Journal of Pediatric Gastroenterology & Nutrition最新文献

{"title":"How Much Protein for Preterm Infants?","authors":"C. Tomlinson","doi":"10.1097/MPG.0000000000002526","DOIUrl":"https://doi.org/10.1097/MPG.0000000000002526","url":null,"abstract":"From the Division of Neonatology, Hospital for Sick Children, and the Departments of Paediatrics and Nutritional Sciences, University of Toronto, Ontario, Canada. Address correspondence and reprint requests to Dr Christopher Tomlinson, Division of Neonatology, Hospital for Sick Children, Toronto and Departments of Paediatrics and Nutritional Sciences, University of Toronto, 555 University Avenue, Toronto, ON, Canada M5G1X8 (e-mail: christopher.tomlinson@sickkids.ca). The authors report no conflicts of interest. Copyright # 2019 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition DOI: 10.1097/MPG.0000000000002526 Invited Commentaries","PeriodicalId":16725,"journal":{"name":"Journal of Pediatric Gastroenterology & Nutrition","volume":"30 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78500192","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring Use of Endoscopy Simulation In North American Pediatric Gastroenterology Fellowship Training Programs.","authors":"Aayush Gabrani, I. Monteiro, C. Walsh","doi":"10.1097/MPG.0000000000002525","DOIUrl":"https://doi.org/10.1097/MPG.0000000000002525","url":null,"abstract":"OBJECTIVES Increasing evidence supports simulation-based training; however, limited data exists regarding its use in pediatric gastroenterology (GI). We explored the use of simulation-based endoscopy training in pediatric GI fellowship programs across North America. METHODS GI fellowship program directors (PDs) from the United States (US) and Canada were surveyed between Aug-Nov 2018. The pre-tested, electronic survey comprised 3 sections: program demographics; details of current simulation-based training; and PDs' perceptions of endoscopy simulation. Responses were analyzed using descriptive statistics. RESULTS Forty-three of 71 (61%) PDs responded (6 Canadian, 37 US). Programs were predominantly academic (95%) and enrolled 1.87 ± 1.01 fellows/year. Twenty-four programs (56%) reported using simulation for endoscopy training, while 8 (19%) used simulation for non-procedural education. Only 2 programs (5%) used endoscopy simulation for assessment. Of those using simulation (n = 24), upper endoscopy and colonoscopy were trained most frequently, and mechanical simulators were used most commonly. Eight programs (33%) required simulation training prior to clinical performance. While 10 programs (42%) provided protected training time, only 2 (8%) tracked hours. Three programs (12.5%) reported having an organized curriculum and 6 (25%) train their endoscopic trainers. Cost, time constraints and lack of a standardized curriculum were perceived as key barriers to integration. Most PDs reported a need for endoscopy simulation to train both technical and non-technical skills; however, they felt simulation cannot replace clinical experience. CONCLUSION PDs recognize the potential importance of endoscopy simulation, particularly for novices; however, only 56% report using it. Perceived barriers indicate the need for inexpensive portable simulators and a validated pediatric simulation curriculum to promote uptake.","PeriodicalId":16725,"journal":{"name":"Journal of Pediatric Gastroenterology & Nutrition","volume":"108 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76275791","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessing the Validity of Adult-Derived Prognostic Models for Primary Sclerosing Cholangitis Outcomes in Children.","authors":"M. Deneau, P. Valentino, C. Mack, Khaled Alqoaer, M. Amin, A. Amir, M. Aumar, M. Auth, A. Broderick, Matthew DiGuglielmo, L. Draijer, W. El-Matary, F. Ferrari, K. Furuya, F. Gottrand, N. Gupta, M. Homan, M. K. Jensen, B. Kamath, Kyung Mo Kim, K. Kolho, B. Koot, R. Iorio, Mercedes Martinez, T. Miloh, P. Mohan, S. Palle, Alexandra Papadopoulou, A. Ricciuto, L. Saubermann, P. Sathya, E. Shteyer, V. Smolka, A. Tanaka, R. Varier, Veena L. Venkat, B. Vitola, M. Woynarowski, S. Guthery","doi":"10.1097/MPG.0000000000002522","DOIUrl":"https://doi.org/10.1097/MPG.0000000000002522","url":null,"abstract":"BACKGROUND Natural history models for primary sclerosing cholangitis (PSC) are derived from adult patient data, but have never been validated in children. It is unclear how accurate such models are for children with PSC. METHODS We utilized the pediatric PSC consortium database to assess the Revised Mayo Clinic, Amsterdam-Oxford and Boberg models. We calculated the risk stratum and predicted survival for each patient within each model using patient data at PSC diagnosis, and compared it to observed survival. We evaluated model fit using the c-statistic. RESULTS Model fit was good at one year (c-statistics 0.93, 0.87, 0.82) and fair at ten years (0.78, 0.75, 0.69) in the Mayo, Boberg and Amsterdam-Oxford models, respectively. The Mayo model correctly classified most children as low risk, whereas the Amsterdam-Oxford model incorrectly classified most as high risk. All of the models underestimated survival of patients classified as high risk. Albumin, bilirubin, AST and platelets were most associated with outcomes. Autoimmune hepatitis was more prevalent in higher risk groups, and over-weighting of AST in these patients accounted for the observed vs. predicted survival discrepancy. CONCLUSION All three models offered good short-term discrimination of outcomes but only fair long-term discrimination. None of the models account for the high prevalence of features of autoimmune hepatitis overlap in children and the associated elevated aminotransferases. A pediatric-specific model is needed. AST, bilirubin, albumin and platelets will be important predictors, but must be weighted to account for the unique features of PSC in children.","PeriodicalId":16725,"journal":{"name":"Journal of Pediatric Gastroenterology & Nutrition","volume":"43 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85087309","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Novel CFC1 Mutation in a Family with Heterotaxy and Biliary Atresia Splenic Malformation Syndromes.","authors":"E. Gonzales, A. Davit-Spraul, E. Jacquemin","doi":"10.1097/MPG.0000000000002531","DOIUrl":"https://doi.org/10.1097/MPG.0000000000002531","url":null,"abstract":"","PeriodicalId":16725,"journal":{"name":"Journal of Pediatric Gastroenterology & Nutrition","volume":"8 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72883722","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trend of Anti-Tissue Transglutaminase Antibody Normalization in Children with Celiac Disease Started on Gluten Free Diet: A Comparative Study between Chemiluminescence and ELISA Serum Assays.","authors":"N. Sansotta, M. Alessio, L. Norsa, G. Previtali, A. Ferrari, G. Guerra, L. D’Antiga","doi":"10.1097/MPG.0000000000002519","DOIUrl":"https://doi.org/10.1097/MPG.0000000000002519","url":null,"abstract":"BACKGROUND The aim of this study is to compare the performance of anti-tissue Transglutaminase (atTG) Chemiluminescence Immuno-Assay (CLIA) versus the standard ELISA methods in monitoring celiac children after the start of gluten free diet (GFD). METHODS Celiac children diagnosed between 2005 and 2016 at our centre were classified into 2 groups based on serum assay (ELISA versus CLIA) used for atTG monitoring, and were compared on percentage of decrease and time to normalisation of atTG on GFD. RESULTS Among 260 included children, the rate of normalisation of atTG levels at 30 months' follow-up was 86% and 70% in ELISA and CLIA group respectively (p < 0.01). Median time to normalisation was 11.7 and 14.7 months in ELISA and CLIA group respectively (p = 0.003). Marsh score at diagnosis was not associated with time to atTG normalisation (p = 0.770), while older age at diagnosis and higher baseline atTG predicted longer time to atTG normalisation (p = 0.01, p < 0.01). CONCLUSION The percentage and the time of the atTG normalisation in celiac children on GFD should be interpreted according to the utilised assay: at 30 months' follow up children tested by CLIA are less likely to normalize atTG levels compared to those tested by ELISA. Younger age at diagnosis and lower baseline atTG are predictors of earlier atTG normalisation, regardless of the adopted assay.","PeriodicalId":16725,"journal":{"name":"Journal of Pediatric Gastroenterology & Nutrition","volume":"88 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91505604","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial Intelligence Applied to Gastrointestinal Diagnostics: A Review.","authors":"Vatsal Patel, Marium N. Khan, A. Shrivastava, K. Sadiq, S. A. Ali, S. Moore, Donald E. Brown, S. Syed","doi":"10.1097/MPG.0000000000002507","DOIUrl":"https://doi.org/10.1097/MPG.0000000000002507","url":null,"abstract":"Artificial intelligence (AI), a discipline encompassed by data science, has seen recent rapid growth in its application to healthcare and beyond, and is now an integral part of daily life. Uses of AI in gastroenterology include the automated detection of disease and differentiation of pathology subtypes and disease severity. While a majority of AI research in gastroenterology focuses on adult applications, there are a number of pediatric pathologies that could benefit from more research. As new and improved diagnostic tools become available and more information is retrieved from them, AI could provide physicians a method to distill enormous amounts of data into enhanced decision making and cost saving for children with digestive disorders. This review provides a broad overview of AI and examples of its possible applications in pediatric gastroenterology.","PeriodicalId":16725,"journal":{"name":"Journal of Pediatric Gastroenterology & Nutrition","volume":"95 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80218473","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neonatal Intestinal Failure is Independently Associated With Impaired Cognitive Development Later in Childhood.","authors":"R. Gunnar, Kaisa Kanerva, S. Salmi, T. Häyrinen, L. Haataja, M. Pakarinen, L. Merras-Salmio","doi":"10.1097/MPG.0000000000002529","DOIUrl":"https://doi.org/10.1097/MPG.0000000000002529","url":null,"abstract":"OBJECTIVE The impact of pediatric intestinal failure (IF) on neurodevelopment beyond infancy has not been systematically studied. Our aim was to evaluate cognitive and motor impairment and to identify risk factors for adverse outcomes among children with IF. METHODS We conducted a cross-sectional single-center study at the Helsinki University Children's Hospital. IF patients with > 60 days of parental nutrition (PN) dependency aged between three and sixteen years (n = 40) were invited to participate. The cognitive and motor skills were evaluated using validated tests: Wechsler Preschool and Primary Scale of Intelligence, 3 edition, Wechsler Intelligence Scale for Children, 4 edition, and Movement Assessment Battery for Children, 2 edition. RESULTS All the patients attending the study tests (n = 30, males = 24) were included. Their median age, gestational age and birth weight was 7.5 (range 3 to 16) years, 35 (IQR 28-38) weeks and 2,238 (IQR 1,040-3,288) grams, respectively. Median duration of PN was 13 (IQR 5-37) months and 9 patients were currently on PN. Median Intelligence quotient (IQ) was 78 (IQR 65-91) and ten (35%) patients had an IQ under 70 (-2 SD). Significant motor impairment was detected in 10 patients (36%) and milder difficulties in 8 (28%). Adverse cognitive outcome was associated with neonatal short bowel syndrome, number of interventions under general anesthesia, and length of inpatient status, while adverse motor outcome was associated with prematurity. CONCLUSION Clinically significant cognitive and motor impairments are alarmingly common among neonatal IF patients. We recommend early neurodevelopmental follow-up for all children with IF.","PeriodicalId":16725,"journal":{"name":"Journal of Pediatric Gastroenterology & Nutrition","volume":"17 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82067362","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy of Single Versus Split Dose Polyethylene Glycol for Colonic Preparation in Children: A Randomized Control Study.","authors":"Parijat R. Tripathi, U. Poddar, S. Yachha, M. Sarma, A. Srivastava","doi":"10.1097/MPG.0000000000002511","DOIUrl":"https://doi.org/10.1097/MPG.0000000000002511","url":null,"abstract":"OBJECTIVES Polyethylene glycol (PEG) is the most effective colon cleansing agent but volume related adverse effects are common. Though split-dose PEG is used in adults, no pediatric study so-far has compared split-dose with single-dose PEG. We aimed at comparing the efficacy and tolerability of split-dose versus single-dose PEG for bowel preparation in children. METHODS Consecutive children (1-18 years) were randomized into either single-dose or split-dose PEG. Single-dose group received 4000 mL/1.73mPEG solution day before colonoscopy while split-dose group received half dose day before and the remaining half on the day of colonoscopy. Effectiveness of bowel preparation was assessed on Aronchik scale, by the endoscopist who was blinded to the type of preparation. Inter-observer variability was analyzed by comparing with independent scoring by the blinded trained endoscopy-nurse. The trial was registered with Clinical Trials Registry of India. (Trail number2017/08/009303) RESULTS:: Of the 220 randomized children, 179 completed the study (split-dose: 93, single-dose: 86) The mean age of the study population was 11.51 (4.82) years (72.6%males). The efficacy of bowel preparation was better with split-dose (satisfactory preparation:76.34% vs. 43.02%, p < 0.001) with almost perfect inter-observer agreement (k = 0.803). Nausea, vomiting and sleep disturbance were significantly less in split-dose than single-dose group (p < 0.05). Split-dose patients were able to drink PEG solution faster (p = 0.002). Total sleep duration and uninterrupted sleep duration was also better in split-dose group as compared to single-dose (p = 0.001). CONCLUSIONS Split-dose PEG is more effective than single-dose regimen for bowel preparation with better tolerability and improved sleep quality in pediatric population.","PeriodicalId":16725,"journal":{"name":"Journal of Pediatric Gastroenterology & Nutrition","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85322791","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"IV Ibuprofen for Prevention of Post-Ercp Pancreatitis in Children: A Randomized Placebo-Controlled Feasibility Study.","authors":"David M. Troendle, Bhaskar Gurram, Rong Huang, B. Barth","doi":"10.1097/MPG.0000000000002524","DOIUrl":"https://doi.org/10.1097/MPG.0000000000002524","url":null,"abstract":"BACKGROUND Post-ERCP pancreatitis (PEP) is reported to occur in up to 11% of pediatric patients. To date, no study has prospectively evaluated an intervention to prevent PEP in children. It is unclear if such a study is even feasible. OBJECTIVE To evaluate the feasibility of studying IV Ibuprofen for PEP prevention in the pediatric population. METHODS This was a prospective randomized double-blind placebo-controlled feasibility study. Patients < 19 years of age undergoing ERCP were randomized to receive 10 mg/kg IV Ibuprofen (max of 800 mg) or placebo (saline) at the time of ERCP. The primary outcome was PEP. Secondary outcomes included post-ERCP related bleeding, rates of other procedural and medication related adverse events. RESULTS 58 patients were randomized and received either IV Ibuprofen or placebo. Pre-procedure and procedure related factors were not significantly different between the groups except that patients in the placebo group tended to weigh less (48.7 kg vs 63.7 kg, p = 0.03). There were 7 episodes of PEP (12%). PEP was less frequently identified in the Ibuprofen group than the control group (7% vs. 17%), but this was not statistically significant (p = 0.42). Mean post-procedural abdominal pain scores were significantly lower in the IV Ibuprofen group than the control group (1.1 vs 3.1, p = 0.01) and the number of patients who had increased abdominal pain after the procedure was significantly lower in Ibuprofen group than the control group (3% vs. 38%, p = 0.002). There were no significant differences in procedure related or drug related adverse events. CONCLUSIONS Post-procedural pain scores and the number of patients who had increased abdominal pain after the procedure were significantly lower in the IV Ibuprofen group. The current study provides encouraging, but only very weak evidence that IV ibuprofen decreases PEP in children. Power analysis suggests that a small handful of high-volume pediatric centers would be able to perform an adequate clinical trial in a reasonable time frame. Focusing on all cause post-procedural pain (PEP and non-PEP) may allow for a more efficiency study design and be just as clinically relevant.","PeriodicalId":16725,"journal":{"name":"Journal of Pediatric Gastroenterology & Nutrition","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76183661","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improving Post-Induction Anti-Tumor Necrosis Factor Therapeutic Drug Monitoring in Pediatric Inflammatory Bowel Disease.","authors":"A. Guido, W. Crandall, E. Homan, Jennifer L. Dotson, R. Maltz, Amy Donegan, Barbara Drobnic, M. Oates, B. Boyle","doi":"10.1097/MPG.0000000000002486","DOIUrl":"https://doi.org/10.1097/MPG.0000000000002486","url":null,"abstract":"OBJECTIVES Adequate serum drug levels of tumor necrosis factor-alpha inhibitors (anti-TNF) have been shown to improve outcomes in patients with inflammatory bowel disease (IBD). We aim to describe the quality improvement (QI) methods used at our institution to improve post-induction therapeutic drug monitoring (TDM) in children initiating anti-TNF therapy (infliximab and adalimumab) and describe the frequency of subtherapeutic anti-TNF levels. METHODS Beginning in February 2016, all patients initiating anti-TNF therapy were identified and tracked. Interventions to improve TDM, including the initiation of therapy plans for infliximab, real-time reminders for practitioners, and scheduling modifications for those initiating anti-TNF therapies were implemented using the Institute for Healthcare Improvement (IHI) Plan-Do-Study-Act (PDSA) cycle approach. Statistical process control charts were used to demonstrate improvement over time. Anti-TNF levels and presence of anti-drug antibodies were also recorded. RESULTS Using QI methodology, we improved post-induction anti-TNF TDM from a baseline of 43% in 2015 to > 80% by the end of 2017, with sustained improvement. Infliximab post-induction TDM improved from a baseline of 59% to 82% while adalimumab post-induction TDM improved from baseline of 14% to 79%. In total, 36% of all anti-TNF post-induction levels were less than 5 μg/mL, with nearly 60% of post-induction infliximab levels being less than 5 μg/mL. CONCLUSIONS Through incremental QI approaches, we improved the utilization of anti-TNF post-induction TDM with sustained improvement, approaching our goal of 90%. Subtherapeutic post-induction infliximab levels were common, indicating a strong need for anti-TNF TDM and an opportunity for dose optimization.","PeriodicalId":16725,"journal":{"name":"Journal of Pediatric Gastroenterology & Nutrition","volume":"25 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73964580","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}