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Steurbaut L, Levy EI, De Geyter C, Buyse S, Vandenplas Y. A narrative review on the diagnosis and management of constipation in infants. Expert Rev Gastroenterol Hepatol 2023; 17:769-783. [PMID: 37501219 DOI: 10.1080/17474124.2023.2242255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 07/25/2023] [Indexed: 07/29/2023]
Abstract
INTRODUCTION Functional constipation is one of the common disorders of gut-brain interaction in infancy, and decreases the quality of life of infants and parents. AREAS COVERED Relevant articles up to November 2022 were reviewed. We searched in PubMed, Google Scholar, and MEDLINE for guidelines, position papers, reviews, and randomized controlled trials on infant constipation. EXPERT OPINION Randomized controlled trials in this specific age group are mostly limited to trials with infant formula. The prevalence of infant constipation in formula-fed infants is decreasing, and can be associated with adaptations in formula composition. While the supplementation of infant formula with pro-, pre- and/or synbiotics decreases the prevalence of constipation, their efficacy in constipated infants is disappointing. There is limited evidence to support the addition of magnesium to infant formula to treat constipation. The evidence for the efficacy and safety of polyethylene glycol in children < 2 years has expanded over the past years. The administration of lactulose or polyethylene glycol is the preferred medical management, in case nutritional management does result in insufficient improvement.
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Affiliation(s)
- Laurine Steurbaut
- Vrije Universiteit Brussel (VUB), UZ Brussel, KidZ Health Castle, Brussels, Belgium
| | - Elvira Ingrid Levy
- Vrije Universiteit Brussel (VUB), UZ Brussel, KidZ Health Castle, Brussels, Belgium
- Department of Pediatrics, C.H.U. Saint-Pieter, Free University of Brussels, Brussels, Belgium
| | - Charlotte De Geyter
- Vrije Universiteit Brussel (VUB), UZ Brussel, KidZ Health Castle, Brussels, Belgium
| | | | - Yvan Vandenplas
- Vrije Universiteit Brussel (VUB), UZ Brussel, KidZ Health Castle, Brussels, Belgium
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Mascarel P, Dierick A, Elbok M. [About an unusual case of lipoid pneumonia]. REVUE DE PNEUMOLOGIE CLINIQUE 2016; 72:296-299. [PMID: 27561978 DOI: 10.1016/j.pneumo.2016.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2016] [Revised: 06/04/2016] [Accepted: 06/09/2016] [Indexed: 06/06/2023]
Abstract
Lipoid pneumonia, although uncommon, should be considered when patients had a chronic pneumonia. We report a case of a 40-year-old female who presented with a chronic pneumonia. The CT-scan analysis, then the bronchoalveolar lavage, revealed a lipoid pneumonia. This lipoid pneumonia was caused by chronic inhalation of niaoulis vapors. This etiology has not been described in the literature. Alveolar condensation disappeared one month after bronchoalveolar lavage. This suggests that bronchoalveolar lavage may contribute to opacity regression besides exogenous lipid eviction.
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Affiliation(s)
- P Mascarel
- Service de radiologie clinique Ste-Clotilde, 127, route du Bois-de-Nèfles, 97400 Ste-Clotilde, Réunion.
| | - A Dierick
- Résidence Rodrigues, 7, rue Henri-Cornu-Technopole, 97400 Ste-Clotilde, Réunion
| | - M Elbok
- Clinique Ste-Clotilde, 127, route du Bois-de-Nèfles, 97400 Ste-Clotilde, Réunion
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de Oliveira GA, Pessanha LB, Guerra LFA, Martins DLN, Rondina RG, Silva JRP. Aspiration pneumonia in children: an iconographic essay. Radiol Bras 2016; 48:391-5. [PMID: 26811557 PMCID: PMC4725401 DOI: 10.1590/0100-3984.2014.0007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
In most cases of aspiration pneumonia in children, the disease is specific to
this age group. Clinical and radiological correlation is essential for the
diagnosis. The present pictorial essay is aimed at showing typical images of the
most common etiologies.
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Affiliation(s)
| | - Laís Bastos Pessanha
- MDs, Residents of Radiology at Universidade Federal do Espírito Santo (UFES), Vitória, ES, Brazil
| | - Luiz Felipe Alves Guerra
- MDs, Residents of Radiology at Universidade Federal do Espírito Santo (UFES), Vitória, ES, Brazil
| | - Diego Lima Nava Martins
- MDs, Residents of Radiology at Universidade Federal do Espírito Santo (UFES), Vitória, ES, Brazil
| | - Ronaldo Garcia Rondina
- MDs, Residents of Radiology at Universidade Federal do Espírito Santo (UFES), Vitória, ES, Brazil
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A review of enteral strategies in infant short bowel syndrome: evidence-based or NICU culture? J Pediatr Surg 2013; 48:1099-112. [PMID: 23701789 DOI: 10.1016/j.jpedsurg.2013.01.023] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2012] [Revised: 01/01/2013] [Accepted: 01/09/2013] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Short bowel syndrome (SBS) is an increasingly common condition encountered across neonatal intensive care units. Improvements in parenteral nutrition (PN), neonatal intensive care and surgical techniques, in addition to an improved understanding of SBS pathophysiology, have contributed in equal parts to the survival of this fragile subset of infants. Prevention of intestinal failure associated liver disease (IFALD) and promotion of intestinal adaptation are primary goals of all involved in the care of these patients. While enteral nutritional and pharmacological strategies are necessary to achieve these goals, there remains great variability in the application of therapeutic strategies in units that are not necessarily evidence-based. MATERIALS AND METHODS A search of major English language medical databases (SCOPUS, Index Medicus, Medline, and the Cochrane database) was conducted for the key words short bowel syndrome, medical management, nutritional management and intestinal adaptation. All pharmacological and nutritional agents encountered in the literature search were classified based on their effects on absorptive capacity, intestinal adaptation and bowel motility that are the three major strategies employed in the management of SBS. The Oxford Center for Evidence-Based Medicine (CEBM) classification for levels of evidence was used to develop grades of clinical recommendation for each variable studied. RESULTS We reviewed various medications used and nutritional strategies included soluble fiber, enteral fat, glutamine, probiotics and sodium supplementation. Most interventions have scientific rationale but little evidence to support their role in the management of infant SBS. While some of these agents symptomatically improve diarrhea, they can adversely influence pancreatico-biliary function or actually impair intestinal adaptation. Surgical anatomy and liver function are two important variables that should determine the selection of pharmacological and nutritional interventions. DISCUSSION There is a paucity of research investigating optimal clinical practice in infant SBS and the little evidence available is consistently of lower quality, resulting in a wide variation of clinical practices among NICUs. Prospective trials should be encouraged to bridge the evidence gap between research and clinical practice to promote further progress in the field.
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Badireddi S, Mohammad SF, Hodgess A, Joshi M. An Unusual Presentation of Endogenous Lipoid Pneumonia: A Case Report. Chest 2010. [DOI: 10.1378/chest.10652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Evaluation and treatment of constipation in infants and children: recommendations of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition. J Pediatr Gastroenterol Nutr 2006; 43:e1-13. [PMID: 16954945 DOI: 10.1097/01.mpg.0000233159.97667.c3] [Citation(s) in RCA: 158] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
Constipation, defined as a delay or difficulty in defecation, present for 2 or more weeks, is a common pediatric problem encountered by both primary and specialty medical providers. The Constipation Guideline Committee of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN) has formulated a clinical practice guideline for the management of pediatric constipation. The Constipation Guideline Committee, consisting of two primary care pediatricians, a clinical epidemiologist, and pediatric gastroenterologists, based its recommendations on an integration of a comprehensive and systematic review of the medical literature combined with expert opinion. Consensus was achieved through Nominal Group Technique, a structured quantitative method. The Committee developed two algorithms to assist with medical management, one for older infants and children and the second for infants less than 1 year of age. The guideline provides recommendations for management by the primary care provider, including evaluation, initial treatment, follow-up management, and indications for consultation by a specialist. The Constipation Guideline Committee also provided recommendations for management by the pediatric gastroenterologist.
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Raya AI, Fernández-de Marco M, Núñez A, Afonso JC, Cortade LE, Carrasco L. Endogenous Lipid Pneumonia in a Dog. J Comp Pathol 2006; 135:153-155. [PMID: 16997006 DOI: 10.1016/j.jcpa.2006.06.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2005] [Accepted: 06/10/2006] [Indexed: 10/24/2022]
Abstract
Endogenous lipid pneumonia has previously been diagnosed in dogs only once. This report describes a case in a dog with a persistent cough, in which the histological diagnosis was based on the presence of numerous foamy macrophages that filled the alveoli and contained small sudanophilic vacuoles. The appearance of endogenous lipid pneumonia in this animal was accompanied by Dirofilaria immitis infection and chronic bronchitis.
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Affiliation(s)
- A I Raya
- Departamento de Anatomía y Anatomía Patológica Comparadas, Edificio Sanidad Animal, Campus Universitario Rabanales, Universidad de Córdoba, 14014 Córdoba
| | - M Fernández-de Marco
- Departamento de Anatomía y Anatomía Patológica Comparadas, Edificio Sanidad Animal, Campus Universitario Rabanales, Universidad de Córdoba, 14014 Córdoba
| | - A Núñez
- Departamento de Anatomía y Anatomía Patológica Comparadas, Edificio Sanidad Animal, Campus Universitario Rabanales, Universidad de Córdoba, 14014 Córdoba
| | - J C Afonso
- Clínica Veterinaria La Fuensanta. Avda de la Fuensanta 35, 14010 Córdoba, Spain
| | - L E Cortade
- Clínica Veterinaria La Fuensanta. Avda de la Fuensanta 35, 14010 Córdoba, Spain
| | - L Carrasco
- Departamento de Anatomía y Anatomía Patológica Comparadas, Edificio Sanidad Animal, Campus Universitario Rabanales, Universidad de Córdoba, 14014 Córdoba.
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Gastro�sophagealer Reflux und Atemwegserkrankungen. Monatsschr Kinderheilkd 2005. [DOI: 10.1007/s00112-005-1092-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Sharif F, Crushell E, O'Driscoll K, Bourke B. Liquid paraffin: a reappraisal of its role in the treatment of constipation. Arch Dis Child 2001; 85:121-4. [PMID: 11466186 PMCID: PMC1718886 DOI: 10.1136/adc.85.2.121] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- F Sharif
- Children's Research Centre, Our Lady's Hospital for Sick Children, and Department of Paediatrics, The Conway Institute for Biomedical and Biomolecular Research, University College Dublin, Ireland
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van Westerloo DJ, Rotteveel J, Kneepkens F. Breakage of a nasoenteral feeding tube in a 5-year-old child. Gastrointest Endosc 2000; 52:806-7. [PMID: 11115930 DOI: 10.1067/mge.2000.110738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- D J van Westerloo
- Department of Pediatrics, Academic Hospital Vrije Universteit, Amsterdam, The Netherlands
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Baker SS, Liptak GS, Colletti RB, Croffie JM, Di Lorenzo C, Ector W, Nurko S. Constipation in infants and children: evaluation and treatment. A medical position statement of the North American Society for Pediatric Gastroenterology and Nutrition. J Pediatr Gastroenterol Nutr 1999; 29:612-26. [PMID: 10554136 DOI: 10.1097/00005176-199911000-00029] [Citation(s) in RCA: 220] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND Constipation, defined as a delay or difficulty in defecation, present for 2 or more weeks, is a common pediatric problem encountered by both primary and specialty medical providers. METHODS The Constipation Subcommittee of the Clinical Guidelines Committee of the North American Society for Pediatric Gastroenterology and Nutrition has formulated clinical practice guidelines for the management of pediatric constipation. The Constipation Subcommittee, consisting of two primary care pediatricians, a clinical epidemiologist, and pediatric gastroenterologists, based its recommendations on an integration of a comprehensive and systematic review of the medical literature combined with expert opinion. Consensus was achieved through Nominal Group Technique, a structured quantitative method. RESULTS The Subcommittee developed two algorithms to assist with medical management, one for older infants and children and the second for infants less than 1 year of age. The guidelines provide recommendations for management by the primary care provider, including evaluation, initial treatment, follow-up management, and indications for consultation by a specialist. The Constipation Subcommittee also provided recommendations for management by the pediatric gastroenterologist. CONCLUSIONS This report, which has been endorsed by the Executive Council of the North American Society for Pediatric Gastroenterology and Nutrition, has been prepared as a general guideline to assist providers of medical care in the evaluation and treatment of constipation in children. It is not intended as a substitute for clinical judgment or as a protocol for the management of all patients with this problem.
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Affiliation(s)
- S S Baker
- Department of Pediatrics, Medical University of South Carolina, Charleston, USA
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Kajetanowicz A, Stinson D, Laybolt KS, Resch L. Lipid-laden macrophages in the tracheal aspirate of ventilated neonates receiving Intralipid: A pilot study. Pediatr Pulmonol 1999; 28:101-8. [PMID: 10423309 DOI: 10.1002/(sici)1099-0496(199908)28:2<101::aid-ppul5>3.0.co;2-g] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Lipid-laden macrophages (LLM) in tracheal aspirates are reported to be pathognomonic findings in exo- and endogenous lipoid pneumonia in adults. A pilot study was carried out to evaluate the effect of lipid infusion on the LLM index of the tracheal aspirates from ventilated neonates. All intubated infants were eligible for the study. Infants receiving parenteral nutrition had intravenous (IV) lipid introduced by 4-7 days of age; most samples after 7 days were from infants receiving IV lipid. Four infants received minimal gastric feeding; none had evidence of aspiration pneumonia. Tracheal aspirates from 28 infants were analyzed for the LLM index. Alveolar macrophages were graded 0-4 in direct relation to the amount of lipid per cell. One hundred macrophages were graded; the maximum possible LLM index was 400. Two hundred forty-five of 387 tracheal aspirate samples were acceptable for analysis. LLM indices increased during the first week after birth; the mean LLM index then continued in the same range, but with a wide distribution of individual values. The mean LLM index from infants receiving an IV lipid infusion during days 4-7 was 87.9 (SD = 44.8), and was significantly higher compared to 58.7 (SD = 40.8) in infants receiving no IV lipid (P < 0. 003). Tracheal aspirates from infants with and without IV lipid infusion yielded many LLM index values >100. These observations invalidate the use of the LLM index >100 as proof of aspiration pneumonia in this group of infants.
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Affiliation(s)
- A Kajetanowicz
- Department of Neonatal Pediatrics, I.W.K. Grace Health Centre, Dalhousie University, Halifax, Nova Scotia, Canada.
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Corcoran BM, Martin M, Darke PGG, Anderson A, Head KW, Clutton RE, Else RW, Fuentes VL. Lipoid pneumonia in a rough collie dog. J Small Anim Pract 1992. [DOI: 10.1111/j.1748-5827.1992.tb01050.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Kurlandsky LE, Vaandrager V, Davy CL, Stockinger FS. Lipoid pneumonia in association with gastroesophageal reflux. Pediatr Pulmonol 1992; 13:184-8. [PMID: 1437335 DOI: 10.1002/ppul.1950130312] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- L E Kurlandsky
- Department of Pediatrics, Butterworth Hospital, Michigan State University College of Human Medicine, Grand Rapids 49503
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Hugosson CO, Riff EJ, Moore CC, Akhtar M, Tufenkeji HT. Lipoid pneumonia in infants: a radiological-pathological study. Pediatr Radiol 1991; 21:193-7. [PMID: 2047157 DOI: 10.1007/bf02011045] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
A series of nine infants, 2-8 months of age, with a history of animal or vegetable fat intake within 10 days after birth, is presented. The infants developed respiratory problems and failure to thrive. Plain films and computed tomography showed areas of consolidation in the medial-posterior parts of the lungs. The areas of consolidation showed three types of changes at computed tomography. Attenuation measurements did not reveal fat. To establish the diagnosis, fine needle aspiration biopsy, tru-cut biopsy and/or open lung biopsy was done in eight infants and bronchopulmonary lavage in one patient. The pathological findings were an intense lymphocytic infiltration with scattered granulomas which contained lipid deposit.
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Affiliation(s)
- C O Hugosson
- Department of Radiology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
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