Journal of Pediatric Gastroenterology and Nutrition最新文献

{"title":"Long-term laboratory follow-up is essential in pediatric patients with celiac.","authors":"Alexander Krauthammer, Anat Guz-Mark, Noam Zevit, Orith Waisbourd-Zinman, Yael Mozer-Glassberg, Vered Nachmias Friedler, Michal Rozenfeld Bar Lev, Manar Matar, Dror Shouval, Raanan Shamir","doi":"10.1002/jpn3.70004","DOIUrl":"https://doi.org/10.1002/jpn3.70004","url":null,"abstract":"<p><strong>Objectives: </strong>Celiac disease (CeD) requires long-term follow. The role of laboratory testing other than celiac serology during follow up is unclear. We aimed to determine which laboratory tests are required during follow up based on the prevalence of abnormal tests and timing of abnormalities appearance.</p><p><strong>Methods: </strong>Retrospective chart-review of children diagnosed with CeD between 1999 and 2018 was conducted. Demographic, clinical and laboratory data were recorded from diagnosis and during follow-up.</p><p><strong>Results: </strong>The cohort included 500 children with CeD [59.8% females, median(IQR) age at diagnosis 5.7(3.7-8.9) years]. Mean follow-up time was 5.5 years (range 1.5-16.2). The most frequently abnormal laboratory tests at time of diagnosis were low ferritin (64.3%), vitamin D (33.6%), zinc (29.9%), hemoglobin (29.2%), and folate (14.7%). In 74 (14.8%) patients, anemia developed only during follow up, while in another 46 patients, anemia resolved after diagnosis and reappeared later (after a mean ± SD 2.8 ± 2.1 years from CeD diagnosis, for the entire group). Abnormal values that developed during follow up were low folate in 40 patients (3.9 ± 2.6 years), and abnormal liver enzymes in 18 patients (3.1 ± 2.7 years). Elevated TSH during follow-up was observed in 14/280 (5%) patients, after a mean ± SD of 2.2 ± 1.6 years from diagnosis. Patients diagnosed as teenagers (12-18 years) had shorter intervals to reappearance of anemia and folate deficiency.</p><p><strong>Conclusions: </strong>Multiple laboratory abnormalities may occur in pediatric patients with CeD, both at diagnosis and during long-term follow-up. We suggest continued monitoring of hemoglobin, ferritin, folate, liver, and thyroid function in addition to celiac serology during follow-up of CeD.</p>","PeriodicalId":16694,"journal":{"name":"Journal of Pediatric Gastroenterology and Nutrition","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143399403","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Feeding hope: A quality improvement initiative to improve identification of food insecurity.","authors":"Nicole Misner, Patoula Panagos-Billiris, Michelle Yavelow, Chaitanya Chaphalkar, Athanasios Tsalatsanis, Racha T Khalaf","doi":"10.1002/jpn3.70010","DOIUrl":"https://doi.org/10.1002/jpn3.70010","url":null,"abstract":"<p><strong>Objectives: </strong>Food insecurity (FI), limited or uncertain access to adequate food, impacts every state, county, and community in the United States. The goals of this quality improvement (QI) initiative were to first achieve greater than 90% compliance with FI screening for patients seen at pediatric GI clinics within 1 year and second increase the proportion of families identified as FI connected with resources to 50% at follow-up visits.</p><p><strong>Methods: </strong>Using plan-do-study-act cycles, interventions were implemented to (1) educate, (2) create a screening process, (3) optimize communication with EMR utilization, and (4) connect families to resources. Descriptive statistics on all variables collected were performed. Differences between the FI and food secure groups were assessed using the Mann-Whitney test for continuous variables and the Chi-squared test for categorical variables. QIMacros® Quality Improvement/SPC Software for Excel was used to create process control charts to show improvement.</p><p><strong>Results: </strong>During the timeframe from August 29, 2022, to February 29, 2024, 2946 visits were completed in the GI clinic, and 58% (1731 patients) were screened for FI. Of the patients that were screened for FI, 13% screened positive. Compliance with FI screening improved to 90%, and connection to resources improved to 75%. Race, ethnicity, preferred language, and insurance were all significantly associated with FI, p < 0.001 CONCLUSIONS: This QI initiative demonstrates standardized FI screening improves FI identification and connection to resources.</p>","PeriodicalId":16694,"journal":{"name":"Journal of Pediatric Gastroenterology and Nutrition","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143391172","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Term infant formula macronutrient composition: An update for clinicians.","authors":"Catherine Larson-Nath, Anam Bashir, Rachel E Herdes, Bridget Kiernan, Joanne Lai, Nicole Martin, Nicole Misner, Akash Pandey, Kanika Puri, Wenjing Zong, Debora Duro","doi":"10.1002/jpn3.70002","DOIUrl":"https://doi.org/10.1002/jpn3.70002","url":null,"abstract":"<p><p>Protein, carbohydrates, and fats comprise the macronutrient components of infant formulas. While all infant formulas in the United States meet specific nutrition standards, the macronutrient composition of formulas is diverse. Each macronutrient in the formula may play a role in treating or managing the disease. In addition, many formulas are marketed as resembling the composition of human milk or improving symptoms such as colic and irritability. For these and other reasons, families are often interested in different formula properties. When choosing a formula for their infant families, they may reach out to clinicians for advice. Therefore, clinicians need to understand the macronutrient composition of the formulas their patients are using. This manuscript discusses the macronutrient composition of term infant formulas and indications of the use of different macronutrient components.</p>","PeriodicalId":16694,"journal":{"name":"Journal of Pediatric Gastroenterology and Nutrition","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143391179","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Providing effective feedback for training: Is there a role for informatics?","authors":"Nidhi P Goyal, Jeannie S Huang","doi":"10.1002/jpn3.70003","DOIUrl":"https://doi.org/10.1002/jpn3.70003","url":null,"abstract":"","PeriodicalId":16694,"journal":{"name":"Journal of Pediatric Gastroenterology and Nutrition","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143382709","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidence of biliary atresia in the United States before and during the COVID-19 pandemic.","authors":"Yasmeen Z Qwaider, Justin Z Amarin, Andrew J Spieker, Haya Hayek, James D Chappell, Natasha B Halasa, Harold N Lovvorn","doi":"10.1002/jpn3.70009","DOIUrl":"https://doi.org/10.1002/jpn3.70009","url":null,"abstract":"<p><strong>Objectives: </strong>The etiology of biliary atresia (BA) is unclear and potentially involves viral triggers. We aimed to compare the incidence of BA in the United States before and during the coronavirus disease 2019 (COVID-19) pandemic, focusing on potential associations with viral circulation disruptions caused by nonpharmaceutical interventions (NPIs).</p><p><strong>Methods: </strong>We queried the Pediatric Health Information System® (PHIS) for all patients discharged with BA between January 1, 2010, and January 31, 2024. Using CDC WONDER, we calculated monthly and overall incidence rates of BA per 1,000,000 live births. We fit a Poisson regression model to assess the association between the widespread implementation of stay-at-home orders (using April 1, 2020, as the cutoff date) and the incidence of BA, accounting for national natality fluctuations.</p><p><strong>Results: </strong>We identified 3456 newborns with BA from 42 hospitals; 2997 (86.7%) were born before and 459 (13.3%) were born during the pandemic. The mean monthly number of newborns with BA was 24.0 (95% confidence interval, 23.0-25.0) for an overall incidence rate of 74.4 (71.5-77.4) per 1,000,000 live births. We did not identify a statistically significant year-to-year contrast in the incidence of BA before (incidence rate ratio [IRR] = 0.995 [0.983-1.008]; p = 0.49) or after the cutoff date (IRR = 0.999 [0.895-1.116]; p = 0.99). In addition, we did not identify sufficient evidence that trends differed between the two periods (IRR = 1.00 [0.893-1.128]; p = 0.95).</p><p><strong>Conclusions: </strong>The NPIs implemented during the COVID-19 pandemic were not significantly associated with changes in the incidence or temporal pattern of BA.</p>","PeriodicalId":16694,"journal":{"name":"Journal of Pediatric Gastroenterology and Nutrition","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143391178","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Eosinophilic esophagitis associated with infliximab therapy in pediatric patients with inflammatory bowel disease.","authors":"Meng-Che Wu, Jonathan N Glickman, Harland S Winter","doi":"10.1002/jpn3.70007","DOIUrl":"https://doi.org/10.1002/jpn3.70007","url":null,"abstract":"","PeriodicalId":16694,"journal":{"name":"Journal of Pediatric Gastroenterology and Nutrition","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143382707","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How does bovine milk-based fortification alter the oxidant-antioxidant profile of breast milk in preterm infants?","authors":"Ozge Aydemir, Yusuf Aydemir, Ozge Surmeli Onay","doi":"10.1002/jpn3.70008","DOIUrl":"https://doi.org/10.1002/jpn3.70008","url":null,"abstract":"<p><strong>Objectives: </strong>Fortification of breast milk (BM) is recommended to enhance protein, vitamin, and mineral content, supporting improved growth in preterm infants. However, the impact of fortification on the oxidant-antioxidant balance in BM has not been previously studied. This study aims to evaluate the effects of fortification with a bovine milk-based fortifier on the total antioxidant capacity (TAC) and total oxidant status (TOS) in preterm BM.</p><p><strong>Methods: </strong>In this prospective cohort study, transitional milk (TM) (6-10 days postpartum) and mature milk (MM) (>15 days postpartum) samples were collected from mothers of preterm infants receiving fortified BM. TAC and TOS were measured in BM samples before and after fortification. The oxidative stress index (OSI), defined as the TOS-to-TAC ratio, was used to assess oxidative stress levels.</p><p><strong>Results: </strong>Seventy-five BM samples from 59 preterm infants, with a mean gestational age of 31.4 ± 2.8 weeks, were analyzed. TAC levels were consistent between TM and MM of the preterm infants. TOS levels and OSI were lower in TM compared to MM (p = 0.019 and p = 0.033, respectively). Fortification led to increased TAC and TOS in both TM (p < 0.001 each) and MM (p < 0.001 each). The OSI was higher in fortified TM (p = 0.032) compared to unfortified TM, while OSI remained unchanged in fortified MM (p = 0.39).</p><p><strong>Conclusions: </strong>Preterm TM exhibits a more favorable oxidant-antioxidant profile compared to MM. Fortification elevates both TAC and TOS in preterm BM. In MM, the oxidant-antioxidant balance is maintained post-fortification; however, in TM, the increase in TOS exceeds that of TAC, resulting in a higher OSI.</p>","PeriodicalId":16694,"journal":{"name":"Journal of Pediatric Gastroenterology and Nutrition","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143391175","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness of nasogastric versus orogastric tube feeding in preterm infants: A systematic review and meta-analysis.","authors":"Shruthi Kumar Bharadwaj, Risha Devi, Sanjana Hansoge Somanath, Abdul Kareem Pullattayil, Vijay Shree Dhyani","doi":"10.1002/jpn3.12476","DOIUrl":"https://doi.org/10.1002/jpn3.12476","url":null,"abstract":"<p><strong>Objectives: </strong>This systematic review and meta-analysis evaluated the effectiveness of nasogastric versus orogastric tube feeding on feeding performance in preterm neonates.</p><p><strong>Methods: </strong>Randomized, quasi-randomized, and cross-over trials published in peer-reviewed journals with no language or country restrictions were included. Preterm neonates (<37 weeks) receiving nasogastric or orogastric enteral feeding until full oral feeds were established formed the exposure and comparison groups.</p><p><strong>Primary outcome: </strong>time to achieve full enteral feeding; secondary outcomes: feeding performance, growth, and adverse events. A comprehensive literature search across multiple databases was conducted up to January 2024. Two authors independently screened studies, assessed the risk of bias, and performed a meta-analysis using a random effects model. Evidence levels were determined following Grades of Recommendation, Assessment, Development, and Evaluation guidelines.</p><p><strong>Results: </strong>Six studies, including 273 preterm neonates, were included. Nasogastric feeding reduced the time to achieve full enteral feeds compared to orogastric feeding (mean difference [MD], -1.62 days; 95% confidence interval [CI], -2.25 to -0.99 days) with very low certainty of evidence. Combined episodes of bradycardia and desaturation per hour were higher in nasogastric feeding than orogastric feeding (MD, 0.24; 95% CI, 0.14-0.34), as were episodes of bradycardia (MD, 0.08; 95% CI, 0.04-0.13) and desaturation (MD, 0.16; 95% CI, 0.10-0.22). No significant differences were found in time to regain birth weight, apnea, necrotizing enterocolitis, or sepsis.</p><p><strong>Conclusions: </strong>Nasogastric tube feeding reduces the time to achieve full enteral feeds but increases episodes of bradycardia and desaturation compared to orogastric feeding in preterm neonates. Cautious interpretation is required as the low to very low certainty evidence highlights the need for larger, well-designed trials for evidence-based recommendations.</p>","PeriodicalId":16694,"journal":{"name":"Journal of Pediatric Gastroenterology and Nutrition","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143382706","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pediatric endoscopic ultrasound-guided liver biopsy: 3-year experience.","authors":"Talia S Schwartz, Marialena Mouzaki, Lara Berklite, Oscar F Lopez-Nunez, Alexander Miethke, Stavra A Xanthakos, David S Vitale","doi":"10.1002/jpn3.70001","DOIUrl":"https://doi.org/10.1002/jpn3.70001","url":null,"abstract":"<p><strong>Objectives: </strong>Liver biopsy is the gold standard for diagnosing and staging liver diseases. Endoscopic ultrasound-guided liver biopsy (EUS-LB) has been reported in adults with equivalent or better safety profiles than percutaneous liver biopsies. The aim of this study was to retrospectively assess the safety and efficacy of EUS-LB in pediatric patients.</p><p><strong>Methods: </strong>This was a retrospective chart review of consecutive pediatric patients undergoing EUS-LB at Cincinnati Children's Hospital Medical Center from March 2020 to April 2023. Patients ≤21 years old were included. EUS-LB was performed via fine-needle biopsy technique with transduodenal and/or transgastric approach. Histology was independently reviewed by one of two expert pathologists, including length (cm) and complete portal tract (CPT) number per the American Association for the Study of Liver Diseases (AASLD) adequacy criteria. Demographics, clinical data, technical information, diagnostic success, and adverse events were recorded.</p><p><strong>Results: </strong>Eighty-three patients were included in the analysis, with various indications that required liver biopsy. All biopsies achieved diagnostic and technical success, with 77 (93%) meeting both AASLD criteria for adequacy. Most patients (57, 69%) underwent biopsy of both hepatic lobes, with an overall median of two needle passes. Total specimen length was a median of 7.9 cm (interquartile range [IQR] 5.2-10.3), and the median maximum intact specimen was 4.2 cm (IQR 3.1-5.4). The median CPT number was 24 (IQR 17-32) per patient. Four mild adverse events (5%) occurred; none involved bleeding.</p><p><strong>Conclusions: </strong>EUS-LB was well tolerated and yielded samples that were technically and diagnostically successful in a pediatric population, with comparable safety to percutaneous liver biopsy.</p>","PeriodicalId":16694,"journal":{"name":"Journal of Pediatric Gastroenterology and Nutrition","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143365188","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical features of magnetically controlled capsule endoscopy in children: A large, retrospective cohort study.","authors":"Weiwei Cheng, Kai Lin, Ling Wang, Xing Wang, Yuling Feng, Zhujun Gu, Haifeng Liu","doi":"10.1002/jpn3.12472","DOIUrl":"https://doi.org/10.1002/jpn3.12472","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to assess the utility of magnetically controlled capsule endoscopy (MCE) in the diagnosis of pediatric gastrointestinal diseases.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted, which collected data from 1040 children (546 males and 494 females; mean age: 11.0 ± 2.6 years) who underwent MCE at Shanghai Children's Hospital between June 2017 and February 2023. Information on gastric visualization, cleanliness, examination times, lesion detection rates, and other parameters were recorded. A 2-week follow-up monitored capsule excretion and adverse reactions.</p><p><strong>Results: </strong>Of the 1055 patients, 78 had difficulty swallowing the capsule, and 15 could not swallow even with assistance, which led to their exclusion. The small intestine was successfully examined in 94.5% (206 out of 218) of the 218 children who were able to proceed with the procedure. The remaining 822 underwent esophagus and stomach examinations. The average transit time of the endoscopy capsule in the esophagus, stomach, and small intestine was 5 (3, 9) s, 57.0 (29.0, 102.0) min, and 306.0 (234.0, 500.0) min. In the examined cases, complete small bowel visualization was achieved in 94.5% of the patients. The most common symptoms reported by the patients were abdominal pain (77.9%) and nausea with vomiting (13.5%). Lesion detection rates were 38.8% in the stomach, 21.1% in the duodenum, and 43.1% in the jejunoileum. No complications, such as capsule retention or intestinal obstruction, were observed.</p><p><strong>Conclusion: </strong>MCE is a feasible and safe method for examining the gastric cavity and small bowel in pediatric patients.</p>","PeriodicalId":16694,"journal":{"name":"Journal of Pediatric Gastroenterology and Nutrition","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143365185","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}