Journal of Pediatric Gastroenterology and Nutrition最新文献

{"title":"Feed fortification strategy impact on the risk of necrotizing enterocolitis in infants with complex congenital heart disease.","authors":"Jemma Woodgate, Vineet Joshi, Jessica Suna, Nicholas Gillman, Supreet Marathe, Craig McBride, Kristen Gibbons, Sainath Raman","doi":"10.1002/jpn3.70144","DOIUrl":"10.1002/jpn3.70144","url":null,"abstract":"<p><strong>Objectives: </strong>Development of necrotizing enterocolitis (NEC) in infants with complex congenital heart disease (CHD) has serious negative clinical outcomes. Unfortified expressed breast milk (EBM) is this high-risk population's enteral feed of choice. EBM often requires fortification to meet nutritional needs to prevent malnutrition. The optimal fortification strategy in this population is unclear. We hypothesize that, in infants with complex CHD at high risk of NEC, using extensively hydrolyzed formulae compared to polymeric infant formulae to fortify EBM will improve growth and reduce the incidence or severity of NEC.</p><p><strong>Methods: </strong>A single-center, retrospective pre- and post-implementation study was conducted in a tertiary pediatric cardiac surgical center in Queensland, Australia. It observed the impact of a change in fortification strategy and formulae selection practice in infants with complex CHD at high risk of NEC.</p><p><strong>Results: </strong>There were 133 infants eligible for study inclusion, with 69 pre-implementation and 64 post-implementation. No impact on growth outcomes was observed between pre- and post-implementation cohorts. There was a trend towards reducing the severity of NEC in the post-implementation group. Pre-implementation, 7 out of 17 infants (41%) diagnosed with NEC were classified as advanced NEC, with 0 out of 16 (0%) post-implementation.</p><p><strong>Conclusions: </strong>The use of extensively hydrolyzed formulae instead of polymeric infant formulae, to fortify EBM in infants with complex CHD at high risk of NEC, has the potential to reduce the severity of NEC, with no impact on growth, across hospitalization.</p>","PeriodicalId":16694,"journal":{"name":"Journal of Pediatric Gastroenterology and Nutrition","volume":" ","pages":"722-730"},"PeriodicalIF":2.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12408970/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144575630","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development and validation of a simple nomogram for predicting severe acute pancreatitis in children.","authors":"Cai-Xia Feng, Wen-Yu Ye, Lian-Cheng Lan, Si-Xing Chen, Xiu-Qi Chen, Qing Tang, Li Huang, Xiao-Yin He, Shu-Heng Liang, Yun Li, Yi Wu, Juan Li, Qing-Wen Shan","doi":"10.1002/jpn3.70138","DOIUrl":"10.1002/jpn3.70138","url":null,"abstract":"<p><strong>Objective: </strong>To develop and validate a nomogram for predicting severe acute pancreatitis (SAP) in children, aiding early identification and intervention of this potentially fatal condition.</p><p><strong>Methods: </strong>This study employed a retrospective dual-center design, involving two large tertiary children's hospitals. All pediatric patients under the age of 18 years diagnosed with acute pancreatitis (AP) were included. The primary predicted outcome was the probability of children with AP progressing to SAP. We used the Least Absolute Shrinkage and Selection Operator (LASSO) regression to select optimal predictors and logistic regression to build a nomogram. The model's performance was evaluated using ROC curves, a Calibration Curve, and Decision Curve Analysis (DCA). Internal and external validations were performed.</p><p><strong>Results: </strong>For the training cohort, we enrolled 152 pediatric AP episodes, among which 23 episodes (15.1%) were categorized as SAP. In the external validation cohort, we included 60 pediatric AP episodes, with 7 episodes (11.7%) being classified as SAP. The nomogram, based on fever, C-reactive protein, blood urea nitrogen, albumin, and calcium, showed good performance with an AUC of 0.875, sensitivity of 0.913, specificity of 0.76 in the training cohort and an AUC of 0.97, sensitivity of 0.857, specificity of 1 in the external validation cohort. Excellent calibration as evidenced by the Hosmer-Lemeshow test (p > 0.05) and the Calibration Curve, and high clinical utility as shown by the Clinical Decision Curve.</p><p><strong>Conclusions: </strong>Our research created and validated a simple nomogram for predicting SAP in children, enabling early risk stratification and guiding effective interventions.</p>","PeriodicalId":16694,"journal":{"name":"Journal of Pediatric Gastroenterology and Nutrition","volume":" ","pages":"699-711"},"PeriodicalIF":2.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144575629","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":"Point-of-care ultrasound provides useful information in children with Crohn's disease visiting the outpatient clinic.","authors":"Elsa A van Wassenaer, Angelika Kindermann, Tim G J de Meij, Johan E van Limbergen, Geert R D'Haens, Marc A Benninga, Bart G P Koot","doi":"10.1002/jpn3.70120","DOIUrl":"10.1002/jpn3.70120","url":null,"abstract":"<p><strong>Objectives: </strong>Point-of-care ultrasound (POCUS) is increasingly used in clinical practice. However, it's additional value next to conventional markers of disease activity has not been studied in paediatric Crohn's disease (CD). This study aimed to assess the clinical added value of POCUS in children with CD.</p><p><strong>Methods: </strong>Consecutive children with CD visiting the outpatient clinic were prospectively enrolled and underwent POCUS in addition to faecal calprotectin (FC) test and mucosal inflammation noninvasive index for paediatric Crohn's disease (MINI-index) assessment. Both tests were categorised into normal, uncertain and abnormal. Paediatric gastroenterologists decided on clinical management before and after POCUS disclosure. Predictive value of POCUS for clinical flares within 4 months was assessed. Outcomes were the proportion (95% CI) of patients where POCUS result was discordant from FC and MINI-index, proportion of patients where POCUS changed clinical management, and predictive values of POCUS for clinical disease flares.</p><p><strong>Results: </strong>We included 76 patients (median age: 16 years, 34 (45%) female, median disease duration: 2 years). In 7 (9% (4%-18%)), and 2 (3% (0%-9%)) patients, the POCUS resulted in a less severe classification and in 43 (57% (45%-70%)), and 44 (58% (46%-69%)), in a more severe classification of disease severity compared to FC and MINI-index, respectively. Clinical management was adjusted in 46 (58%) cases after POCUS result disclosure. The positive and negative predictive value for clinical flares within 4 months of an abnormal POCUS were 71 (57%-82)% and 74 (64%-83)%, respectively.</p><p><strong>Conclusions: </strong>POCUS seems a valuable noninvasive monitoring tool for children with CD. Our results support the application of POCUS in the clinical management of these children.</p>","PeriodicalId":16694,"journal":{"name":"Journal of Pediatric Gastroenterology and Nutrition","volume":" ","pages":"562-569"},"PeriodicalIF":2.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12409054/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144368924","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What are we waiting for: Serious bacterial infections in children prior to liver transplant are associated with high morbidity but not expedited transplant.","authors":"Bridget A Whitehead, Swati Antala, Anna M Banc-Husu, Katie Neighbors, Justin A Godown, Matt Hall, Cary Thurm, Sarah A Taylor, Estella M Alonso","doi":"10.1002/jpn3.70130","DOIUrl":"10.1002/jpn3.70130","url":null,"abstract":"<p><strong>Objectives: </strong>Children with end-stage liver disease (ESLD) are at risk for complications including serious bacterial infections (SBI). We used the linkage of the Scientific Registry of Transplant Recipients (SRTR) and Pediatric Health Information System (PHIS) databases to examine frequency and morbidity of SBI and identify patient-specific risk factors.</p><p><strong>Methods: </strong>We identified children listed for liver transplant between 2003 and 2019 who were hospitalized before transplant. Hospitalizations were characterized by SBI status using International Classification of Diseases (ICD) codes and healthcare utilization was compared using Chi-square and t tests. Univariate and multivariate logistic regression were performed to identify patient variables associated with pre-transplant SBI.</p><p><strong>Results: </strong>A total of 1849 patients had 7601 hospitalizations and the majority (85%) were without SBI. Hospitalizations with SBI had longer length of stay (p < 0.001) and greater likelihood of needing therapies in the intensive care (p < 0.001). Almost one-third (32%) had hospitalization with SBI; in multivariate analysis, those with ascites (odds ratio [OR] 1.54 95% confidence interval [CI] 1.16-2.03) and nonprivate insurance (OR 1.40 95% CI 1.10-1.78) had higher odds of SBI. Patients with SBI had longer time on the waiting list (p = 0.023) despite being more likely to have approved exception (p = 0.006).</p><p><strong>Conclusions: </strong>Despite experiencing a life-threatening complication of ESLD, patients with SBI do not undergo more expeditious transplant. They are more likely to have approved exception requests but have longer waitlist time. The current organ allocation system does not effectively prioritize these high-risk patients. SBI risk varies by insurance status, highlighting ongoing health disparities in pediatric transplantation.</p>","PeriodicalId":16694,"journal":{"name":"Journal of Pediatric Gastroenterology and Nutrition","volume":" ","pages":"634-643"},"PeriodicalIF":2.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144506031","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 inflammatory bowel disease in patients of Middle Eastern descent seen at a large urban children's hospital.","authors":"Renee Dass, Gillian Greenberg, Ronald Thomas, Kirsten Cares","doi":"10.1002/jpn3.70127","DOIUrl":"10.1002/jpn3.70127","url":null,"abstract":"","PeriodicalId":16694,"journal":{"name":"Journal of Pediatric Gastroenterology and Nutrition","volume":" ","pages":"583-586"},"PeriodicalIF":2.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144326084","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":"Variability in the management of portal hypertension across European countries: A survey-study by ESPGHAN Portal Hypertension Special Interest Group.","authors":"Ioannis Roilidis, Oanez Ackermann, Ruth De Bruyne, Toni Illhardt, Hubert van der Doef, Emer Fitzpatrick, Fotini Sotiriadou, Marianne Hørby Jørgensen, Daniela Liccardo, Maria Mercadal-Hally, Marumbo Mtegha, Angelo Di Giorgio, Tassos Grammatikopoulos","doi":"10.1002/jpn3.70115","DOIUrl":"10.1002/jpn3.70115","url":null,"abstract":"<p><p>Portal hypertension (PHT) remains a significant burden in children with chronic liver disease (CLD) or portal vein thrombosis (PVT). Management strategies vary depending on the underlying cause and clinical presentation. There is a lack of consensus on various aspects of PHT, including the optimal approach to screening, prophylactic endoscopy and treatment, and pharmacological interventions. This brief communication summarizes the results of a recent questionnaire-based study conducted by the European Society for Paediatric Gastroenterology, Hepatology, and Nutrition Portal Hypertension Special Interest Group to explore current practices in the management of PHT among its members. Screening for the presence of varices and the approach to primary and secondary prophylaxis differ across Europe. The survey also demasked a high variability of both pharmacological and surgical management of PHT and highlights knowledge gaps and areas for future research.</p>","PeriodicalId":16694,"journal":{"name":"Journal of Pediatric Gastroenterology and Nutrition","volume":" ","pages":"674-678"},"PeriodicalIF":2.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144275166","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":"Coming of age of pediatric endoscopy: We have come a long way.","authors":"Deborah A Goldman","doi":"10.1002/jpn3.70134","DOIUrl":"10.1002/jpn3.70134","url":null,"abstract":"","PeriodicalId":16694,"journal":{"name":"Journal of Pediatric Gastroenterology and Nutrition","volume":" ","pages":"483-484"},"PeriodicalIF":2.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12408945/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144540612","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Metallic plate in tobacco filters: A new pediatric challenge.","authors":"Annalisa Di Carmine, Marco Di Mitri, Cristian Bisanti, Edoardo Collautti, Simone D'Antonio, Michele Libri, Tommaso Gargano, Mario Lima","doi":"10.1002/jpn3.70132","DOIUrl":"10.1002/jpn3.70132","url":null,"abstract":"","PeriodicalId":16694,"journal":{"name":"Journal of Pediatric Gastroenterology and Nutrition","volume":" ","pages":"748-752"},"PeriodicalIF":2.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12408944/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144540615","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management of paediatric ulcerative colitis, part 1: Ambulatory care-An updated evidence-based consensus guideline from the European Society of Paediatric Gastroenterology, Hepatology and Nutrition and the European Crohn's and Colitis Organisation.","authors":"Eytan Wine, Marina Aloi, Stephanie Van Biervliet, Jiri Bronsky, Javier Martín di Carpi, Marco Gasparetto, Laura Gianolio, Hannah Gordon, Iva Hojsak, Alexandra S Hudson, Séamus Hussey, Johan van Limbergen, Erasmo Miele, Lorenzo Norsa, Ola Olén, Gianluca Pellino, Patrick van Rheenen, Lissy de Ridder, Richard K Russell, Dror S Shouval, Eunice Trindade, Dan Turner, David C Wilson, Anat Yerushalmy Feler, Amit Assa","doi":"10.1002/jpn3.70097","DOIUrl":"10.1002/jpn3.70097","url":null,"abstract":"<p><strong>Objectives: </strong>Despite advances in the management of ambulatory paediatric ulcerative colitis (UC), challenges remain as many patients are refractory to therapy and some require colectomy. The aim of these guidelines is to provide an update on optimal care for UC through detailed recommendations and practice points.</p><p><strong>Methods: </strong>These guidelines are an update to those published in 2018 and are a joint effort of the Paediatric IBD Porto group of European Society of Paediatric Gastroenterology, Hepatology and Nutrition and the European Crohn's and Colitis Organisation. An extensive literature search with subsequent evidence appraisal using the Oxford methodology was performed, followed by three online voting sessions and a consensus face-to-face meeting. Thirty-nine recommendations and 77 practice points were endorsed by the 25 experts with at least an 84% consensus rate.</p><p><strong>Results: </strong>Robust evidence-based recommendations and detailed practice points are provided. In addition to reemphasising and updating the role of more 'traditional' UC therapies, these guidelines outline optimising the use of antitumour necrosis factor therapies and integrating newer biologics and small molecules, as well as supportive therapy, to improve outcomes and provide an updated management algorithm. Measurement and monitoring tools and decision aids are provided, and additional aspects, including nutritional support, extraintestinal manifestations, pouchitis, inflammatory bowel disease-unclassified and patient support, are discussed. Some aspects, including surgery and thromboprophylaxis, are covered in the acute severe UC guidelines.</p><p><strong>Conclusions: </strong>These guidelines serve as an aid in managing children with UC through a combination of evidence-based recommendations and more practical practice points in the ambulatory setting.</p>","PeriodicalId":16694,"journal":{"name":"Journal of Pediatric Gastroenterology and Nutrition","volume":" ","pages":"765-815"},"PeriodicalIF":2.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12408984/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144659490","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The prevalence of iron deficiency in pediatric esophageal atresia.","authors":"Kelly Kiremidjian, Steven J Staffa, Denis Chang, Michael Manfredi, Jessica L Yasuda","doi":"10.1002/jpn3.70145","DOIUrl":"10.1002/jpn3.70145","url":null,"abstract":"","PeriodicalId":16694,"journal":{"name":"Journal of Pediatric Gastroenterology and Nutrition","volume":" ","pages":"731-735"},"PeriodicalIF":2.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144600830","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}