more; older children and children whose parents’ education is secondary or lower tend to have more screen time. Preschool children mostly watch TV, use smart phone or tablet less, and use computer the least; gaming console is not being used by children of this age. Parents are most likely to watch TV or use a smart phone next to a child; the TV is often or almost always used as a background in the families of 29.9% of the children. Significant interactions have been found between the use of information technology and health indicators: longer exposure time is associated with greater estimates of children‘s emotional, behavioural problems, somatic complaints and general somatic symptoms, as well as with more frequent acute illnesses and shorter sleep times, even when controlling for children’s age. When formulating recommendations for children’s information technology use, it is important to bear in mind that significant increase in somatic symptoms is associated with 1-2 hours of daily screen time, while behavioural and emotional difficulties become evident with 2-3 hours and more.

Helicobacter pylori infection in children differs from infection in adults in many aspects. The rate of infection, epidemiology, clinical presentations and complications, the applicability of diagnostic tests, antibiotic resistance, treatment options, and success rates differ significantly. Due to all these differences, management guidelines for children and adults differ also substantially. In 2017, the Updated ESPGHAN and NASPGHAN Guidelines on the management of H. pylori infection in children were published, emphasizing the differences in clinical presentation and indications for treatment, stating that the primary goal of clinical investigation in children is to identify the cause of upper gastrointestinal symptoms rather than the presence of H. pylori infection. Therefore, the diagnosis should be based on upper endoscopy, and the "test and treat strategy" should not be used in children. Due to an increasing rate of antibiotic resistance worldwide, the updated guidelines recommend broader use of antimicrobial susceptibility testing for H. pylori strains in order to tailor eradication treatment accordingly. Moreover, treatment in children should be prescribed only when indicated and should be based on the rate of eradication in local populations aiming for treatment success above 90%. During the last two decades there has been a steady decrease in the rate of H. pylori infection in both children and adults in the Western world. Two recent publications studying the incidence of H. pylori infection confirmed that early childhood is a time for acquisition of infection both in industrialized and nonindustrialized countries. In addition, they showed that H. pylori could be acquired outside the family. In respect to the inverse association between H. pylori and allergy, a longitudinal study demonstrated that early exposure to H. pylori at any age was inversely associated with atopy and allergic conditions.

BACKGROUND Selective immunoglobulin A (IgA) deficiency is the most common inherited immunodeficiency disorder worldwide. An early diagnosis is advocated because of the increased risk of infections, autoimmune diseases, and allergic reactions. We investigated the usefulness of a rapid point-of-care test in detecting for IgA deficiency in a population with a previously unknown prevalence. MATERIAL AND METHODS Altogether, 1000 children aged 11-13 years from randomly selected Lithuanian schools were enrolled. A point-of-care test with a fingertip sample was used to screen for the presence of IgA deficiency in children whose parents gave consent. Those with suspected IgA deficiency were referred to hospital for further clinical examination and confirmation of the diagnosis. In addition, their medical histories were compared with those of 30 age- and sex-matched healthy controls. RESULTS IgA deficiency was suspected in one girl and in three boys on the basis of the rapid test, and the diagnosis was confirmed for all four cases (prevalence 0.4%, 95% confidence interval 0.16-1.02%). There was no difference in disease history or complications between IgA-deficient children and healthy controls. CONCLUSIONS The rapid antibody test is a practical and accurate method to diagnose selective IgA deficiency in children. The prevalence of IgA deficiency among Lithuanian schoolchildren is 1:250.

Objective The aim of this study was to evaluate the current implementation of the 2009 North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition-European Society for Pediatric Gastroenterology, Hepatology, and Nutrition guidelines, and to assess proton pump inhibitors' (PPIs) prescribing patterns among pediatricians from different European countries. Methods A randomly identified sample of general pediatricians distributed across 11 European countries. They were asked to complete a case report-structured questionnaire investigating their approaches to infants, children, and adolescents with symptoms suggestive of gastroesophageal reflux. Results A total of 567 European general pediatricians completed the study questionnaire. Only 1.8% of them showed complete adherence to the guidelines. Forty-six percent of them reported that they diagnose gastroesophageal reflux disease based on clinical symptoms irrespective of the age of the child; 39% prescribe PPIs in infants with unexplained crying and/or distressed behavior and 36% prescribe PPIs in infants with uncomplicated recurrent regurgitation and vomiting; 48% prescribed PPIs in children younger than 8 to 12 years with vomiting and heartburn, without specific testing; 45% discontinue PPI therapy abruptly rather than tapering the dose. The overall rate of pediatricians overprescribing PPIs was 82%. Conclusions The overall results of our survey show that the majority of pediatricians are unaware of 2009 North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition-European Society for Pediatric Gastroenterology, Hepatology, and Nutrition reflux guidelines and often prescribe PPIs despite a lack of efficacy for the symptoms being treated. The overdiagnosis of gastroesophageal reflux disease places undue burden on both families and national health systems, which has not been affected by the publication of international guidelines.

BACKGROUND: According to a recent survey, the 2009 North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition-European Society for Pediatric Gastroenterology, Hepatology, and Nutrition gastroesophageal reflux guidelines are poorly adhered to by European primary care pediatricians. The main issue raised from the survey was the prescription of unnecessary acid suppressive medications, especially in infants. No inquiry into the reasons was made. The primary objective of the present study was to assess the applicability of the guidelines in European primary care pediatricians undergoing specific trainings. METHODS: One hundred pediatricians involved in the previous survey agreed to participate and were randomly divided into 2 groups: one group was trained in the guidelines through an online podcast and the other group was trained through a synopsis. During the following 3 months, each involved pediatrician was asked to enroll every consecutive infant, child, or adolescent with suggestive reflux symptoms. For every enrolled patient, pediatricians filled in a report concerning their diagnostic and therapeutic choices. RESULTS: A total of 382 patients (boys/girls 186/196, infants/children/adolescents 194/123/65) were enrolled by pediatricians. Infants with unexplained crying and/or distressed behavior who were prescribed proton-pump inhibitors were 3.7% compared with 45.2% of the survey data obtained before the training (P

Objective: The aim of this study was to evaluate the current implementation of the 2009 North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition-European Society for Pediatric Gastroenterology, Hepatology, and Nutrition guidelines, and to assess proton pump inhibitors' (PPIs) prescribing patterns among pediatricians from different European countries. Methods: A randomly identified sample of general pediatricians distributed across 11 European countries. They were asked to complete a case report-structured questionnaire investigating their approaches to infants, children, and adolescents with symptoms suggestive of gastroesophageal reflux. Results: A total of 567 European general pediatricians completed the study questionnaire. Only 1.8% of them showed complete adherence to the guidelines. Forty-six percent of them reported that they diagnose gastroesophageal reflux disease based on clinical symptoms irrespective of the age of the child; 39% prescribe PPIs in infants with unexplained crying and/or distressed behavior and 36% prescribe PPIs in infants with uncomplicated recurrent regurgitation and vomiting; 48% prescribed PPIs in children younger than 8 to 12 years with vomiting and heartburn, without specific testing; 45% discontinue PPI therapy abruptly rather than tapering the dose. The overall rate of pediatricians overprescribing PPIs was 82%. Conclusions: The overall results of our survey show that the majority of pediatricians are unaware of 2009 North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition-European Society for Pediatric Gastroenterology, Hepatology, and Nutrition reflux guidelines and often prescribe PPIs despite a lack of efficacy for the symptoms being treated. The overdiagnosis of gastroesophageal reflux disease places undue burden on both families and national health systems, which has not been affected by the publication of international guidelines.

In the last decade, scientific studies in the field of children's gastroenterology performed in Lithuania explored different problems: pathology of Helicobacter pylori infection and food allergy. Our studies revealed that children with atopic dermatitis had gastrointestinal complaints (abdominal pain, diarrhea, distension and unstable stool, which appeared with the exacerbation of skin rash) more often as compared to nonallergic children of the control group. Abdominal pain in children with atopic dermatitis with local rash was more frequent and lasted longer than in control group children, whereas children with extended rash had stools more frequently. Gastrointestinal disorders in children with atopic dermatitis statistically significantly did not depend on the extent of skin rash and severity of atopic dermatitis. In our scientific research on the importance of H. pylori infection on children's gastrointestinal system, children with chronic dyspepsia were examined. Endoscopy, rapid urease test, biopsies from antrum and corpus of stomach and their histological examination as well as serologic tests were done. According to the results obtained, we recommend to examine children with chronic dyspepsia in a complex way: not only endoscopic examination, but H. pylori diagnostic tests should be performed as well. Serologic test is not suitable for screening H. pylori infection in children. Considering this, we recommend to use no fewer than two different methods to diagnose this infection. The highest frequency of H. pylori infection was found in children with duodenal ulcer; histological changes in their gastric pylorus and corpus mucosa were greatest. More than half of children with nonulcer dyspepsia were infected with H. pylori. After eradication of H. pylori infection, the prevalence of dyspepsia in children with duodenal ulcer decreased.