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Freeman AJ, Huang R, Heltshe SL, Gelfond D, Leung DH, Ramsey BR, Borowitz D, Sathe M. Association between stool consistency and clinical variables among infants with cystic fibrosis: Findings from the BONUS study. J Cyst Fibros 2022; 21:830-836. [PMID: 35585010 PMCID: PMC10056424 DOI: 10.1016/j.jcf.2022.05.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 04/04/2022] [Accepted: 05/06/2022] [Indexed: 12/09/2022]
Abstract
BACKGROUND Concerns related to stool consistency are common in the first year of life among children with cystic fibrosis (CF). However, normal stool patterns for infants with CF have not been described. METHODS Secondary analysis was completed from the previously described BONUS cohort which followed 231 infants with CF through the first 12 months of life. Pain, stool category, stool frequency, feeding type, PERT dose, acid suppression medication, antibiotics usage, stool softener usage and fecal calprotectin were described at 3, 6, and 12 months. Repeated measure ANOVA was used to test the difference in mean stool number. Generalized linear mixed models were used to investigate the relationship between stool characteristics and various factors. RESULTS The frequency of constipation was stable throughout the first year of life (10-13%) while watery stool significantly decreased from 21.3% at 3 months to 5.8% at 12 months (p=<0.001). The number of stools at months 6 (mean=2.40) and 12 (mean=2.50) are significantly lower than in month 3 (mean=2.83), p<0.025. Exclusive breast feeding was associated with an increased risk for constipation (OR=2.64 [1.60-4.37], p = 0.002) while exclusive formula feeding and acid suppression was associated with decreased risk for constipation (OR=0.40 [0.26-0.61], p=<0.0001 and OR=0.59 [0.39-0.89], p = 0.01 respectively). Pain was not significantly associated with stool consistency. CONCLUSION Stool frequency and consistency evolves in infant with CF in a fashion similar to that reported in non-CF infants over the first year. Constipation was not associated with pain and was less common among infants receiving acid suppression or exclusively formula feeding.
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Affiliation(s)
- A Jay Freeman
- Associate Professor, Division Gastroenterology, Hepatology and Nutrition, Children's Healthcare of Atlanta and Department of Pediatrics, Emory University, Atlanta, GA, USA.
| | - Rong Huang
- Lead Biostatistician, Research Administration, Children's Medical Center Dallas, Dallas, TX, USA
| | - Sonya L Heltshe
- Associate Professor, Cystic Fibrosis Foundation Therapeutics Development Network Coordinating Center, Seattle Children's Research Institute, Seattle, WA, USA and Division of Pulmonary Medicine, Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
| | - Daniel Gelfond
- WNY Pediatric Gastroenterology and Volunteer Faculty, University of Buffalo School of Medicine, Buffalo, NY, USA
| | - Daniel H Leung
- Associate Professor, Division of Gastroenterology, Hepatology and Nutrition, Texas Children's Hospital, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Bonnie R Ramsey
- Vice Chair and Endowed Professor, Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
| | - Drucy Borowitz
- Emeritus Clinical Professor of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA
| | - Meghana Sathe
- Associate Professor, Division Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, University of Texas Southwestern and Children's Health, Dallas, TX, USA
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Goetz D, Kopp BT, Salvator A, Moore-Clingenpeel M, McCoy K, Leung DH, Kloster M, Ramsey BR, Heltshe SH, Borowitz D. Pulmonary findings in infants with cystic fibrosis during the first year of life: Results from the Baby Observational and Nutrition Study (BONUS) cohort study. Pediatr Pulmonol 2019; 54:581-586. [PMID: 30672141 PMCID: PMC6557408 DOI: 10.1002/ppul.24261] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 12/30/2018] [Indexed: 12/22/2022]
Abstract
IMPORTANCE Treatment recommendations for infants with CF standardize care, but most surveillance or treatment guidance of pulmonary manifestations are consensus-based due to sparse evidence. OBJECTIVE To report observations about pulmonary correlates of growth and other clinical features in infants with CF. METHODS We analyzed data from the prospective Baby Observational and Nutrition Study conducted in 28 centers across the US, including clinical features, medications, guardian diaries of respiratory symptoms, oropharyngeal swab cultures and chest radiographs (CXR) collected over the first year of life. RESULTS Cough was reported in 84% of infants in the first year. Up to 30% had clinically important cough but only 6.3% had crackles; 16.5% had wheeze. Wisconsin CXR score was above 5 in 23% (normal = 0; maximum score = 100). Pseudomonas was recovered from at least one respiratory culture in 24% of infants and was associated with crackles/wheezes and use of proton pump inhibitors (PPI) (OR = 5.47; 95%CI = 1.36, 21.92; P = 0.02) or PPI plus histamine-2 (H2) blocker (OR = 8.2; 95%CI = 2.41, 27.93; P = 0.001), but not H2 blocker alone. Hospitalization for respiratory indications occurred in 18% of infants and was associated with crackles/wheeze and abnormal CXR but not low weight, Pseudomonas or use of acid blockade. CONCLUSIONS Cough is common in infants with CF, but few present with crackles/wheeze or CXR changes. Pseudomonas is associated with use of PPI or PPI plus H2 blocker, but not with respiratory hospitalization. These observations cannot prove cause and effect but add to our understanding of pulmonary manifestations of CF in infants. TRIAL REGISTRATION United States ClinicalTrials.Gov registry NCT01424696 (clinicaltrials.gov).
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Affiliation(s)
- Danielle Goetz
- Department of Pediatrics, Division of Pediatric Pulmonology, University at Buffalo, Buffalo, New York
| | - Benjamin T Kopp
- Nationwide Children's Hospital, Division of Pulmonary Medicine, Columbus, Ohio
| | - Ann Salvator
- Biostatistics Core, Research Institute at Nationwide Children's Hospital, Columbus, Ohio
| | | | - Karen McCoy
- Nationwide Children's Hospital, Division of Pulmonary Medicine, Columbus, Ohio
| | - Daniel H Leung
- Baylor College of Medicine, Department of Pediatrics, Division of Gastroenterology, Hepatology, and Nutrition, Houston, Texas
| | - Margaret Kloster
- Cystic Fibrosis Foundation Therapeutics Development Network Coordinating Center, Seattle Children's Research Institute, Seattle, Washington.,Department of Pediatrics, Division of Pulmonary and Sleep Medicine, University of Washington, Seattle, Washington
| | - Bonnie R Ramsey
- Cystic Fibrosis Foundation Therapeutics Development Network Coordinating Center, Seattle Children's Research Institute, Seattle, Washington.,Department of Pediatrics, Division of Pulmonary and Sleep Medicine, University of Washington, Seattle, Washington
| | - Sonya H Heltshe
- Cystic Fibrosis Foundation Therapeutics Development Network Coordinating Center, Seattle Children's Research Institute, Seattle, Washington.,Department of Pediatrics, Division of Pulmonary and Sleep Medicine, University of Washington, Seattle, Washington
| | - Drucy Borowitz
- Department of Pediatrics, Division of Pediatric Pulmonology, University at Buffalo, Buffalo, New York.,Cystic Fibrosis Foundation, Bethesda, Maryland
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