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van den Akker CHP, Embleton ND, Lapillonne A, Mihatsch WA, Salvatore S, Canani RB, Dinleyici EC, Domellöf M, Guarino A, Gutiérrez-Castrellón P, Hojsak I, Indrio F, Mosca A, Orel R, van Goudoever JHB, Weizman Z, Mader S, Zimmermann LJI, Shamir R, Vandenplas Y, Szajewska H. Reevaluating the FDA's warning against the use of probiotics in preterm neonates: A societal statement by ESPGHAN and EFCNI. J Pediatr Gastroenterol Nutr 2024. [PMID: 38572770 DOI: 10.1002/jpn3.12204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 02/14/2024] [Accepted: 03/14/2024] [Indexed: 04/05/2024]
Abstract
The recent advisory issued by the United States Food and Drug Administration, cautioning against the routine administration of probiotics in preterm neonates, has sparked a lively debate within the scientific community. This commentary presents a perspective from members of the Special Interest Group on Gut Microbiota and Modifications within the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) and other authors who contributed to the ESPGHAN position paper on probiotics for preterm infants, as well as representatives from the European Foundation for the Care of Newborn Infants. We advocate for a more nuanced and supportive approach to the use of certain probiotics in this vulnerable population, balancing the demonstrated benefits and risks.
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Affiliation(s)
- Chris H P van den Akker
- Department of Pediatrics-Neonatology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development, and Amsterdam Gastroenterology Endocrinology Metabolism Research Institutes, Amsterdam, The Netherlands
| | - Nicholas D Embleton
- Neonatal Unit, Royal Victoria Infirmary, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Alexandre Lapillonne
- Department of Neonatology, APHP Necker University Hospital, Paris Cite University, Paris, France
- Department of Pediatrics, Children's Nutrition Research Center, Baylor College of Medicine, Houston, Texas, USA
| | - Walter A Mihatsch
- Department of Pediatrics, Ulm University, Ulm, Germany
- Department of Health Management, Neu-Ulm University of Applied Sciences, Neu-Ulm, Germany
- Department of Pediatrics, Zollernalb Klinikum, Balingen, Germany
| | - Silva Salvatore
- Department of Medicine and Technological Innovation, Pediatrics, Hospital "F. Del Ponte", University of Insubria, Varese, Italy
| | - Roberto B Canani
- Department of Translational Medical Science and the ImmunoNutritionLab at the Ceinge Research Center and Task Force on Microbiome Studies, University of Naples Federico II, Naples, Italy
| | - Ener C Dinleyici
- Department of Pediatrics, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Magnus Domellöf
- Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden
| | - Alfredo Guarino
- Department of Translational Medical Science, Section of Pediatrics, University of Naples Federico II, Naples, Italy
| | | | - Iva Hojsak
- Department of Pediatrics, University of Zagreb Medical School, Children's Hospital Zagreb, Zagreb, Croatia
| | - Flavia Indrio
- Department of Experimental Medicine, Pediatric Section, Medical School MedTech, University of Salento, Lecce, Italy
| | - Alexis Mosca
- Department Pediatric Gastroenterology and Nutrition, Robert-Debré Hospital, APHP, Paris, France
| | - Rok Orel
- Department of Gastroenterology, Hepatology and Nutrition, University Medical Center Ljubljana, University Children's Hospital Ljubljana, Medical Faculty, University of Ljubljana, Ljubeljana, Slovenia
| | - Johannes Hans B van Goudoever
- Department of Pediatrics, Amsterdam UMC, Emma Children's Hospital, University of Amsterdam, Amsterdam, The Netherlands
| | - Zvi Weizman
- Faculty of Health Sciences, Ben-Gurion University, Beer-Sheva, Israel
| | - Silke Mader
- European Foundation for the Care of Newborn Infants (EFCNI), Munich, Germany
| | - Luc J I Zimmermann
- European Foundation for the Care of Newborn Infants (EFCNI), Munich, Germany
- Department of Pediatrics, School for Oncology and Reproduction (GROW), Maastricht UMC+, Maastricht, The Netherlands
| | - Raanan Shamir
- Institute for Gastroenterology, Nutrition and Liver Diseases, Schneider Children's Medical Center, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yvan Vandenplas
- Department of Pediatrics, UZ Brussel, KidZ Health Castle, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Hania Szajewska
- Department of Pediatrics, The Medical University of Warsaw, Warsaw, Poland
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Indrio F, Dinleyici EC, Berni Canani R, Domellöf M, Francavilla R, Guarino A, Gutierrez Castrellon P, Orel R, Salvatore S, Van den Akker CHP, Weizman Z. Prebiotics in the management of pediatric gastrointestinal disorders: Position paper of the ESPGHAN special interest group on gut microbiota and modifications. J Pediatr Gastroenterol Nutr 2024; 78:728-742. [PMID: 38270255 DOI: 10.1002/jpn3.12134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 12/28/2023] [Accepted: 01/11/2024] [Indexed: 01/26/2024]
Abstract
Prebiotics are substrates that are selectively utilized by host microorganisms conferring a health benefit. Compared to probiotics there are few studies with prebiotics in children. Most studies have been performed using infant formula supplemented with prebiotics, while add-on prebiotic supplementation as prevention or treatment of childhood gastrointestinal disorders has rarely been reported. The aim of this position paper was to summarize evidence and make recommendations for prebiotic supplementation in children with gastrointestinal diseases. Recommendations made are based on publications up to January 1, 2023. Within the scope of the European Society for Paediatric Gastroenterology Hepatology and Nutrition Special Interest Group on Gut Microbiota and Modifications, as in our previous biotic recommendations, at least two randomized controlled clinical trials were required for recommendation. There are some studies showing benefits of prebiotics on selected outcomes; however, we cannot give any positive recommendations for supplementing prebiotics in children with gastrointestinal disorders.
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Affiliation(s)
- Flavia Indrio
- Department of Experimental Medicine, Pediatric Section, University of Salento, Lecce, Italy
| | - Ener Cagri Dinleyici
- Department of Pediatrics, Eskisehir Osmangazi University Faculty of Medicine, Eskisehir, Turkiye
| | - Roberto Berni Canani
- Department of Translational Medical Sciences-Section of Paediatrics, University of Naples Federico II, Naples, Italy
| | - Magnus Domellöf
- Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden
| | - Ruggiero Francavilla
- Interdisciplinary Department of Medicine, Pediatric Section, Children's Hospital 'Giovanni XXIII', University of Bari Aldo Moro, Bari, Italy
| | - Alfredo Guarino
- Department of Translational Medical Sciences-Section of Paediatrics, University of Naples Federico II, Naples, Italy
| | - Pedro Gutierrez Castrellon
- Innovación y Desarrollo de Estrategias en Salud (IDEAS), Mexico City, Mexico
- International Scientific Council for Probiotics A.C., Mexico City, Mexico
| | - Rok Orel
- Department of Gastroenterology, Hepatology and Nutrition, University Medical Centre Ljubljana, University Children's Hospital, Ljubljana, Slovenia
| | - Silvia Salvatore
- Department of Pediatrics, "F. Del Ponte" Hospital, University of Insubria, Varese, Italy
| | - Chris H P Van den Akker
- Department of Pediatrics-Neonatology, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Zvi Weizman
- Faculty of Health Sciences, Ben-Gurion University, Beer-Sheva, Israel
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Vandenplas Y, Broekaert I, Domellöf M, Indrio F, Lapillonne A, Pienar C, Ribes-Koninckx C, Shamir R, Szajewska H, Thapar N, Thomassen RA, Verduci E, West C. An ESPGHAN Position Paper on the Diagnosis, Management, and Prevention of Cow's Milk Allergy. J Pediatr Gastroenterol Nutr 2024; 78:386-413. [PMID: 38374567 DOI: 10.1097/mpg.0000000000003897] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 06/25/2023] [Indexed: 07/27/2023]
Abstract
A previous guideline on cow's milk allergy (CMA) developed by the European Society of Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) was published in 2012. This position paper provides an update on the diagnosis, treatment, and prevention of CMA with focus on gastrointestinal manifestations. All systematic reviews and meta-analyses regarding prevalence, pathophysiology, symptoms, and diagnosis of CMA published after the previous ESPGHAN document were considered. Medline was searched from inception until May 2022 for topics that were not covered in the previous document. After reaching consensus on the manuscript, statements were formulated and voted on each of them with a score between 0 and 9. A score of ≥6 was arbitrarily considered as agreement. Available evidence on the role of dietary practice in the prevention, diagnosis, and management of CMA was updated and recommendations formulated. CMA in exclusively breastfed infants exists, but is uncommon and suffers from over-diagnosis. CMA is also over-diagnosed in formula and mixed fed infants. Changes in stool characteristics, feeding aversion, or occasional spots of blood in stool are common and in general should not be considered as diagnostic of CMA, irrespective of preceding consumption of cow's milk. Over-diagnosis of CMA occurs much more frequently than under-diagnosis; both have potentially harmful consequences. Therefore, the necessity of a challenge test after a short diagnostic elimination diet of 2-4 weeks is recommended as the cornerstone of the diagnosis. This position paper contains sections on nutrition, growth, cost, and quality of life.
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Affiliation(s)
- Yvan Vandenplas
- Vrije Universiteit Brussel (VUB), UZ Brussel, KidZ Health Castle, Brussels, Belgium
| | - Ilse Broekaert
- Department of Paediatrics, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Magnus Domellöf
- Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden
| | - Flavia Indrio
- Department of Medical and Surgical Science, University of Foggia, Foggia, Italy
| | - Alexandre Lapillonne
- Neonatal Intensive Care Unit, Necker-Enfants Malades Hospital, Paris University, Paris, France
- CNRC, Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - Corina Pienar
- Department of Pediatrics, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania
| | - Carmen Ribes-Koninckx
- Gastroenterology and Hepatology & Instituto de Investigacion Sanitaria, La Fe University Hospital, Valencia, Spain
| | - Raanan Shamir
- Institute of Gastroenterology, Nutrition and Liver Diseases, Schneider Children's Medical Center, Lea and Arieh Pickel Chair for Pediatric Research, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Hania Szajewska
- Department of Paediatrics, The Medical University of Warsaw, Warsaw, Poland
| | - Nikhil Thapar
- Gastroenterology, Hepatology and Liver Transplant, Queensland Children's Hospital, Brisbane, Australia
- School of Medicine, University of Queensland, Brisbane, Australia
- Woolworths Centre for Child Nutrition Research, Queensland University of Technology, Brisbane, Australia
- UCL Great Ormond Street Institute of Child Health, London, UK
| | - Rut Anne Thomassen
- Department of Paediatric Medicine, Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
| | - Elvira Verduci
- Department of Paediatrics, Vittore Buzzi Children's Hospital, University of Milan, Milan, Italy
| | - Christina West
- Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden
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Pastore M, Indrio F, Bali D, Vural M, Giardino I, Pettoello-Mantovani M. Alarming Increase of Eating Disorders in Children and Adolescents. J Pediatr 2023; 263:113733. [PMID: 37717906 DOI: 10.1016/j.jpeds.2023.113733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Accepted: 09/13/2023] [Indexed: 09/19/2023]
Affiliation(s)
- Maria Pastore
- European Pediatric Association, Union of National European Pediatric Societies and Associations, Working Group on Social Pediatrics, Berlin, Germany; Residency Program in Pediatrics, University of Foggia, Pediatric Unit, Scientific Institute "Casa Sollievo della Sofferenza", Foggia, Italy
| | - Flavia Indrio
- European Pediatric Association, Union of National European Pediatric Societies and Associations, Working Group on Social Pediatrics, Berlin, Germany; Institute of Pediatrics, Pediatric Unit, University of Salento, Lecce, Italy
| | - Donjeta Bali
- European Pediatric Association, Union of National European Pediatric Societies and Associations, Working Group on Social Pediatrics, Berlin, Germany; Albanian Society of Pediatrics, Working Group on Social Pediatrics, Tirana, Albania
| | - Mehmet Vural
- European Pediatric Association, Union of National European Pediatric Societies and Associations, Working Group on Social Pediatrics, Berlin, Germany; Turkish Pediatric Association, Neonatology, Istanbul, Turkey; Department of Pediatrics, Cerrapasha University, Istanbul, Turkey
| | - Ida Giardino
- Department of Clinical and Experimental Medicine, University of Foggia, Italy
| | - Massimo Pettoello-Mantovani
- European Pediatric Association, Union of National European Pediatric Societies and Associations, Working Group on Social Pediatrics, Berlin, Germany; Residency Program in Pediatrics, University of Foggia, Pediatric Unit, Scientific Institute "Casa Sollievo della Sofferenza", Foggia, Italy.
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Bali D, Pastore M, Indrio F, Giardino I, Vural M, Pettoello-Mantovani C, Pop TL, Pettoello-Mantovani M. Bullying and Cyberbullying Increasing in Preadolescent Children. J Pediatr 2023; 261:113565. [PMID: 37329977 DOI: 10.1016/j.jpeds.2023.113565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 06/12/2023] [Indexed: 06/19/2023]
Affiliation(s)
- Donjeta Bali
- European Paediatric Association/Union of National European Paediatric Societies and Associations, Berlin, Germany; Association pour l'Activité et la Recherche Scìentifiques, Bevaix, Neouchatel, Switzerland; Albania Society of Pediatrics, Tirana, Albania
| | - Maria Pastore
- European Paediatric Association/Union of National European Paediatric Societies and Associations, Berlin, Germany; Residency program in Pediatrics, University of Foggia, Scientific Institute "Casa Sollievo della Sofferenza", Foggia, Italy
| | - Flavia Indrio
- European Paediatric Association/Union of National European Paediatric Societies and Associations, Berlin, Germany; Residency program in Pediatrics, University of Foggia, Scientific Institute "Casa Sollievo della Sofferenza", Foggia, Italy; Italian Academy of Pediatrics, Milan, Italy
| | - Ida Giardino
- Residency program in Pediatrics, University of Foggia, Scientific Institute "Casa Sollievo della Sofferenza", Foggia, Italy
| | - Mehmet Vural
- European Paediatric Association/Union of National European Paediatric Societies and Associations, Berlin, Germany; Association pour l'Activité et la Recherche Scìentifiques, Bevaix, Neouchatel, Switzerland; Turkish Pediatric Association, Istanbul, Turkey
| | | | - Tudor Lucian Pop
- European Paediatric Association/Union of National European Paediatric Societies and Associations, Berlin, Germany; Association pour l'Activité et la Recherche Scìentifiques, Bevaix, Neouchatel, Switzerland; Second Pediatric Clinic, "Iuliu Haţieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania; Romanian Society of Social Pediatrics, Cluj, Romania
| | - Massimo Pettoello-Mantovani
- European Paediatric Association/Union of National European Paediatric Societies and Associations, Berlin, Germany; Association pour l'Activité et la Recherche Scìentifiques, Bevaix, Neouchatel, Switzerland; Residency program in Pediatrics, University of Foggia, Scientific Institute "Casa Sollievo della Sofferenza", Foggia, Italy; Italian Academy of Pediatrics, Milan, Italy.
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Nigri L, Carrasco-Sanz A, Pop TL, Giardino I, Vural M, Ferrara P, Indrio F, Pettoello-Mantovani M. Burnout in Primary Care Pediatrics and the Additional Burden from the COVID-19 Pandemic. J Pediatr 2023; 260:113447. [PMID: 37120131 PMCID: PMC10139743 DOI: 10.1016/j.jpeds.2023.113447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 04/23/2023] [Indexed: 05/01/2023]
Affiliation(s)
- Luigi Nigri
- Association pour l'Activité et la Recherche Scìentifiques, Neuchatel, Switzerland; Italian Federation of Primary Care Pediatricians, Rome, Italy; European Pediatric Association/Union of National European Pediatric Societies and Associations, Berlin, Germany
| | - Angel Carrasco-Sanz
- Association pour l'Activité et la Recherche Scìentifiques, Neuchatel, Switzerland; European Pediatric Association/Union of National European Pediatric Societies and Associations, Berlin, Germany; European Confederation of Primary Care Pediatricians, Lyon, France; Spanish Primary Care Pediatric Association, Madrid, Spain
| | - Tudor Lucian Pop
- Association pour l'Activité et la Recherche Scìentifiques, Neuchatel, Switzerland; European Pediatric Association/Union of National European Pediatric Societies and Associations, Berlin, Germany; Romania Society of Social Pediatrics, Cluj, Romania
| | - Ida Giardino
- Association pour l'Activité et la Recherche Scìentifiques, Neuchatel, Switzerland; Department of Biomedical Sciences, University of Foggia, Foggia, Italy
| | - Mehmet Vural
- Association pour l'Activité et la Recherche Scìentifiques, Neuchatel, Switzerland; European Pediatric Association/Union of National European Pediatric Societies and Associations, Berlin, Germany; Turkish Pediatric Association, Istanbul, Turkey
| | - Pietro Ferrara
- Association pour l'Activité et la Recherche Scìentifiques, Neuchatel, Switzerland; European Pediatric Association/Union of National European Pediatric Societies and Associations, Berlin, Germany; Italian Academy of Pediatrics, Milan, Italy
| | - Flavia Indrio
- European Pediatric Association/Union of National European Pediatric Societies and Associations, Berlin, Germany; Department of Biomedical Sciences, University of Foggia, Foggia, Italy
| | - Massimo Pettoello-Mantovani
- Association pour l'Activité et la Recherche Scìentifiques, Neuchatel, Switzerland; European Pediatric Association/Union of National European Pediatric Societies and Associations, Berlin, Germany; Italian Academy of Pediatrics, Milan, Italy.
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Norsa L, Goulet O, Alberti D, DeKooning B, Domellöf M, Haiden N, Hill S, Indrio F, Kӧglmeier J, Lapillonne A, Luque V, Moltu SJ, Saenz De Pipaon M, Savino F, Verduci E, Bronsky J. Nutrition and Intestinal Rehabilitation of Children With Short Bowel Syndrome: A Position Paper of the ESPGHAN Committee on Nutrition. Part 1: From Intestinal Resection to Home Discharge. J Pediatr Gastroenterol Nutr 2023; 77:281-297. [PMID: 37256827 DOI: 10.1097/mpg.0000000000003849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Short bowel syndrome (SBS) is the leading cause of intestinal failure (IF) in children. The mainstay of treatment for IF is parenteral nutrition (PN). The aim of this position paper is to review the available evidence on managing SBS and to provide practical guidance to clinicians dealing with this condition. All members of the Nutrition Committee of the European Society for Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) contributed to this position paper. Some renowned experts in the field joined the team to guide with their experience. A systematic literature search was performed from 2005 to May 2021 using PubMed, MEDLINE, and Cochrane Database of Systematic Reviews. In the absence of evidence, recommendations reflect the expert opinion of the authors. Literature on SBS mainly consists of retrospective single-center experience, thus most of the current papers and recommendations are based on expert opinion. All recommendations were voted on by the expert panel and reached >90% agreement. The first part of this position paper focuses on the physiological mechanism of intestinal adaptation after surgical resection. It subsequently provides some clinical practice recommendations for the primary management of children with SBS from surgical resection until discharged home on PN.
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Affiliation(s)
- Lorenzo Norsa
- From the Department of Paediatric Hepatology, Gastroenterology and Transplantation, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Olivier Goulet
- the Department of Pediatric Gastroenterology-Hepatology-Nutrition, Necker-Enfants Malades Hospital, Université Paris Descartes, Paris, France
| | - Daniele Alberti
- the Department of Pediatric Surgery, ASST Spedali Civili, Brescia, Italy
- the Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Barbara DeKooning
- the Paediatric Gastroenterology, Erasmus MC, Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Magnus Domellöf
- the Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden
| | - Nadja Haiden
- the Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Susan Hill
- the Department of Paediatric Gastroenterology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Flavia Indrio
- the Department of Medical and Surgical Science, University of Foggia, Foggia, Italy
| | - Jutta Kӧglmeier
- the Department of Paediatric Gastroenterology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Alexandre Lapillonne
- the Neonatal Intensive Care Unit, Necker-Enfants Malades Hospital, Paris University, Paris, France
- the CNRC, Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - Veronica Luque
- Serra Hunter, Universitat Rovira I Virgili, IISPV, Tarragona, Spain
| | - Sissel J Moltu
- the Department of Neonatology, Oslo University Hospital, Oslo, Norway
| | - Miguel Saenz De Pipaon
- the Department of Neonatology, Instituto de Investigación Sanitaria del Hospital Universitario La Paz - IdiPAZ, Hospital Universitario La Paz - Universidad Autónoma de Madrid, Madrid, Spain
| | - Francesco Savino
- the Dipartimento di Patologia e cura del bambino "Regina Margherita", A.U.O. Città delle Salute e della Scienza di Torino, Torino, Italy
| | - Elvira Verduci
- the Department of Pediatrics, Ospedale dei Bambini Vittore Buzzi University of Milan, Milan, Italy
| | - Jiri Bronsky
- the Department of Paediatrics, University Hospital Motol, Prague, Czech Republic
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Norsa L, Goulet O, Alberti D, DeKooning B, Domellöf M, Haiden N, Hill S, Indrio F, Kӧglmeier J, Lapillonne A, Luque V, Moltu SJ, Saenz De Pipaon M, Savino F, Verduci E, Bronsky J. Nutrition and Intestinal Rehabilitation of Children With Short Bowel Syndrome: A Position Paper of the ESPGHAN Committee on Nutrition. Part 2: Long-Term Follow-Up on Home Parenteral Nutrition. J Pediatr Gastroenterol Nutr 2023; 77:298-314. [PMID: 37256821 DOI: 10.1097/mpg.0000000000003850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Short bowel syndrome (SBS) is the leading cause of intestinal failure (IF) in children. The preferred treatment for IF is parenteral nutrition which may be required until adulthood. The aim of this position paper is to review the available evidence on managing SBS and to provide practical guidance to clinicians dealing with this condition. All members of the Nutrition Committee of the European Society for Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) contributed to this position paper. Some renowned experts in the field joined the team to guide with their expertise. A systematic literature search was performed from 2005 to May 2021 using PubMed, MEDLINE, and Cochrane Database of Systematic Reviews. In the absence of evidence, recommendations reflect the expert opinion of the authors. Literature on SBS mainly consists of retrospective single-center experience, thus most of the current papers and recommendations are based on expert opinion. All recommendations were voted on by the expert panel and reached >90% agreement. This second part of the position paper is dedicated to the long-term management of children with SBS-IF. The paper mainly focuses on how to achieve intestinal rehabilitation, treatment of complications, and on possible surgical and medical management to increase intestinal absorption.
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Affiliation(s)
- Lorenzo Norsa
- From the Department of Paediatric Hepatology, Gastroenterology and Transplantation, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Olivier Goulet
- the Department of Pediatric Gastroenterology-Hepatology-Nutrition, APHP Necker-Enfants Malades Hospital, Université Paris Cité, Paris, France
| | - Daniele Alberti
- the Department of Pediatric Surgery, ASST Spedali Civili, Brescia, Italy
- the Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Barbara DeKooning
- From the Department of Paediatric Hepatology, Gastroenterology and Transplantation, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Magnus Domellöf
- the Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden
| | - Nadja Haiden
- the Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Susan Hill
- the Department of Paediatric Gastroenterology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Flavia Indrio
- the Department of Medical and Surgical Science, University of Foggia, Foggia, Italy
| | - Jutta Kӧglmeier
- the Department of Paediatric Gastroenterology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Alexandre Lapillonne
- the Neonatal Intensive Care Unit, APHP Necker-Enfants Malades Hospital, Paris Cité University, Paris, France
- the CNRC, Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - Veronica Luque
- Serra Hunter, Universitat Rovira I Virgili, IISPV, Tarragona, Spain
| | - Sissel J Moltu
- the Department of Neonatology, Oslo University Hospital, Oslo, Norway
| | - Miguel Saenz De Pipaon
- the Department of Neonatology, Instituto de Investigación Sanitaria del Hospital Universitario La Paz - IdiPAZ, Hospital Universitario La Paz - Universidad Autónoma de Madrid, Madrid, Spain
| | - Francesco Savino
- the Dipartimento di Patologia e cura del bambino "Regina Margherita", A.U.O. Città delle Salute e della Scienza di Torino, Torino, Italy
| | - Elvira Verduci
- the Department of Pediatrics, Ospedale dei Bambini Vittore Buzzi University of Milan, Milan, Italy
| | - Jiri Bronsky
- the Department of Paediatrics, University Hospital Motol, Prague, Czech Republic
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Bali D, Vural M, Giardino I, Namazova-Baranova L, Indrio F, Pettoello-Mantovani M. Food Safety: The European Union's Food Safety Initiative and Its Impact on Risks from Microbial and Chemical Hazards in Infant Food Chains. J Pediatr 2023; 259:113474. [PMID: 37182658 DOI: 10.1016/j.jpeds.2023.113474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 04/23/2023] [Indexed: 05/16/2023]
Affiliation(s)
- Donjeta Bali
- European Paediatric Association/Union of National European Paediatric Societies and Associations (EPA/UNEPSA), Berlin, Germany; Association pour l'Activité et la Recherche Scìentifiques, Neouchatel, Switzerland; Albanian Society of Pediatrics, Tirana, Albania
| | - Mehmet Vural
- European Paediatric Association/Union of National European Paediatric Societies and Associations (EPA/UNEPSA), Berlin, Germany; Association pour l'Activité et la Recherche Scìentifiques, Neouchatel, Switzerland; Turkish Pediatric Association, Istanbul, Turkey
| | - Ida Giardino
- European Paediatric Association/Union of National European Paediatric Societies and Associations (EPA/UNEPSA), Berlin, Germany; Association pour l'Activité et la Recherche Scìentifiques, Neouchatel, Switzerland; Scientific Institute "Casa Sollievo della Sofferenza", University of Foggia, Foggia, Italy
| | - Leyla Namazova-Baranova
- European Paediatric Association/Union of National European Paediatric Societies and Associations (EPA/UNEPSA), Berlin, Germany; Association pour l'Activité et la Recherche Scìentifiques, Neouchatel, Switzerland
| | - Flavia Indrio
- European Paediatric Association/Union of National European Paediatric Societies and Associations (EPA/UNEPSA), Berlin, Germany; Association pour l'Activité et la Recherche Scìentifiques, Neouchatel, Switzerland; Scientific Institute "Casa Sollievo della Sofferenza", University of Foggia, Foggia, Italy
| | - Massimo Pettoello-Mantovani
- European Paediatric Association/Union of National European Paediatric Societies and Associations (EPA/UNEPSA), Berlin, Germany; Association pour l'Activité et la Recherche Scìentifiques, Neouchatel, Switzerland; Italian Academy of Pediatrics, Milan, Italy.
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10
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Barone M, Iannone A, Cristofori F, Dargenio VN, Indrio F, Verduci E, Di Leo A, Francavilla R. Risk of obesity during a gluten-free diet in pediatric and adult patients with celiac disease: a systematic review with meta-analysis. Nutr Rev 2023; 81:252-266. [PMID: 35947766 PMCID: PMC10857815 DOI: 10.1093/nutrit/nuac052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
CONTEXT Obesity is a significant risk factor for many pathological conditions. Whether a gluten-free diet (GFD) is a risk factor for overweight or obesity remains controversial. OBJECTIVE The primary aim of this study was to assess the prevalence of body mass index (BMI) categories at disease presentation and the variation in BMI category from underweight/normal to overweight/obese and vice versa during a GFD. DATA SOURCES PubMed, Scopus, and Web of Science databases were searched through February 2021 for retrospective, cross-sectional, and prospective studies reporting BMI categories at disease diagnosis and during a GFD. DATA EXTRACTION Data were extracted by 2 reviewers independently. Disagreements were resolved by consensus; a third reviewer was consulted, if necessary. Risk of bias was assessed with the Cochrane ROBINS-I tool. DATA ANALYSIS Subgroup analysis based on age (pediatric/adult patients), study design (prospective, cross-sectional, retrospective), and duration of GFD was performed.. Forty-five studies were selected (7959 patients with celiac disease and 20 524 healthy controls). The mean BMI of celiac patients at presentation was significantly lower than that of controls (P < 0.001). During a GFD, the mean BMI increased significantly (mean difference = 1.14 kg/m2 [95%CI, 0.68-1.60 kg/m2]; I2 = 82.8%; P < 0.001), but only 9% of patients (95%CI, 7%-12%; I2 = 80.0%) changed from the underweight/normal BMI category to the overweight/obese category, while 20% (95%CI, 11%-29%; I2 = 85.8%) moved into a lower BMI category. CONCLUSION Most celiac patients had a normal BMI at presentation, although the mean BMI was significantly lower than that of controls. A GFD does not increase the risk of becoming overweight/obese, especially in children. The quality of several studies was suboptimal, with moderate or high overall risk of bias and heterogeneity.
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Affiliation(s)
- Michele Barone
- are with the Gastroenterology Unit, Department of Emergency and Organ Transplantation, University of Bari “Aldo Moro,” Bari, Italy
| | - Andrea Iannone
- are with the Gastroenterology Unit, Department of Emergency and Organ Transplantation, University of Bari “Aldo Moro,” Bari, Italy
| | - Fernanda Cristofori
- are with the Interdisciplinary Department of Medicine, Pediatric Section, University of Bari “Aldo Moro,” Bari, Italy
| | - Vanessa Nadia Dargenio
- are with the Interdisciplinary Department of Medicine, Pediatric Section, University of Bari “Aldo Moro,” Bari, Italy
| | - Flavia Indrio
- is with the Department of Pediatrics, Scientific Institute “Casa Sollievo della Sofferenza,” Foggia, Italy
| | - Elvira Verduci
- is with the Department of Pediatrics, Ospedale dei Bambini “Vittore Buzzi,” Milan, Italy
| | - Alfredo Di Leo
- are with the Gastroenterology Unit, Department of Emergency and Organ Transplantation, University of Bari “Aldo Moro,” Bari, Italy
| | - Ruggiero Francavilla
- are with the Interdisciplinary Department of Medicine, Pediatric Section, University of Bari “Aldo Moro,” Bari, Italy
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11
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Embleton ND, Jennifer Moltu S, Lapillonne A, van den Akker CHP, Carnielli V, Fusch C, Gerasimidis K, van Goudoever JB, Haiden N, Iacobelli S, Johnson MJ, Meyer S, Mihatsch W, de Pipaon MS, Rigo J, Zachariassen G, Bronsky J, Indrio F, Köglmeier J, de Koning B, Norsa L, Verduci E, Domellöf M. Enteral Nutrition in Preterm Infants (2022): A Position Paper From the ESPGHAN Committee on Nutrition and Invited Experts. J Pediatr Gastroenterol Nutr 2023; 76:248-268. [PMID: 36705703 DOI: 10.1097/mpg.0000000000003642] [Citation(s) in RCA: 40] [Impact Index Per Article: 40.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVES To review the current literature and develop consensus conclusions and recommendations on nutrient intakes and nutritional practice in preterm infants with birthweight <1800 g. METHODS The European Society of Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) Committee of Nutrition (CoN) led a process that included CoN members and invited experts. Invited experts with specific expertise were chosen to represent as broad a geographical spread as possible. A list of topics was developed, and individual leads were assigned to topics along with other members, who reviewed the current literature. A single face-to-face meeting was held in February 2020. Provisional conclusions and recommendations were developed between 2020 and 2021, and these were voted on electronically by all members of the working group between 2021 and 2022. Where >90% consensus was not achieved, online discussion meetings were held, along with further voting until agreement was reached. RESULTS In general, there is a lack of strong evidence for most nutrients and topics. The summary paper is supported by additional supplementary digital content that provide a fuller explanation of the literature and relevant physiology: introduction and overview; human milk reference data; intakes of water, protein, energy, lipid, carbohydrate, electrolytes, minerals, trace elements, water soluble vitamins, and fat soluble vitamins; feeding mode including mineral enteral feeding, feed advancement, management of gastric residuals, gastric tube placement and bolus or continuous feeding; growth; breastmilk buccal colostrum, donor human milk, and risks of cytomegalovirus infection; hydrolyzed protein and osmolality; supplemental bionutrients; and use of breastmilk fortifier. CONCLUSIONS We provide updated ESPGHAN CoN consensus-based conclusions and recommendations on nutrient intakes and nutritional management for preterm infants.
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Affiliation(s)
| | | | | | - Chris H P van den Akker
- the Department of Pediatrics - Neonatology, Amsterdam UMC - Emma Children's Hospital, University of Amsterdam, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Virgilio Carnielli
- Polytechnic University of Marche and Division of Neonatology, Ospedali Riuniti, Ancona, Ancona, Italy
| | - Christoph Fusch
- the Department of Pediatrics, Nuremberg General Hospital, Paracelsus Medical School, Nuremberg, Germany
- the Division of Neonatology, Department of Pediatrics, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Konstantinos Gerasimidis
- the Human Nutrition, School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow Royal Infirmary, Glasgow, UK
| | - Johannes B van Goudoever
- Amsterdam UMC, University of Amsterdam, Vrije Universiteit, Emma Children's Hospital, Amsterdam, The Netherlands
| | - Nadja Haiden
- the Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Silvia Iacobelli
- the Réanimation Néonatale et Pédiatrique, Néonatologie - CHU La Réunion, Saint-Pierre, France
| | - Mark J Johnson
- the Department of Neonatal Medicine, University Hospital Southampton NHS Trust, Southampton, UK
- the National Institute for Health Research Biomedical Research Centre Southampton, University Hospital Southampton NHS Trust and University of Southampton, Southampton, UK
| | - Sascha Meyer
- the Department of General Paediatrics and Neonatology, University Hospital of Saarland, Homburg, Germany
| | - Walter Mihatsch
- the Department of Pediatrics, Ulm University, Ulm, Germany
- the Department of Health Management, Neu-Ulm University of Applied Sciences, Neu-Ulm, Germany
| | - Miguel Saenz de Pipaon
- the Department of Pediatrics-Neonatology, La Paz University Hospital, Autonoma University of Madrid, Madrid, Spain
| | - Jacques Rigo
- the Neonatal Unit, University of Liège, CHR Citadelle, Liège, Belgium
| | - Gitte Zachariassen
- H.C. Andersen Children's Hospital, Odense University Hospital and University of Southern Denmark, Odense, Denmark
| | - Jiri Bronsky
- the Department of Paediatrics, University Hospital Motol, Prague, Czech Republic
| | - Flavia Indrio
- the Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Jutta Köglmeier
- the Department of Paediatric Gastroenterology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Barbara de Koning
- the Paediatric Gastroenterology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Lorenzo Norsa
- the Paediatric Hepatology, Gastroenterology and Transplantation, ASST Papa Giovanni XXIIII, Bergamo, Italy
| | - Elvira Verduci
- the Department of Health Sciences, University of Milan, Milan, Italy
- the Department of Paediatrics, Ospedale dei Bambini Vittore Buzzi, Milan, Italy
| | - Magnus Domellöf
- the Department of Clinical Sciences, Paediatrics, Umeå University, Umeå, Sweden
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12
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Ferrara P, Cammisa I, Corsello G, Giardino I, Vural M, Pop TL, Pettoello-Mantovani C, Indrio F, Pettoello-Mantovani M. Online "Sharenting": The Dangers of Posting Sensitive Information About Children on Social Media. J Pediatr 2023:S0022-3476(23)00018-5. [PMID: 36669588 DOI: 10.1016/j.jpeds.2023.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 01/10/2023] [Indexed: 01/19/2023]
Affiliation(s)
- Pietro Ferrara
- Pediatric Unit, Campus Bio-Medico University, Rome, Italy; Italian Academy of Pediatrics, Milan, Italy
| | | | - Giovanni Corsello
- Italian Academy of Pediatrics, Milan, Italy; Italian Society of Pediatrics, Rome, Italy
| | - Ida Giardino
- University of Foggia, Foggia, Italy; Association pour l'Activité et la Recherche Scìentifiques, Neouchatel, Switzerland
| | - Mehmet Vural
- Association pour l'Activité et la Recherche Scìentifiques, Neouchatel, Switzerland; European Paediatric Association/Union of National European Paediatric Societies and Associations (EPA/UNEPSA), Berlin, Germany; Turkish Pediatric Association, Istanbul, Turkey
| | - Tudor Lucian Pop
- Association pour l'Activité et la Recherche Scìentifiques, Neouchatel, Switzerland; European Paediatric Association/Union of National European Paediatric Societies and Associations (EPA/UNEPSA), Berlin, Germany; Romania Society of Social Pediatrics, Cluj, Romania
| | | | | | - Massimo Pettoello-Mantovani
- Italian Academy of Pediatrics, Milan, Italy; Association pour l'Activité et la Recherche Scìentifiques, Neouchatel, Switzerland; European Paediatric Association/Union of National European Paediatric Societies and Associations (EPA/UNEPSA), Berlin, Germany.
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13
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Köglmeier J, Assecaira I, Banci E, De Koning B, Haiden N, Indrio F, Kastelijn W, Kennedy D, Luque V, Norsa L, Verduci E, Sugar A. The Use of Blended Diets in Children With Enteral Feeding Tubes: A Joint Position Paper of the ESPGHAN Committees of Allied Health Professionals and Nutrition. J Pediatr Gastroenterol Nutr 2023; 76:109-117. [PMID: 36053165 DOI: 10.1097/mpg.0000000000003601] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES This joint position paper of the Committees of Allied Health Professionals (CAHP) and Nutrition (CON) of the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) provides a comprehensive guide for health professionals to manage blended diets in children via gastrostomy tubes. METHODS A systematic literature search was performed from 1992 to 2021 using Pubmed, MEDLINE, and Cochrane Database of Systematic Reviews and recent guidelines reviewed. In the absence of evidence, recommendations reflect the authors' expert opinion. Final consensus was obtained by multiple e-mail exchange and virtual meetings of the CAHP and CON. RESULTS Reported benefits of blended diets include reduced GERD and infections, improved defecation, level of alertness and attention span, skin conditions, and appearance of hair and nails. Families report a sense of greater normality. Small case series, cross-sectional surveys, questionnaire-based small case studies, reports of personal experience, and single-center pilot studies are available in the medical literature. A total of 20 recommendations for practice were made based on the results and consensus process. CONCLUSIONS There is little evidence published to formally inform about the potential health benefits or risks of this practice and how to use it in the best way. This leaves health professionals caring for such patients in a relative vacuum regarding what to consider when providing a duty of care to patients and carers who wish to pursue this method of feeding. This article provides guidelines for safe and appropriate use of a BD, but more research is needed.
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Affiliation(s)
- Jutta Köglmeier
- From the Department of Paediatric Gastroenterology, Great Ormond Street Hospital for Children NHS Foundation Trust London, United Kingdom
| | - Ines Assecaira
- the Medical University of Lisbon and Dietetic and Nutrition Department, University Hospital of Northern Lisbon, Lisbon, Portugal
| | - Elena Banci
- Dietetics Unit, Meyer Children's University Hospital, Florence, Italy
| | - Barbara De Koning
- Paediatric Gastroenterology, Erasmus MC-Sophia Children's Hospital Rotterdam, The Netherlands
| | - Nadja Haiden
- the Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Flavia Indrio
- the Department of Medical and Surgical Science University of Foggia, Italy
| | - Wendy Kastelijn
- the Department of Internal Medicine, Division of Dietetics, Erasmus MCUniversity Medical Center Rotterdam, The Netherlands
- the Department of Nutrition and Dietetics, School of Health Care Studies, Hanze University of Applied Sciences, Groningen, The Netherlands
| | - Denise Kennedy
- the First Dietitians, First Community Health and Care Redhill, Surrey, United Kingdom
| | | | - Lorenzo Norsa
- Pediatric Hepatology, Gastroenterology and Transplantation, ASST Papa Giovanni XXIIII, Bergamo, Italy
| | - Elvira Verduci
- the Department of Pediatrics, Ospedale dei Bambini Vittore Buzzi, University of Milan, Italy
| | - Analou Sugar
- the Department of Paediatric Speech and Language Therapy, Chelsea and Westminster Hospital NHS Foundation Trust London, United Kingdom
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14
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Cinquetti M, Dargenio V, Fingerle M, Marchiotto C, Biasin M, Pettoello Mantovani M, Indrio F. Role of social media use in onset of functional gastrointestinal disorders in children. Clin Exp Pediatr 2022:cep.2022.00843. [PMID: 36550775 DOI: 10.3345/cep.2022.00843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 06/10/2022] [Accepted: 09/22/2022] [Indexed: 12/24/2022] Open
Abstract
The use of social media has increased considerably in recent years. However, these tools are not always used consciously, and the stress that can result from their inappropriate use is often underestimated. Children, who tend to be heavy users of social media, are exposed to risks associated with their intensive use. Data on the consequences of social media on children's health are extensive; however, few studies have examined the association between their use and functional gastrointestinal disorders (FGIDs). Our research showed that social media use is associated with adverse health outcomes such as stress, poor sleep quality, and gastrointestinal disorders in children and adolescents. FGIDs should be considered a group of biopsychosocial disorders involving gut dysfunction and psychological health. Stress may exacerbate the symptoms of these disorders and is associated with psychological comorbidities. Recent findings demonstrated a high prevalence of social media use and the incidence of psychological disorders, such as anxiety and depression, and decreased well-being in children with FGIDs. This review underlines that social media use is an emerging aspect of the psychosocial lives of children and adolescents; thus, it may be involved in FGID onset. Further studies in this field are needed to elucidate the link between social media and gastrointestinal health. Clinicians and politicians can play an important role in promoting the regulated and responsible use of digital platforms to protect the psychological health and preserve the well-being of children and adolescents.
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Affiliation(s)
- Mauro Cinquetti
- Maternal and Child Department, Azienda ULSS 9 Scaligera, Verona, Italy
| | - Vanessa Dargenio
- Department of Medical and Surgical Science, Pediatric Section, University of Foggia, Foggia, Italy
| | - Michele Fingerle
- Maternal and Child Department, Azienda ULSS 9 Scaligera, Verona, Italy
| | | | - Marco Biasin
- Department of Medicine, University of Verona, Verona, Italy
| | - Massimo Pettoello Mantovani
- European Pediatric Association, Union of National European Pediatric Societies and Associations, Berlin, GermanyAssociation pour l'Activité et la Recherche Scìentifiques, Nouchatel, Switzerland; University of Foggia, Foggia, Italy; Italian Society of Pedi
| | - Flavia Indrio
- Department of Medical and Surgical Science, Pediatric Section, University of Foggia, Foggia, Italy
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15
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Pettoello-Mantovani M, Pop TL, Giardino I, Vural M, Indrio F, Ferrara P. Lost in Transition: The Issue of Vanishing Unaccompanied Alien Children in Europe. J Pediatr 2022; 256:3-4.e1. [PMID: 36509159 DOI: 10.1016/j.jpeds.2022.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 12/06/2022] [Indexed: 12/14/2022]
Affiliation(s)
- Massimo Pettoello-Mantovani
- European Pediatric Association/Union of National European Pediatric Societies and Associations (EPA/UNEPSA), Berlin, Germany; Association for Scientific Activity and Research, Nouchatel, Switzerland; Italian Academy of Pediatrics, Milan, Italy.
| | - Tudor Lucian Pop
- European Pediatric Association/Union of National European Pediatric Societies and Associations (EPA/UNEPSA), Berlin, Germany; Association for Scientific Activity and Research, Nouchatel, Switzerland; Romania Society of Social Pediatrics, Cluj, Romania
| | - Ida Giardino
- Association for Scientific Activity and Research, Nouchatel, Switzerland; Department of Biomedical Sciences, University of Foggia, Foggia, Italy
| | - Mehmet Vural
- European Pediatric Association/Union of National European Pediatric Societies and Associations (EPA/UNEPSA), Berlin, Germany; Association for Scientific Activity and Research, Nouchatel, Switzerland; Turkish Pediatric Association, Istanbul, Turkey
| | - Flavia Indrio
- European Pediatric Association/Union of National European Pediatric Societies and Associations (EPA/UNEPSA), Berlin, Germany; Association for Scientific Activity and Research, Nouchatel, Switzerland
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16
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Indrio F, Marchese F, Beghetti I, Pettoello Mantovani M, Grillo A, Aceti A. Biotics in neonatal period: what's the evidence? Minerva Pediatr (Torino) 2022; 74:672-681. [PMID: 35912792 DOI: 10.23736/s2724-5276.22.06968-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Breastfeeding is considered the gold standard for infants' nutrition and provides unique benefits for infants' health. Great research interest has been raised about the use of bioactive components in neonatal medicine, both as standalone products and as addition to infant formula, in the attempt to reproduce human milk beneficial effects. Thus, the aim of this narrative review is to summarize most recent evidence on biotics' use in the neonatal period, with a focus on infant formula (IF) supplemented with probiotics, prebiotics, synbiotics and postbiotics. Growing data indicate overall positive effects of biotic supplemented formula on microbiome composition and metabolic activity. Furthermore, some benefits are also emerging from randomized controlled trials evaluating the clinical impact these enriched formulas may have on the health of formula fed infants. However, clear evidence still lacks and none of this supplemented IF has demonstrated conclusive superiority. To date, whereas no routine recommendations can be done, biotics supplemented IF have generally proven to be well-tolerated and safe in ensuring infants' normal growth, paving the way for future IF alternatives for those infants who are not able to be (fully) breastfed. More RCTs, with adequate design and statistical power, are still needed to better clarify, if present, which benefits the supplementation of IF may confer to infants' short and long-term outcomes.
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Affiliation(s)
- Flavia Indrio
- Pediatric Section, Department of Medical and Surgical Science, University of Foggia, Foggia, Italy -
| | - Flavia Marchese
- Pediatric Section, Department of Medical and Surgical Science, University of Foggia, Foggia, Italy
| | - Isadora Beghetti
- Neonatal Intensive Care Unit, Department of Medical and Surgical Sciences, University of Bologna, IRCCS University Hospital of Bologna, Bologna, Italy
| | | | - Assunta Grillo
- Pediatric Section, Department of Medical and Surgical Science, University of Foggia, Foggia, Italy
| | - Arianna Aceti
- Neonatal Intensive Care Unit, Department of Medical and Surgical Sciences, University of Bologna, IRCCS University Hospital of Bologna, Bologna, Italy
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17
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Pettoello-Mantovani M, Cokugras H, Ferrara P, Indrio F, Giardino I, Canpolat N, Kasapçopur Ö, Zeybek AC, Beser OF, Pettoello-Mantovani C, Cokugras FC. Child Brides and Forced Marriages: An Aspect of Child Abuse and Neglect. J Pediatr 2022; 250:116-117.e2. [PMID: 35940291 DOI: 10.1016/j.jpeds.2022.07.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 07/29/2022] [Indexed: 11/17/2022]
Affiliation(s)
- Massimo Pettoello-Mantovani
- European Pediatric Association, Union of National European Pediatric Societies and Associations, Berlin, Germany; Italian Academy of Pediatrics, Milan, Italy; Association for Scientific Research, Neuchatel, Switzerland.
| | | | - Pietro Ferrara
- European Pediatric Association, Union of National European Pediatric Societies and Associations, Berlin, Germany; Italian Academy of Pediatrics, Milan, Italy
| | - Flavia Indrio
- European Pediatric Association, Union of National European Pediatric Societies and Associations, Berlin, Germany
| | - Ida Giardino
- Association for Scientific Research, Neuchatel, Switzerland
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18
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Ferrara P, Ruiz R, Corsello G, Giardino I, Carrasco-Sanz A, Vural M, Namazova-Baranova L, Indrio F, Pop TL, Pettoello-Mantovani M. Adequate Training and Multidisciplinary Support May Assist Pediatricians in Properly Handling and Managing Gender Incongruence and Dysphoria. J Pediatr 2022; 249:121-123.e2. [PMID: 35853484 DOI: 10.1016/j.jpeds.2022.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 07/13/2022] [Indexed: 10/17/2022]
Affiliation(s)
- Pietro Ferrara
- European Pediatric Association/Union of National European Pediatric Societies and Associations (EPA/UNEPSA), Berlin, Germany; Department of Pediatrics, Campus BioMedico University, Rome, Italy
| | - Roberta Ruiz
- Department of Pediatrics, Catholic University of Sacred Hearth, Rome, Italy
| | - Giovanni Corsello
- European Pediatric Association/Union of National European Pediatric Societies and Associations (EPA/UNEPSA), Berlin, Germany; Department of Pediatrics, University of Palermo, Palermo, Italy; Italian Academy of Pediatrics, Milan, Italy
| | - Ida Giardino
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Angel Carrasco-Sanz
- European Pediatric Association/Union of National European Pediatric Societies and Associations (EPA/UNEPSA), Berlin, Germany; European Confederation of Primary Care Pediatrics, Lyon, France
| | - Mehmet Vural
- European Pediatric Association/Union of National European Pediatric Societies and Associations (EPA/UNEPSA), Berlin, Germany; Turkish Pediatric Association, Istanbul, Turkey
| | - Leyla Namazova-Baranova
- European Pediatric Association/Union of National European Pediatric Societies and Associations (EPA/UNEPSA), Berlin, Germany
| | - Flavia Indrio
- European Pediatric Association/Union of National European Pediatric Societies and Associations (EPA/UNEPSA), Berlin, Germany; Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Tudor Lucian Pop
- European Pediatric Association/Union of National European Pediatric Societies and Associations (EPA/UNEPSA), Berlin, Germany; Association for the Scientific Research Activities, Neuchâtel, Switzerland
| | - Massimo Pettoello-Mantovani
- European Pediatric Association/Union of National European Pediatric Societies and Associations (EPA/UNEPSA), Berlin, Germany; Italian Academy of Pediatrics, Milan, Italy; Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy; Association for the Scientific Research Activities, Neuchâtel, Switzerland.
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19
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Zaza P, Indrio F, Fracchiolla A, Rinaldi M, Meliota G, Salatto A, Bonacaro A, Maffei G. Cleft Palate and Aortic Dilatation as Clues for Loeys–Dietz Syndrome. Children 2022; 9:children9091290. [PMID: 36138598 PMCID: PMC9497579 DOI: 10.3390/children9091290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 08/19/2022] [Accepted: 08/23/2022] [Indexed: 11/16/2022]
Abstract
Loeys–Dietz syndrome (LDS) is a rare autosomal-dominant disorder of the connective tissue with some typical vascular findings, skeletal manifestations, craniofacial features, and cutaneous findings with a wide phenotypic spectrum. Six different genes are involved in LDS and the diagnosis is based on the identification of a heterozygous pathogenic variant in TGFBR1, TGFBR2, SMAD3, TGFB2, TGFB3, or SMAD2 in children with suggestive findings. These genes distinguish LDS into six classes (LDS1–LDS6, respectively). Delay in diagnosis of Loeys–Dietz syndrome may be associated with an adverse prognosis due to a very high augmented risk of early complications such as aortic or vascular rupture. The present report describes a case of an early diagnosis of LDS in a neonate with cleft soft palate and aortic root dilatation.
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Affiliation(s)
- Pierluigi Zaza
- Ospedali Riuniti Foggia Italy-U.O.C. Neonatologia e Terapia Intensiva Neonatale, 71100 Foggia, Italy
| | - Flavia Indrio
- Department of Medical and Surgical Science Pediatric Section, University of Foggia, 71100 Foggia, Italy
- Correspondence:
| | - Annalisa Fracchiolla
- Ospedali Riuniti Foggia Italy-U.O.C. Neonatologia e Terapia Intensiva Neonatale, 71100 Foggia, Italy
| | - Matteo Rinaldi
- Ospedali Riuniti Foggia Italy-U.O.C. Neonatologia e Terapia Intensiva Neonatale, 71100 Foggia, Italy
| | - Giovanni Meliota
- Ospedale Giovanni XXIII U.O. Cardiologia Pediatrica, 70124 Bari, Italy
| | - Alessia Salatto
- DAI Materno-Infantile, Azienda Ospedaliera-Universitaria Federico II di Napoli, 80100 Napoli, Italy
| | - Antonio Bonacaro
- School of Health and Sports Sciences, University of Suffolk, Ipswich IP4 1QJ, UK
| | - Gianfranco Maffei
- Ospedali Riuniti Foggia Italy-U.O.C. Neonatologia e Terapia Intensiva Neonatale, 71100 Foggia, Italy
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Di Profio E, Magenes VC, Fiore G, Agostinelli M, La Mendola A, Acunzo M, Francavilla R, Indrio F, Bosetti A, D’Auria E, Borghi E, Zuccotti G, Verduci E. Special Diets in Infants and Children and Impact on Gut Microbioma. Nutrients 2022; 14:nu14153198. [PMID: 35956374 PMCID: PMC9370825 DOI: 10.3390/nu14153198] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 07/29/2022] [Accepted: 08/01/2022] [Indexed: 02/07/2023] Open
Abstract
Gut microbiota is a complex system that starts to take shape early in life. Several factors influence the rise of microbial gut colonization, such as term and mode of delivery, exposure to antibiotics, maternal diet, presence of siblings and family members, pets, genetics, local environment, and geographical location. Breastfeeding, complementary feeding, and later dietary patterns during infancy and toddlerhood are major players in the proper development of microbial communities. Nonetheless, if dysbiosis occurs, gut microbiota may remain impaired throughout life, leading to deleterious consequences, such as greater predisposition to non-communicable diseases, more susceptible immune system and altered gut–brain axis. Children with specific diseases (i.e., food allergies, inborn errors of metabolism, celiac disease) need a special formula and later a special diet, excluding certain foods or nutrients. We searched on PubMed/Medline, Scopus and Embase for relevant pediatric studies published over the last twenty years on gut microbiota dietary patterns and excluded case reports or series and letters. The aim of this review is to highlight the changes in the gut microbiota in infants and children fed with special formula or diets for therapeutic requirements and, its potential health implications, with respect to gut microbiota under standard diets.
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Affiliation(s)
- Elisabetta Di Profio
- Department of Pediatrics, Vittore Buzzi Children’s Hospital, Università di Milano, 20154 Milan, Italy
| | - Vittoria Carlotta Magenes
- Department of Pediatrics, Vittore Buzzi Children’s Hospital, Università di Milano, 20154 Milan, Italy
| | - Giulia Fiore
- Department of Pediatrics, Vittore Buzzi Children’s Hospital, Università di Milano, 20154 Milan, Italy
| | - Marta Agostinelli
- Department of Pediatrics, Vittore Buzzi Children’s Hospital, Università di Milano, 20154 Milan, Italy
| | - Alice La Mendola
- Department of Pediatrics, Vittore Buzzi Children’s Hospital, Università di Milano, 20154 Milan, Italy
| | - Miriam Acunzo
- Department of Pediatrics, Vittore Buzzi Children’s Hospital, Università di Milano, 20154 Milan, Italy
| | - Ruggiero Francavilla
- Pediatric Section, Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70121 Bari, Italy
| | - Flavia Indrio
- Department of Medical and Surgical Sciences, University of Foggia, 71122 Foggia, Italy
| | - Alessandra Bosetti
- Department of Pediatrics, Vittore Buzzi Children’s Hospital, Università di Milano, 20154 Milan, Italy
| | - Enza D’Auria
- Department of Pediatrics, Vittore Buzzi Children’s Hospital, Università di Milano, 20154 Milan, Italy
- Correspondence:
| | - Elisa Borghi
- Department of Health Sciences, University of Milan, 20142 Milan, Italy
| | - Gianvincenzo Zuccotti
- Department of Pediatrics, Vittore Buzzi Children’s Hospital, Università di Milano, 20154 Milan, Italy
- Department of Biomedical and Clinical Sciences L. Sacco, University of Milan, 20144 Milan, Italy
- Pediatric Clinical Research Center, Fondazione Romeo ed Enrica Invernizzi, University of Milan, 20122 Milan, Italy
| | - Elvira Verduci
- Department of Pediatrics, Vittore Buzzi Children’s Hospital, Università di Milano, 20154 Milan, Italy
- Department of Health Sciences, University of Milan, 20142 Milan, Italy
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Cinquetti M, Dargenio V, Giardino I, Pettoello-Mantovani M, Indrio F. Social Media and Functional Gastrointestinal Disorders in Children. J Pediatr 2022; 247:182-183.e3. [PMID: 35533744 DOI: 10.1016/j.jpeds.2022.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 05/03/2022] [Indexed: 02/07/2023]
Affiliation(s)
- Mauro Cinquetti
- Dipartimento Materno Infantile, AULSS 9 Scaligera, Verona, Italy
| | - Vanessa Dargenio
- European Pediatric Association, Union of National European Pediatric Societies and Associations, Berlin, Germany; Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Ida Giardino
- European Pediatric Association, Union of National European Pediatric Societies and Associations, Berlin, Germany; Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy; Section of Social Pediatrics, Association for Scientific and Research Activities (ARS), Neuchâtel, Switzerland
| | - Massimo Pettoello-Mantovani
- European Pediatric Association, Union of National European Pediatric Societies and Associations, Berlin, Germany; Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy; Section of Social Pediatrics, Association for Scientific and Research Activities (ARS), Neuchâtel, Switzerland.
| | - Flavia Indrio
- European Pediatric Association, Union of National European Pediatric Societies and Associations, Berlin, Germany; Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
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22
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Indrio F, Dargenio VN, Marchese F, Giardino I, Vural M, Carrasco-Sanz A, Pietrobelli A, Pettoello-Mantovani M. The Importance of Strengthening Mother and Child Health Services during the First 1000 Days of Life: The Foundation of Optimum Health, Growth and Development. J Pediatr 2022; 245:254-256.e0. [PMID: 35259398 DOI: 10.1016/j.jpeds.2022.03.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 03/01/2022] [Indexed: 10/18/2022]
Affiliation(s)
- Flavia Indrio
- Department of Medicine and Surgery, University of Foggia, Foggia, Italy
| | | | - Flavia Marchese
- Department of Medicine and Surgery, University of Foggia, Foggia, Italy
| | - Ida Giardino
- Department of Clinical and Experimental Sciences, University of Foggia, Foggia, Italy
| | - Mehmet Vural
- European Pediatric Association, Union of National European Pediatric Societies and Associations, Berlin, Germany; Association for Scientific Research, Nouchatel, Switzerland, Nouchatel, Switzerland; Turkish Pediatric Association, Istanbul, Turkey
| | - Angel Carrasco-Sanz
- European Pediatric Association, Union of National European Pediatric Societies and Associations, Berlin, Germany; Association for Scientific Research, Nouchatel, Switzerland, Nouchatel, Switzerland; European Confederation of Primary Care Pediatricians, Lyon, France
| | - Angelo Pietrobelli
- Women's and Children's Hospital, Section 1000 days of Life, University of Verona, Verona, Italy; Pennington Biomedical Research Center, Baton Rouge, LA
| | - Massimo Pettoello-Mantovani
- European Pediatric Association, Union of National European Pediatric Societies and Associations, Berlin, Germany; Association for Scientific Research, Nouchatel, Switzerland, Nouchatel, Switzerland; Italian Academy of Pediatrics, Milan, Italy.
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Pettoello-Mantovani M, Cardemil C, Cohen R, Levy C, Giardino I, Indrio F, Somekh E. Importance of Coronavirus Disease 2019 Vaccination in Children: Viewpoint and Recommendations of the Union of European National Societies of Pediatrics. J Pediatr 2022; 243:242-245. [PMID: 34973285 PMCID: PMC8716156 DOI: 10.1016/j.jpeds.2021.12.066] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 12/28/2021] [Indexed: 12/19/2022]
Affiliation(s)
- Massimo Pettoello-Mantovani
- European Paediatric Association/Union of National European Paediatric Societies and Associations (EPA/UNEPSA), Berlin, Germany; Association pour l'Activité et la Recherche Scìentifiques, ARS, Nouchatel, Switzerland; Italian Academy of Pediatrics, Milan, Italy; Department of Pediatrics, University of Foggia, "Casa Sollievo" Scientific Institute, San Giovanni Rotondo, Italy
| | - Cristina Cardemil
- Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health (NIH), Rockville, MD
| | - Robert Cohen
- Pediatric Infectious Disease Group (GPIP), Créteil, France; Association Clinique et thérapeutique Infantile du Val de Marne, Créteil, France; Paris Est University, IMRB-GRC GEMINI, Créteil, France
| | - Corinne Levy
- Pediatric Infectious Disease Group (GPIP), Créteil, France; Association Clinique et thérapeutique Infantile du Val de Marne, Créteil, France; Paris Est University, IMRB-GRC GEMINI, Créteil, France
| | - Ida Giardino
- Department of Biomedical Sciences, University of Foggia, Foggia, Italy
| | - Flavia Indrio
- Department of Pediatrics, University of Foggia, "Casa Sollievo" Scientific Institute, San Giovanni Rotondo, Italy
| | - Eli Somekh
- European Paediatric Association/Union of National European Paediatric Societies and Associations (EPA/UNEPSA), Berlin, Germany; Association pour l'Activité et la Recherche Scìentifiques, ARS, Nouchatel, Switzerland; Department of Pediatrics, Mayanei Hayeshuah Medical Center, Bnei Brak, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Israel Pediatric Society, Tel Aviv, Israel
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24
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Dargenio VN, Cristofori F, Dargenio C, Giordano P, Indrio F, Celano G, Francavilla R. Use of Limosilactobacillus reuteri DSM 17938 in paediatric gastrointestinal disorders: an updated review. Benef Microbes 2022; 13:221-242. [PMID: 35212258 DOI: 10.3920/bm2021.0151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Strains of lactobacilli are the most widely used probiotics and can be found in a large variety of food products and food supplements throughout the world. In this study, the evidence on Limosilactobacillus reuteri DSM 17938 (LR DSM 17938) has been reviewed. This species secretes reuterin and other substances singularly or in microvesicles, inhibiting pathogen growth and interacting with the intestinal microbiota and mucosa, restoring homeostasis. The use of LR DSM 17938 has been exploited in several pathological conditions. Preclinical research has shown that this probiotic can ameliorate dysbiosis and, by interacting with intestinal mucosal cells, can raise the pain threshold and promote gastrointestinal motility. These aspects are amongst the significant components in functional gastrointestinal disorders, such as colic and regurgitation in infants, functional abdominal pain and functional constipation in children and adolescents. This strain can decrease the duration of acute diarrhoea and hospitalization for acute gastroenteritis but does not seem to prevent nosocomial diarrhoea and antibiotic-associated diarrhoea. Because of its ability to survive in the gastric environment, it has been tested in Helicobacter pylori infection, showing a significant decrease of antibiotic-associated side effects and a tendency to increase the eradication rate. Finally, all these studies have shown the excellent safety of LR DSM 17938 even at higher dosages. In conclusion data from various clinical trials here reviewed can guide the clinician to find the correct dose, frequency of administration, and therapy duration.
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Affiliation(s)
- V N Dargenio
- Interdisciplinary Department of Medicine, Paediatric Section. University of Bari Aldo Moro, Children's Hospital 'Giovanni XXIII', Via Amendola 207, 70126 Bari, Italy
| | - F Cristofori
- Interdisciplinary Department of Medicine, Paediatric Section. University of Bari Aldo Moro, Children's Hospital 'Giovanni XXIII', Via Amendola 207, 70126 Bari, Italy
| | - C Dargenio
- Interdisciplinary Department of Medicine, Paediatric Section. University of Bari Aldo Moro, Children's Hospital 'Giovanni XXIII', Via Amendola 207, 70126 Bari, Italy
| | - P Giordano
- Interdisciplinary Department of Medicine, Paediatric Section. University of Bari Aldo Moro, Children's Hospital 'Giovanni XXIII', Via Amendola 207, 70126 Bari, Italy
| | - F Indrio
- Department of Paediatrics, University of Foggia, Via Pinto 1, 71100 Foggia, Italy
| | - G Celano
- Department of Soil, Plant and Food Science, University of Bari Aldo Moro, Via Amendola 265/a, 70126 Bari, Italy
| | - R Francavilla
- Interdisciplinary Department of Medicine, Paediatric Section. University of Bari Aldo Moro, Children's Hospital 'Giovanni XXIII', Via Amendola 207, 70126 Bari, Italy
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25
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Salatto A, Indrio F, Campanella V, Maggipinto C, Cocomazzi R, Canale F, Nobili M, Maffei G, Bartoli F. Correction to: Idiopathic neonatal hemoperitoneum presented as scrotal hematoma: it's a diagnostic challenge? Ital J Pediatr 2022; 48:16. [PMID: 35101063 PMCID: PMC8805336 DOI: 10.1186/s13052-022-01212-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Alessia Salatto
- Department of Medical and Surgical Science University of Foggia, Pediatric Surgery Ospedali Riuniti Foggia, Foggia, Italy
| | - Flavia Indrio
- Department of Medical and Surgical Science University of Foggia, Pediatric Surgery Ospedali Riuniti Foggia, Foggia, Italy.
| | - Vittoria Campanella
- Department of Medical and Surgical Science University of Foggia, Pediatric Surgery Ospedali Riuniti Foggia, Foggia, Italy
| | - Cosetta Maggipinto
- Department of Medical and Surgical Science University of Foggia, Pediatric Surgery Ospedali Riuniti Foggia, Foggia, Italy
| | | | - Francesco Canale
- Department of Pediatric Surgery, AUO "Ospedali Riuniti", Foggia, Italy
| | - Maria Nobili
- Department of Pediatric Surgery, AUO "Ospedali Riuniti", Foggia, Italy
| | | | - Fabio Bartoli
- Department of Medical and Surgical Science University of Foggia, Pediatric Surgery Ospedali Riuniti Foggia, Foggia, Italy
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Indrio F, Marchese F, Rinaldi M, Maffei G, Dargenio V, Cinquepalmi R, Mantovani MP, Aceti A. Is acidemia at birth a risk factor for functional gastrointestinal disorders? Eur J Pediatr 2022; 181:3625-3633. [PMID: 35927380 PMCID: PMC9508039 DOI: 10.1007/s00431-022-04565-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 06/15/2022] [Accepted: 07/11/2022] [Indexed: 11/25/2022]
Abstract
UNLABELLED Functional gastrointestinal disorders (FGIDs) are common in early childhood. It has been demonstrated that neonatal acidemia at delivery can lead to significant neonatal morbidity. The primary aim of this study was to evaluate the relationship between acidemia at birth and the development of FGIDs, as regurgitation, colic, and constipation, in term infants. Term newborns born at the Foggia University Hospital, Italy during the year 2020 were included in the study. As per routine clinical practice, a cord blood gas analysis on a blood sample drawn from the umbilical artery (UA) of each infant immediately after birth was performed, and Apgar score was recorded. One year after birth, each infant's parents were interviewed through a phone call to investigate development of FGIDs, feeding practices, and morbidities. During the study period, 1574 term newborns met the inclusion criteria. The prevalence of infantile colic, regurgitation, and constipation was higher in infants with low UA pH (colic 51.5% vs. 25.4%, p < 0.001; regurgitation 30.6% vs. 15.2%, p < 0.001; constipation 24.6% vs. 16.0%, p = 0.015), with infants having moderate-severe acidemia facing the highest risk for all the examined FGIDs. In binary logistic regression analyses, UA pH and perinatal antibiotic exposure proved to be independently associated with the later diagnosis of each FGID. CONCLUSION Newborns with acidemia at birth appear to face a higher risk of FGIDs in infancy. Avoiding low cord blood pH should continue to be the goal for obstetricians, while enhanced long-term surveillance for infants who experienced birth acidemia should be required. WHAT IS KNOWN • Cord blood gas analysis is recommended in all high-risk deliveries, and in some centers, it is performed after all deliveries. • Neonatal acidemia at birth has been linked to adverse outcomes, mainly neurological. Recently, perinatal asphyxia has been reported to increase the risk of developing necrotizing enterocolitis in term infants. WHAT IS NEW • An association between acidemia at birth and risk of developing FGIDs such as regurgitation and colic during the first year of life had never been described so far. • An increased surveillance of infants with low UA pH at birth may be beneficial and could allow for early detection of any of the reported FGIDs.
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Affiliation(s)
- Flavia Indrio
- Department of Medical and Surgical Science, Pediatric Section, University of Foggia, Viale Pinto 1, 71122, Foggia, Italy.
| | - Flavia Marchese
- Department of Medical and Surgical Science, Pediatric Section, University of Foggia, Viale Pinto 1, 71122 Foggia, Italy
| | - Matteo Rinaldi
- Department of Neonatology and NICU, Ospedali Riuniti Foggia, Viale Pinto 1, 71122 Foggia, Italy
| | - Gianfranco Maffei
- Department of Neonatology and NICU, Ospedali Riuniti Foggia, Viale Pinto 1, 71122 Foggia, Italy
| | - Vanessa Dargenio
- Department of Medical and Surgical Science, Pediatric Section, University of Foggia, Viale Pinto 1, 71122 Foggia, Italy
| | - Roberta Cinquepalmi
- Department of Medical and Surgical Science, Pediatric Section, University of Foggia, Viale Pinto 1, 71122 Foggia, Italy
| | - Massimo Pettoello Mantovani
- European Pediatric Association, Union of National European Pediatric Societies and Associations, Berlin, Germany ,Association Pour L’Activité Et La Recherche Scìentifiques, Nouchatel, Switzerland ,University of Foggia, Foggia, Italy ,Italian Society of Pediatrics, Rome, Italy ,Italian Academy of Pediatrics, Milan, Italy
| | - Arianna Aceti
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy ,Neonatal Intensive Care Unit, IRCCS AOUBO, Via Massarenti 9, 40138 Bologna, Italy
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Cristofori F, D’Abramo FS, Rutigliano V, Dargenio VN, Castellaneta S, Piscitelli D, De Benedittis D, Indrio F, Raguseo LC, Barone M, Francavilla R. Esophageal Eosinophilia and Eosinophilic Esophagitis in Celiac Children: A Ten Year Prospective Observational Study. Nutrients 2021; 13:nu13113755. [PMID: 34836010 PMCID: PMC8625488 DOI: 10.3390/nu13113755] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 10/12/2021] [Accepted: 10/19/2021] [Indexed: 02/07/2023] Open
Abstract
UNLABELLED The association between eosinophilic esophagitis and celiac disease is still controversial and its prevalence is highly variable. We aimed to investigate the prevalence of esophageal eosinophilia and eosinophilic esophagitis in a large group of children with celiac disease, prospectively followed over 11 years. METHODS Prospective observational study performed between 2008 and 2019. Celiac disease diagnosis was based on ESPGHAN criteria. At least four esophageal biopsies were sampled in patients who underwent endoscopy. The presence of at least 15 eosinophils/HPF on esophageal biopsies was considered suggestive of esophageal eosinophilia; at the same time, eosinophilic esophagitis was diagnosed according to the International Consensus Diagnostic Criteria for Eosinophilic Esophagitis. RESULTS A total of 465 children (M 42% mean age 7.1 years (range: 1-16)) were diagnosed with celiac disease. Three hundred and seventy patients underwent endoscopy, and esophageal biopsies were available in 313. The prevalence of esophageal eosinophilia in children with celiac disease was 1.6% (95% CI: 0.54-2.9%). Only one child was diagnosed as eosinophilic esophagitis; we calculated a prevalence of 0.3% (95% CI: 0.2-0.5%). The odds ratio for an association between eosinophilic esophagitis and celiac disease was at least 6.5 times higher (95% CI: 0.89-47.7%; p = 0.06) than in the general population. CONCLUSION The finding of an increased number of eosinophils (>15/HPF) in celiac patients does not have a clinical implication or warrant intervention, and therefore we do not recommend routine esophageal biopsies unless clinically indicated.
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Affiliation(s)
- Fernanda Cristofori
- Interdisciplinary Department of Medicine, Pediatric Section “B. Trambusti”, University of Bari “Aldo Moro”, Via Amendola 207, 70126 Bari, Italy; (F.C.); (V.R.); (V.N.D.); (S.C.); (L.C.R.)
| | - Fulvio Salvatore D’Abramo
- Department of Emergency and Organ Transplantation, Section of Gastroenterology, University of Bari “Aldo Moro”, Piazza G. Cesare 11, 70124 Bari, Italy; (F.S.D.); (M.B.)
| | - Vincenzo Rutigliano
- Interdisciplinary Department of Medicine, Pediatric Section “B. Trambusti”, University of Bari “Aldo Moro”, Via Amendola 207, 70126 Bari, Italy; (F.C.); (V.R.); (V.N.D.); (S.C.); (L.C.R.)
| | - Vanessa Nadia Dargenio
- Interdisciplinary Department of Medicine, Pediatric Section “B. Trambusti”, University of Bari “Aldo Moro”, Via Amendola 207, 70126 Bari, Italy; (F.C.); (V.R.); (V.N.D.); (S.C.); (L.C.R.)
| | - Stefania Castellaneta
- Interdisciplinary Department of Medicine, Pediatric Section “B. Trambusti”, University of Bari “Aldo Moro”, Via Amendola 207, 70126 Bari, Italy; (F.C.); (V.R.); (V.N.D.); (S.C.); (L.C.R.)
| | - Domenico Piscitelli
- Department of Emergency and Organ Transplantation, Section of Pathology, University of Bari “Aldo Moro”, Piazza G. Cesare 11, 70124 Bari, Italy;
| | - Davide De Benedittis
- Department of Information Engineering, University of Pisa, Largo L. Lazzarino 2, 56122 Pisa, Italy;
| | - Flavia Indrio
- Department of Medical and Surgical Science, University of Foggia, Viale L. Pinto, 71122 Foggia, Italy;
| | - Lidia Celeste Raguseo
- Interdisciplinary Department of Medicine, Pediatric Section “B. Trambusti”, University of Bari “Aldo Moro”, Via Amendola 207, 70126 Bari, Italy; (F.C.); (V.R.); (V.N.D.); (S.C.); (L.C.R.)
| | - Michele Barone
- Department of Emergency and Organ Transplantation, Section of Gastroenterology, University of Bari “Aldo Moro”, Piazza G. Cesare 11, 70124 Bari, Italy; (F.S.D.); (M.B.)
| | - Ruggiero Francavilla
- Interdisciplinary Department of Medicine, Pediatric Section “B. Trambusti”, University of Bari “Aldo Moro”, Via Amendola 207, 70126 Bari, Italy; (F.C.); (V.R.); (V.N.D.); (S.C.); (L.C.R.)
- Correspondence: ; Tel.: +39-080-5592063
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28
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Ferrara P, Franceschini G, Corsello G, Mestrovic J, Giardino I, Vural M, Pop TL, Namazova-Baranova L, Somekh E, Indrio F, Pettoello-Mantovani M. Effects of Coronavirus Disease 2019 (COVID-19) on Family Functioning. J Pediatr 2021; 237:322-323.e2. [PMID: 34224744 PMCID: PMC8253665 DOI: 10.1016/j.jpeds.2021.06.082] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 06/30/2021] [Indexed: 02/05/2023]
Affiliation(s)
- Pietro Ferrara
- European Paediatric Association/Union of National European Paediatric Societies and Associations, Berlin, Germany; Italian Society of Pediatrics, Rome, Italy; Division of Pediatrics, University Campus BioMedico, Rome, Italy
| | | | - Giovanni Corsello
- European Paediatric Association/Union of National European Paediatric Societies and Associations, Berlin, Germany; Italian Society of Pediatrics, Rome, Italy
| | - Julije Mestrovic
- European Paediatric Association/Union of National European Paediatric Societies and Associations, Berlin, Germany; Division of Pediatrics, Medical School of Split, University Hospital of Split, Split, Croatia
| | - Ida Giardino
- Department of Biomedical Sciences, University of Foggia, Foggia, Italy
| | - Mehmet Vural
- European Paediatric Association/Union of National European Paediatric Societies and Associations, Berlin, Germany; Division of Pediatrics, Medical Faculty, University of Istanbul, Istanbul University Cerrahpaşa, Istanbul, Turkey
| | - Tudor Lucian Pop
- European Paediatric Association/Union of National European Paediatric Societies and Associations, Berlin, Germany; Division of Pediatrics, University of Medicine and Pharmacy Iuliu Haţieganu, Cluj-Napoca, Romania
| | - Leyla Namazova-Baranova
- European Paediatric Association/Union of National European Paediatric Societies and Associations, Berlin, Germany; Russian Academy of Pediatrics, Moscow, Russia
| | - Eli Somekh
- European Paediatric Association/Union of National European Paediatric Societies and Associations, Berlin, Germany; Department of Pediatrics, Mayanei Hayeshuah Medical Center, Bnei Brak, Israel
| | - Flavia Indrio
- European Paediatric Association/Union of National European Paediatric Societies and Associations, Berlin, Germany; Department of Pediatrics, Scientific Institute "Casa Sollievo della Sofferenza", Foggia, Italy
| | - Massimo Pettoello-Mantovani
- European Paediatric Association/Union of National European Paediatric Societies and Associations, Berlin, Germany; Department of Pediatrics, Scientific Institute "Casa Sollievo della Sofferenza", Foggia, Italy.
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Indrio F, Pettoello Mantovani M, Salatto A, Rinaldi M, Nadia Dargenio V, Cristofori F, Marchese F, Paolo Bianchi F, Nappi L, Maffei G. Retrospective Study on Breastfeeding Practices by SARS-COV-2 Positive Mothers in a High Risk Area for Coronavirus Infection. Turk Arch Pediatr 2021; 56:479-484. [PMID: 35110118 PMCID: PMC8849628 DOI: 10.5152/turkarchpediatr.2021.21156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND During the pandemic of SARS-Cov-2, among other clinical and public health issues, a major concern raised by SARS-CoV-2 is the possibility of transmission of the infection from mother to child in the perinatal period. This has placed a question mark on the safety of breastfeeding, with ambiguity on the joint management of SARS-CoV-2 positive or suspected mothers and their children. It was aimed to evaluate breastfeeding rates for newborns of asymptomatic SARS-CoV-2 positive mothers who were temporarily separated from their babies at birth, compared to those who were not separated. RESULTS Babies who were not isolated from their mothers at delivery were significantly more likely to be breastfed and were at no higher risk of infection with SARS-CoV-2. CONCLUSION Following the World Health Organization (WHO) recommendations and strict hand and mask hygiene measures, breastfeeding practices can be established and maintained through rooming-in, thus promoting the mother-child bond without compromising the safety of the newborn.
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Affiliation(s)
- Flavia Indrio
- Department of Medical and Surgical Science, University of Foggia, Italy,Corresponding author:Flavia Indrio ✉
| | | | - Alessia Salatto
- Department of Medical and Surgical Science, University of Foggia, Italy
| | - Matteo Rinaldi
- Department of Neonatology and NICU, Ospedali Riuniti, Foggia, Italy
| | - Vanessa Nadia Dargenio
- Department of Medical and Surgical Science, University of Foggia, Italy,Department of Biomedical Sciences and Human Oncology, “A. Moro” University, Bari, Italy
| | - Fernanda Cristofori
- Department of Biomedical Sciences and Human Oncology, “A. Moro” University, Bari, Italy
| | - Flavia Marchese
- Department of Medical and Surgical Science, University of Foggia, Italy
| | | | - Luigi Nappi
- Department of Medical and Surgical Science, University of Foggia, Italy
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Ferrara P, Franceschini G, Corsello G, Mestrovic J, Giardino I, Vural M, Pop TL, Namazova-Baranova L, Indrio F, Pettoello-Mantovani M. Increased Exposure to Violence and Risk of Neurodevelopmental Disorders in Children. J Pediatr 2021; 236:335-336.e2. [PMID: 34102213 DOI: 10.1016/j.jpeds.2021.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 06/02/2021] [Indexed: 02/06/2023]
Affiliation(s)
- Pietro Ferrara
- European Paediatric Association/Union of National European Paediatric Societies and Associations (EPA/UNEPSA), Berlin, Germany; Italian Society of Pediatrics, Rome, Italy; University Campus BioMedico, Rome, Italy
| | | | - Giovanni Corsello
- European Paediatric Association/Union of National European Paediatric Societies and Associations (EPA/UNEPSA), Berlin, Germany; Italian Society of Pediatrics, Rome, Italy
| | - Julije Mestrovic
- European Paediatric Association/Union of National European Paediatric Societies and Associations (EPA/UNEPSA), Berlin, Germany; Medical School of Split, University Hospital of Split, Split, Croatia
| | - Ida Giardino
- Department of Biomedical Sciences, University of Foggia, Foggia, Italy
| | - Mehmet Vural
- European Paediatric Association/Union of National European Paediatric Societies and Associations (EPA/UNEPSA), Berlin, Germany; Faculty of Medicine, Istanbul University Cerrahpaşa, Istanbul, Turkey
| | - Tudor Lucian Pop
- European Paediatric Association/Union of National European Paediatric Societies and Associations (EPA/UNEPSA), Berlin, Germany; University of Medicine and Pharmacy Iuliu Haţieganu, Cluj-Napoca, Romania
| | - Leyla Namazova-Baranova
- European Paediatric Association/Union of National European Paediatric Societies and Associations (EPA/UNEPSA), Berlin, Germany; Russian Academy of Pediatrics, Moscow, Russia
| | - Flavia Indrio
- European Paediatric Association/Union of National European Paediatric Societies and Associations (EPA/UNEPSA), Berlin, Germany; Department of Pediatrics, Scientific Institute "Casa Sollievo della Sofferenza", Foggia, Italy
| | - Massimo Pettoello-Mantovani
- European Paediatric Association/Union of National European Paediatric Societies and Associations (EPA/UNEPSA), Berlin, Germany; Department of Pediatrics, Scientific Institute "Casa Sollievo della Sofferenza", Foggia, Italy.
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Moltu SJ, Bronsky J, Embleton N, Gerasimidis K, Indrio F, Köglmeier J, de Koning B, Lapillonne A, Norsa L, Verduci E, Domellöf M. Nutritional Management of the Critically Ill Neonate: A Position Paper of the ESPGHAN Committee on Nutrition. J Pediatr Gastroenterol Nutr 2021; 73:274-289. [PMID: 33605663 DOI: 10.1097/mpg.0000000000003076] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVES The nutritional management of critically ill term neonates and preterm infants varies widely, and controversies exist in regard to when to initiate nutrition, mode of feeding, energy requirements, and composition of enteral and parenteral feeds. Recommendations for nutritional support in critical illness are needed. METHODS The ESPGHAN Committee on Nutrition (ESPGHAN-CoN) conducted a systematic literature search on nutritional support in critically ill neonates, including studies on basic metabolism. The Medline database and the Cochrane Library were used in the search for relevant publications. The quality of evidence was reviewed and discussed before voting on recommendations, and a consensus of 90% or more was required for the final approval. Important research gaps were also identified. RESULTS This position paper provides clinical recommendations on nutritional support during different phases of critical illness in preterm and term neonates based on available literature and expert opinion. CONCLUSION Basic research along with adequately powered trials are urgently needed to resolve key uncertainties on metabolism and nutrient requirements in this heterogeneous patient population.
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Affiliation(s)
| | - Jiri Bronsky
- Department of Paediatrics, University Hospital Motol, Prague, Czech Republic
| | - Nicholas Embleton
- Newcastle Neonatal Service, Newcastle Hospitals NHS Trust and Newcastle University, Newcastle upon Tyne, UK
| | - Konstantinos Gerasimidis
- Human Nutrition, School of Medicine, Dentistry and Nursing, University of Glasgow, New Lister Building, Glasgow Royal Infirmary, Glasgow, UK
| | - Flavia Indrio
- Department of Medical and Surgical Sciences, University of Foggia, Italy
| | - Jutta Köglmeier
- Department of paediatric Gastroenterology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Barbara de Koning
- Paediatric Gastroenterology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Alexandre Lapillonne
- Paris University, APHP Necker-Enfants Malades hospital, Paris, France and CNRC, Baylor College of Medicine, Houston, TX
| | - Lorenzo Norsa
- Paediatreic Hepatology Gastroenterology and Transplantation, ASST Papa Giovanni XXIIII, Bergamo, Italy
| | - Elvira Verduci
- Department of Health Sciences, University of Milan; Department of Paediatrics, Ospedale dei Bambini Vittore Buzzi Milan, Italy
| | - Magnus Domellöf
- Department of Clinical Sciences, Paediatrics, Umeå University, Umeå, Sweden
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Campanella V, Salatto A, Rinaldi M, Indrio F, Maggipinto C, Cocomazzi R, Canale F, Fracchiolla A, Nobili M, Maffei G, Bartoli F. Midgut volvulus and meconium peritonitis induced non-immune hydrops. Journal of Pediatric Surgery Case Reports 2021. [DOI: 10.1016/j.epsc.2021.101927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Indrio F, Enninger A, Aldekhail W, Al-Ghanem G, Al-Hussaini A, Al-Hussaini B, Al-Refaee F, Al-Said K, Eid B, Faysal W, Hijazeen R, Isa HM, Onkarappa D, Rawashdeh M, Rohani P, Sokhn M. Management of the Most Common Functional Gastrointestinal Disorders in Infancy: The Middle East Expert Consensus. Pediatr Gastroenterol Hepatol Nutr 2021; 24:325-336. [PMID: 34316467 PMCID: PMC8279821 DOI: 10.5223/pghn.2021.24.4.325] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 03/24/2021] [Accepted: 05/15/2021] [Indexed: 11/18/2022] Open
Abstract
The occurrence of functional gastrointestinal disorders (FGIDs) is a formidable challenge for infants, parents, and healthcare professionals. Although data from the Middle East are scarce, experts consider FGIDs a prevalent condition in everyday clinical practice. The new Rome IV criteria revisited the definitions from a clinical perspective to provide a practical and consistent diagnostic protocol for FGIDs. However, the treatment practices for functional disorders vary considerably among Middle Eastern countries, often resulting in mismanagement with unnecessary investigations and treatments. In addition, the role of various treatment modalities, including probiotics such as Lactobacillus reuteri DSM 17938, in FGIDs requires further discussion and evaluation. During a consensus meeting, a locally relevant approach for treating common FGIDs such as infant regurgitation, infant colic, and functional constipation was discussed and approved by regional experts. The participants suggested a simplified treatment plan and protocol for general pediatricians and other primary care physicians managing FGIDs. This easy-to-follow standardized protocol will help streamline the initial management of this complex disorder in the Middle East region and even globally.
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Affiliation(s)
- Flavia Indrio
- Department of Medical and Surgical Science, University of Foggia, Foggia, Italy
| | - Axel Enninger
- Department of General and Special Pediatrics, Olga Hospital (Klinikum Stuttgart), Stuttgart, Germany
| | - Wajeeh Aldekhail
- Department of Pediatric Gastroenterology, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Ghanem Al-Ghanem
- Department of Neonatal Perinatal Medicine, Adan Hospital, Ahmadi, Kuwait
| | - Abdulrahman Al-Hussaini
- Division of Pediatric Gastroenterology, Children's Specialized Hospital, King Fahad Medical City, College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Bakr Al-Hussaini
- Department of Pediatric Gastroenterology, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - Fawaz Al-Refaee
- Pediatrics Department, Al-Adan Hospital, Ministry of Health, Kuwait City, Kuwait
| | - Khoula Al-Said
- Department of Child Health, Pediatric Gastroenterology, Hepatology and Nutrition, Royal Hospital, Muscat, Oman
| | - Bassam Eid
- Pediatrics/Pediatric Gastroenterology Unit, Hotel Dieu de France, Beirut, Lebanon
| | - Wafaa Faysal
- Pediatric Department, Dr Sulaiman Al Habib Hospital, Dubai, UAE
| | | | - Hasan M.A. Isa
- Pediatric Department, Salmaniya Medical Complex/Arabian Gulf University, Manama, Bahrain
| | | | | | - Pejman Rohani
- Department of Pediatrics, Mofid Children's Hospital, Pediatric Gastroenterology, Hepatology, and Nutrition Research Center, Research Institute for Children Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maroun Sokhn
- Pediatric Department, Saint George Hospital, Beirut, Lebanon
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Salatto A, Indrio F, Campanella V, Curci M, Maggipinto C, Cocomazzi R, Canale F, Nobili M, Bartoli F. A Rare Case of Mesenteric Chylous Cyst in Infant: Case Report and Review of Literature. Front Surg 2021; 8:666488. [PMID: 34195222 PMCID: PMC8236529 DOI: 10.3389/fsurg.2021.666488] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 05/19/2021] [Indexed: 11/13/2022] Open
Abstract
The occurrence of a mesenteric cyst (MC) is common in adults while in children and in infants is rare. In adults mesenteric cysts are often asymptomatic and discovered incidentally; however, in children they commonly present with symptoms of abdominal pain or distension with fever and leucocytosis. We report on a rare case, in our experience, of Mesenteric Chylous cyst (MCC) in an infant with signs and symptoms of intestinal obstruction. Discussion of literature is also reported.
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Affiliation(s)
- Alessia Salatto
- Department of Medical and Surgical Science, University of Foggia, Foggia, Italy
| | - Flavia Indrio
- Department of Medical and Surgical Science, University of Foggia, Foggia, Italy
| | - Vittoria Campanella
- Department of Medical and Surgical Science, University of Foggia, Foggia, Italy
| | - Marina Curci
- Department of Medical and Surgical Science, University of Foggia, Foggia, Italy
| | - Cosetta Maggipinto
- Department of Medical and Surgical Science, University of Foggia, Foggia, Italy
| | - Raffaella Cocomazzi
- Department of Medical and Surgical Science, University of Foggia, Foggia, Italy
| | - Francesco Canale
- Department of Medical and Surgical Science, University of Foggia, Foggia, Italy
| | - Maria Nobili
- Department of Medical and Surgical Science, University of Foggia, Foggia, Italy
| | - Fabio Bartoli
- Department of Medical and Surgical Science, University of Foggia, Foggia, Italy
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35
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Kaban RK, Wardhana, Hegar B, Rohsiswatmo R, Handryastuti S, Amelia N, Muktiarti D, Indrio F, Vandenplas Y. Lactobacillus reuteri DSM 17938 Improves Feeding Intolerance in Preterm Infants. Pediatr Gastroenterol Hepatol Nutr 2019; 22:545-553. [PMID: 31777720 PMCID: PMC6856506 DOI: 10.5223/pghn.2019.22.6.545] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Accepted: 06/15/2019] [Indexed: 01/29/2023] Open
Abstract
PURPOSE Feeding tolerance is extremely important in preterm infants. This study aimed to evaluate whether preterm infants receiving Lactobacillus reuteri DSM 17938 would develop fewer symptoms of feeding intolerance. Secondary outcomes were duration of parenteral nutrition, time to reach full feeding, length of hospital stay, sepsis, necrotizing enterocolitis (NEC), diarrhea, and mortality. METHODS This double-blind randomized controlled trial of L. reuteri DSM 17938 versus placebo included 94 neonates with a gestational age of 28-34 weeks and birth weight of 1,000-1,800 g. RESULTS Feeding intolerance (vomiting and/or distension) was less common in the probiotic group than in the placebo group (8.5% vs. 25.5%; relative risk, 0.33; 95% confidence interval, 0.12-0.96; p=0.03). No significant intergroup differences were found in proven sepsis, time to reach full feeding, length of hospital stay, or diarrhea. The prevalence of NEC (stages 2 and 3) was 6.4% in the placebo group vs. 0% in the probiotic group (relative risk, 1.07; 95% confidence interval, 0.99-1.15; p=0.24). Mortality rates were 2.1% in the probiotic group and 8.5% in the placebo group, p=0.36). CONCLUSION The administration of L. reuteri DSM 17938 to preterm infants was safe and significantly reduced feeding intolerance. No significant differences were found in any other secondary outcomes.
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Affiliation(s)
- Risma K Kaban
- Department of Pediatric Health, Faculty of Medicine, Universitas Indonesia-Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Wardhana
- Department of Pediatric Health, Faculty of Medicine, Universitas Indonesia-Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Badriul Hegar
- Department of Pediatric Health, Faculty of Medicine, Universitas Indonesia-Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Rinawati Rohsiswatmo
- Department of Pediatric Health, Faculty of Medicine, Universitas Indonesia-Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Setyo Handryastuti
- Department of Pediatric Health, Faculty of Medicine, Universitas Indonesia-Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Novie Amelia
- Department of Pediatric Health, Faculty of Medicine, Universitas Indonesia-Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Dina Muktiarti
- Department of Pediatric Health, Faculty of Medicine, Universitas Indonesia-Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Flavia Indrio
- Department of Paediatrics, University of Bari, Bari, Italy
| | - Yvan Vandenplas
- KidZ Health Castle, UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium
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36
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Bronsky J, Campoy C, Embleton N, Fewtrell M, Mis NF, Gerasimidis K, Hojsak I, Hulst J, Indrio F, Lapillonne A, Molgaard C, Moltu SJ, Verduci E, Vora R, Domellöf M. Palm Oil and Beta-palmitate in Infant Formula: A Position Paper by the European Society for Paediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) Committee on Nutrition. J Pediatr Gastroenterol Nutr 2019; 68:742-760. [PMID: 31022096 DOI: 10.1097/mpg.0000000000002307] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Palm oil (PO) is used in infant formulas in order to achieve palmitic acid (PA) levels similar to those in human milk. PA in PO is esterified predominantly at the SN-1,3 position of triacylglycerol (TAG), and infant formulas are now available in which a greater proportion of PA is in the SN-2 position (typical configuration in human milk). As there are some concerns about the use of PO, we aimed to review literature on health effects of PO and SN-2-palmitate in infant formulas. METHODS PubMed and Cochrane Database of Systematic Reviews were systematically searched for relevant studies on possible beneficial effects or harms of either PO or SN-2-palmitate in infant formula on various health outcomes. RESULTS We identified 12 relevant studies using PO and 21 studies using SN-2-palmitate. Published studies have variable methodology, subject characteristics, and some are underpowered for the key outcomes. PO is associated with harder stools and SN-2-palmitate use may lead to softer stool consistency. Bone effects seem to be short-lasting. For some outcomes (infant colic, faecal microbiota, lipid metabolism), the number of studies is very limited and summary evidence inconclusive. Growth of infants is not influenced. There are no studies published on the effect on markers of later diseases. CONCLUSIONS There is insufficient evidence to suggest that PO should be avoided as a source of fat in infant formulas for health reasons. Inclusion of high SN-2-palmitate fat blend in infant formulas may have short-term effects on stool consistency but cannot be considered essential.
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Affiliation(s)
- Jiri Bronsky
- Department of Paediatrics, University Hospital Motol, Prague, Czech Republic
| | | | - Nicholas Embleton
- Newcastle Neonatal Service, Newcastle Hospitals NHS Trust and Newcastle University, Newcastle upon Tyne, UK
| | - Mary Fewtrell
- Childhood Nutrition Research Centre, UCL GOS Institute of Child Health, London, UK
| | - Nataša Fidler Mis
- Department of Gastroenterology, Hepatology and Nutrition, University Children's Hospital, University Medical Centre Ljubljana, Slovenia
| | - Konstantinos Gerasimidis
- Human Nutrition, School of Medicine, Dentistry and Nursing, University of Glasgow, New Lister Building, Glasgow Royal Infirmary, Glasgow, UK
| | - Iva Hojsak
- Children's Hospital Zagreb, University of Zagreb School of Medicine, Zagreb, Croatia
| | - Jessie Hulst
- Department of Paediatric Gastroenterology, Erasmus MC, Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Flavia Indrio
- Ospedale Pediatrico Giovanni XXIII University of Bari, Bari, Italy
| | - Alexandre Lapillonne
- Paris Descartes University, APHP Necker-Enfants Malades hospital, Paris, France.,CNRC, Baylor College of Medicine, Houston, Texas
| | - Christian Molgaard
- Department of Nutrition, Exercise and Sports, University of Copenhagen.,Pediatric Nutrition Unit, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | | | - Elvira Verduci
- Department of Pediatrics, San Paolo Hospital, Department of Health Sciences, University of Milan, Milan, Italy
| | - Rakesh Vora
- Leeds teaching hospitals NHS trust, Leeds, UK
| | - Magnus Domellöf
- Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden
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Francavilla R, Piccolo M, Francavilla A, Polimeno L, Semeraro F, Cristofori F, Castellaneta S, Barone M, Indrio F, Gobbetti M, De Angelis M. Clinical and Microbiological Effect of a Multispecies Probiotic Supplementation in Celiac Patients With Persistent IBS-type Symptoms: A Randomized, Double-Blind, Placebo-controlled, Multicenter Trial. J Clin Gastroenterol 2019; 53:e117-e125. [PMID: 29688915 PMCID: PMC6382041 DOI: 10.1097/mcg.0000000000001023] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
GOALS The goals of this study were to evaluate the efficacy and safety of a probiotic mixture in patients with celiac disease (CD) with irritable bowel syndrome (IBS)-type symptoms despite a strict gluten-free diet (GFD). BACKGROUND About 30% of patients with CD adherent to a GFD suffer from IBS-type symptoms; a possible cause resides in the imbalances of the intestinal microbiota in CD. Probiotics may represent a potential treatment. STUDY CD patients with IBS-type symptoms entered a prospective, double-blind, randomized placebo-controlled study. A 6-week treatment period was preceded by a 2-week run-in and followed by a 6-week follow-up phase. Clinical data were monitored throughout the study by validated questionnaires: IBS Severity Scoring System (IBS-SSS); Gastrointestinal Symptom Rating Scale (GSRS); Bristol Stool Form Scale (BSFS); and IBS Quality of Life Questionnaire (IBS-QOL). The fecal microbiota were assayed using plate counts and 16S rRNA gene-based analysis. RESULTS In total, 109 patients were randomized to probiotics (n=54) or placebo (n=55). IBS-SSS and GSRS decreased significantly in probiotics, as compared with placebo [(-15.9%±14.8% vs. 8.2%±25.9%; P<0.001) and (-19.8%±16.6% vs. 12.9%±31.6%; P<0.001)], respectively. Treatment success was significantly higher in patients receiving probiotics, as compared with placebo (15.3% vs. 3.8%; P<0.04). Presumptive lactic acid bacteria, Staphylococcus and Bifidobacterium, increased in patients receiving probiotic treatment. No adverse events were reported. CONCLUSIONS A 6-week probiotic treatment is effective in improving the severity of IBS-type symptoms, in CD patients on strict GFD, and is associated with a modification of gut microbiota, characterized by an increase of bifidobacteria.
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Affiliation(s)
| | | | | | | | | | | | | | - Michele Barone
- Department of Emergency and Organ Transplantation, University of Bari Aldo Moro
| | | | - Marco Gobbetti
- Faculty of Science and Technology, Piazza Università, Free University of Bozen, Bolzano, Italy
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Abstract
Colic is a common and distressing functional gastrointestinal disorder during infancy. It is a behavioral phenomenon in infants aged 1-4 months involving prolonged inconsolable crying and agitated status with multifactorial etiology. Colic can be considered as a benign, self-limited process because the baby normally grows and feeds even with transient irritable mood. Nevertheless, infantile colic is a common difficulty causing anxiety during parenthood and a recurrent reason for them to seek medical help, especially if it is the first child. The causes of colic can be classified as non-gastrointestinal or gastrointestinal. The former includes altered feeding techniques, modified child-parent relationship, immaturity of central nervous system, behavioral etiology, and maternal smoking or nicotine replacement therapy. Instead, the latter involves inadequate production of lactase enzyme, cow's milk protein intolerance, alteration of intestinal microbiota, gastrointestinal immaturity, or inflammation which causes intestinal hyperperistalsis due to increase in serotonin secretion and motilin receptor expression.Probiotics may play a crucial part in the manipulation of the microbiota. Probiotic administration is likely to maintain intestinal homeostasis through the modulation of permeability and peristalsis, influencing the gut-brain axis and inhibiting hypersensitivity. This is a decisive field in the development of preventive and therapeutic strategies for infantile colic. However, further studies are needed for each specific formulation in order to better characterize pharmacodynamic and pharmacokinetic properties and to evaluate their application as a possible preventive strategy if administered early during infancy against the later development of pain-related FGIDs.
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Affiliation(s)
- Flavia Indrio
- Department of Pediatrics, Section of Gastroenterology and Nutrition, "Aldo Moro" University of Bari, Ospedale Pediatrico Giovanni XXIII, Bari, Italy.
| | - Vanessa Nadia Dargenio
- Department of Pediatrics, Ospedale Pediatrico Giovanni XXIII, "Aldo Moro" University of Bari, Bari, Italy
| | - Paola Giordano
- Department of Pediatrics, Ospedale Pediatrico Giovanni XXIII, "Aldo Moro" University of Bari, Bari, Italy
| | - Ruggiero Francavilla
- Department of Pediatrics, Ospedale Pediatrico Giovanni XXIII, "Aldo Moro" University of Bari, Bari, Italy
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Francavilla R, Cristofori F, Dellatte S, Indrio F. Response to Cabrera-Chávez et al. Am J Gastroenterol 2018; 113:1560-1561. [PMID: 30166631 DOI: 10.1038/s41395-018-0235-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- R Francavilla
- Interdisciplinary Department of Medicine-Pediatric Section, University of Bari, Bari, Italy. Tandoi Group Factory, Corato, Italy
| | - F Cristofori
- Interdisciplinary Department of Medicine-Pediatric Section, University of Bari, Bari, Italy. Tandoi Group Factory, Corato, Italy
| | - S Dellatte
- Interdisciplinary Department of Medicine-Pediatric Section, University of Bari, Bari, Italy. Tandoi Group Factory, Corato, Italy
| | - F Indrio
- Interdisciplinary Department of Medicine-Pediatric Section, University of Bari, Bari, Italy. Tandoi Group Factory, Corato, Italy
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40
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Abstract
The symbiotic relationship between microbes and human is fundamental for a physiological development and health. The microbiome of the newborn undergoes to dramatic changes during the process of birth and in the first thousand days of life. Mother Nature provided us with the best possible start to achieve eubiosis: vaginal delivery to receive our mother's microbiome and breast milk that favours the establishment of beneficial bacteria. Infants deprived of one or both of these evolutionary gifts undergo to important modification of the microbial communities leading to a state of dysbiosis enhancing the chance of the emergence of a variety of immune, inflammatory and metabolic disorders. Are we able to imitate nature? Is there any intervention for dysbiosis in children born by cesarean section? In this review we will try to answer to this intriguing question on the basis of the most recent scientific evidences.
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Francavilla R, Cristofori F, Verzillo L, Gentile A, Castellaneta S, Polloni C, Giorgio V, Verduci E, DʼAngelo E, Dellatte S, Indrio F. Randomized Double-Blind Placebo-Controlled Crossover Trial for the Diagnosis of Non-Celiac Gluten Sensitivity in Children. Am J Gastroenterol 2018; 113:421-430. [PMID: 29380821 DOI: 10.1038/ajg.2017.483] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 10/29/2017] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Non-celiac gluten sensitivity (NCGS) is characterized by intestinal and extra-intestinal symptoms that are related to the ingestion of gluten in subjects who are not affected by either celiac disease (CD) or wheat allergy (WA). In this multicenter study, we aim for the first time to evaluate the prevalence of NCGS in pediatric subjects with chronic functional gastrointestinal symptoms associated with gluten ingestion using a double-blind placebo-controlled (DBPC) gluten challenge with crossover. METHODS Among 1,114 children with chronic gastrointestinal symptoms (negative CD and WA), those exhibiting a positive correlation between symptoms and gluten ingestion were eligible for a diagnostic challenge including the following phases: run-in, open gluten-free diet (GFD) and DBPC crossover gluten challenge. Patients were randomized to gluten (10 g/daily) and placebo (rice starch) for 2 weeks each, separated by a washout week. The gluten challenge was considered positive in the presence of a minimum 30% decrease of global visual analogue scale between gluten and placebo. RESULTS Out of 1,114 children, 96.7% did not exhibit any correlation with gluten ingestion. Thirty-six children were eligible; after the run-in and open GFD, 28 patients entered the gluten challenge. Eleven children (39.2%; 95% CI: 23.6-53.6%) tested positive. CONCLUSIONS This is the first demonstration of the existence of NCGS in children that reinforce the need for a DBPC for the diagnosis as the diagnosis is ruled out in >60% of cases. The registration identifier in ClinicalsTrials.gov is NCT02431585.
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Affiliation(s)
- R Francavilla
- Interdisciplinary Department of Medicine-Pediatric Section, University of Bari, Bari, Italy
| | - F Cristofori
- Interdisciplinary Department of Medicine-Pediatric Section, University of Bari, Bari, Italy
| | - L Verzillo
- Interdisciplinary Department of Medicine-Pediatric Section, University of Bari, Bari, Italy
| | - A Gentile
- Interdisciplinary Department of Medicine-Pediatric Section, University of Bari, Bari, Italy
| | - S Castellaneta
- Department of Pediatrics, San Paolo Hospital, Bari Italy
| | - C Polloni
- Department of Pediatrics, Santa Maria del Carmine Hospital, Rovereto TN, Italy
| | - V Giorgio
- Department of Pediatrics, Catholic University, Rome, Italy
| | - E Verduci
- Department of Pediatrics, University of Milan, S. Paolo Hospital, Milan, Italy
| | - E DʼAngelo
- Department of Pediatrics, Santa Maria Incoronata dell'Olmo Hospital
| | | | - F Indrio
- Interdisciplinary Department of Medicine-Pediatric Section, University of Bari, Bari, Italy
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Sung V, D'Amico F, Cabana MD, Chau K, Koren G, Savino F, Szajewska H, Deshpande G, Dupont C, Indrio F, Mentula S, Partty A, Tancredi D. Lactobacillus reuteri to Treat Infant Colic: A Meta-analysis. Pediatrics 2018; 141:peds.2017-1811. [PMID: 29279326 DOI: 10.1542/peds.2017-1811] [Citation(s) in RCA: 112] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/20/2017] [Indexed: 02/04/2023] Open
Abstract
CONTEXT Lactobacillus reuteri DSM17938 has shown promise in managing colic, but conflicting study results have prevented a consensus on whether it is truly effective. OBJECTIVE Through an individual participant data meta-analysis, we sought to definitively determine if L reuteri DSM17938 effectively reduces crying and/or fussing time in infants with colic and whether effects vary by feeding type. DATA SOURCES We searched online databases (PubMed, Medline, Embase, the Cumulative Index to Nursing and Allied Health Literature, the Database of Abstracts of Reviews of Effects, and Cochrane), e-abstracts, and clinical trial registries. STUDY SELECTION These were double-blind randomized controlled trials (published by June 2017) of L reuteri DSM17398 versus a placebo, delivered orally to infants with colic, with outcomes of infant crying and/or fussing duration and treatment success at 21 days. DATA EXTRACTION We collected individual participant raw data from included studies modeled simultaneously in multilevel generalized linear mixed-effects regression models. RESULTS Four double-blind trials involving 345 infants with colic (174 probiotic and 171 placebo) were included. The probiotic group averaged less crying and/or fussing time than the placebo group at all time points (day 21 adjusted mean difference in change from baseline [minutes] -25.4 [95% confidence interval (CI): -47.3 to -3.5]). The probiotic group was almost twice as likely as the placebo group to experience treatment success at all time points (day 21 adjusted incidence ratio 1.7 [95% CI: 1.4 to 2.2]). Intervention effects were dramatic in breastfed infants (number needed to treat for day 21 success 2.6 [95% CI: 2.0 to 3.6]) but were insignificant in formula-fed infants. LIMITATIONS There were insufficient data to make conclusions for formula-fed infants with colic. CONCLUSIONS L reuteri DSM17938 is effective and can be recommended for breastfed infants with colic. Its role in formula-fed infants with colic needs further research.
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Affiliation(s)
- Valerie Sung
- Murdoch Children's Research Institute, The Royal Children's Hospital, and the University of Melbourne, Melbourne, Victoria, Australia;
| | - Frank D'Amico
- Department of Mathematics, Duquesne University, Pittsburgh, Pennsylvania.,University of Pittsburgh Medical Center St. Margaret's Hospital, Pittsburgh, Pennsylvania
| | - Michael D Cabana
- Department of Pediatrics, Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, San Francisco, California
| | - Kim Chau
- University of Toronto and The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Gideon Koren
- University of Toronto and The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Francesco Savino
- Ospendale Infantile Regina Margherita, Citta della Salute e della Scienza di Torino, Torino, Italy
| | - Hania Szajewska
- Department of Paediatrics, The Medical University of Warsaw, Warsaw, Poland
| | - Girish Deshpande
- Department of Neonatology, Nepean Hospital and Sydney Medical School Nepean, University of Sydney, Sydney, New South Wales, Australia
| | - Christophe Dupont
- Department of Pediatric Gastroenterology, Paris Descartes University and Necker-Enfants Malades Hospital, Paris, France
| | - Flavia Indrio
- Department of Pediatrics, University of Bari, Bari, Italy
| | - Silja Mentula
- Bacteriology Unit, National Institute for Health and Welfare, Helsinki, Finland
| | - Anna Partty
- Department of Pediatrics and Adolescent Medicine, Turku University Hospital, Turku, Finland; and
| | - Daniel Tancredi
- Department of Pediatrics, University of California Davis Health System, Sacramento, California
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Gutiérrez-Castrellón P, Indrio F, Bolio-Galvis A, Jiménez-Gutiérrez C, Jimenez-Escobar I, López-Velázquez G. Efficacy of Lactobacillus reuteri DSM 17938 for infantile colic: Systematic review with network meta-analysis. Medicine (Baltimore) 2017; 96:e9375. [PMID: 29390535 PMCID: PMC5758237 DOI: 10.1097/md.0000000000009375] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND 5% to 40% of infants cry excessively, usually accompanied by fussiness and excessive of gas. There are no uniform criteria for treatment of infantile colic. Lactobacillus reuteri DSM 17938 has been used with promising results. The objective of this network-meta-analysis (NMA) is to compare the efficacy of L reuteri DSM 17938 with other interventions for infantile colic. METHODS RCTs, published between 1960 and 2015 for the treatment of infantile colic were included. Primary outcome was duration of crying after 21 to 28 days of treatment. Different databases were searched. Information was analyzed using control group as central axis. A random effect model was used. Hedges standard mean difference (SMD) and odds ratio (OR) were calculated. A SUCRA analysis was performed to evaluate superiority for each intervention. RESULTS 32 RCTs were analyzed, including 2242 patients. Studies with L reuteri DSM 17938 versus Ctrl., Diet versus Ctrl. and Acupuncture versus Ctrl. were the most influential studies in the NMA. L reuteri DSM 17938 [WMD -51.3 h (CI95% -72.2 to -30.5 h), P .0001] and dietetic approaches [WMD -37.4 h (CI95% -56.1 to -18.7 h), P .0001] were superior compared to the other treatments. CONCLUSIONS L reuteri DSM 17938 and some dietetic approaches are better to other interventions for treatment of infantile colic.
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Affiliation(s)
- Pedro Gutiérrez-Castrellón
- Center for Translational Research on Early Programming Nutrition and Mother-Child Nutrition, Hospital General Dr Manuel Gea González & Dirección de Investigación. Universidad Tecnológica de México-Unitec México
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Indrio F, Riezzo G, Giordano P, Ficarella M, Miolla MP, Martini S, Corvaglia L, Francavilla R. Effect of a Partially Hydrolysed Whey Infant Formula Supplemented with Starch and Lactobacillus reuteri DSM 17938 on Regurgitation and Gastric Motility. Nutrients 2017; 9:E1181. [PMID: 29143799 PMCID: PMC5707653 DOI: 10.3390/nu9111181] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 10/22/2017] [Accepted: 10/25/2017] [Indexed: 12/12/2022] Open
Abstract
Functional regurgitation (FR) is common in early infancy and represents a major drain on healthcare resources. This double-blind, randomized controlled trial investigated the effects of a formula containing partially hydrolysed, 100% whey protein, starch and Lactobacillus reuteri (DSM 17938) on gastric emptying rate (GErate) and regurgitation frequency in infants with FR. Enrolled infants were randomly allocated to receive either the test formula or a standard starter formula for four weeks. Ultrasound GErate assessment was performed at baseline (week 0) and at week 4; the number of regurgitations, feed volumes and potential adverse events were recorded in a daily diary. Eighty infants aged four weeks to five months were enrolled; 72 (test group = 37; control group = 35) completed the study. Compared to controls, the test group showed greater percentage changes in GErate (12.3% vs. 9.1%, p < 0.01). Mean daily regurgitations decreased from 7.4 (0.8) at week 0 to 2.6 (1.0) at week 4 in the test group and from 7.5 (1.0) to 5.3 (1.0) in controls (between-group difference, p < 0.0001). Compared to a standard formula, a starch-thickened partially hydrolysed whey protein formula supplemented with Lactobacillus reuteri is more effective in decreasing the frequency of regurgitation and improving GErate, and can be of benefit to infants with FR.
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Affiliation(s)
- Flavia Indrio
- Department of Pediatrics, University of Bari Aldo Moro, 70125 Bari, Italy.
| | - Giuseppe Riezzo
- Laboratory of Experimental Pathophysiology, National Institute for Digestive Diseases, IRCCS Saverio de Bellis, 70013 Castellana Grotte, Italy.
| | - Paola Giordano
- Department of Pediatrics, University of Bari Aldo Moro, 70125 Bari, Italy.
| | - Maria Ficarella
- Department of Pediatrics, University of Bari Aldo Moro, 70125 Bari, Italy.
| | - Maria Paola Miolla
- Department of Pediatrics, University of Bari Aldo Moro, 70125 Bari, Italy.
| | - Silvia Martini
- Neonatology and Neonatal Intensive Care Unit, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, S. Orsola-Malpighi Hospital, 40138 Bologna, Italy.
| | - Luigi Corvaglia
- Neonatology and Neonatal Intensive Care Unit, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, S. Orsola-Malpighi Hospital, 40138 Bologna, Italy.
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Indrio F, Miqdady M, Al Aql F, Haddad J, Karima B, Khatami K, Mouane N, Rahmani A, Alsaad S, Salah M, Samy G, Tafuri S. Knowledge, attitudes, and practices of pediatricians on infantile colic in the Middle East and North Africa region. BMC Pediatr 2017; 17:187. [PMID: 29058577 PMCID: PMC5651634 DOI: 10.1186/s12887-017-0939-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 10/12/2017] [Indexed: 12/27/2022] Open
Abstract
Background Regional evidence-based guidelines for the prophylaxis and management of infantile colic are not available for the Middle East and North Africa (MENA) region. The Allied Against Infantile Functional GI Disorders (ACT) Working Group was created in January, 2015 to determine the knowledge gaps and the current management practices of infantile colic by physicians in the MENA region. The ACT group determined the need for a survey to address these questions. The objectives of the survey were to highlight current clinical practices on the management of infantile colic and to raise awareness on colic severity in the MENA region. Methods The ACT working group developed the survey which included respondent characteristics and closed questions on practice in colic prevention. The survey was subject to validation and ethics committee approval in all countries. Results A total of 1628 physicians (mostly pediatricians (75.4%), neonatologists (2.4%) and general practitioners (19.8%)) responded to the survey. The 5 most represented countries were KSA (27.9%), Kuwait (22.1%), Morocco (13.8%), Lebanon (10.6%), and Iraq (7.4%). Most of the respondents (77.8%) practiced in governmental settings. A majority of respondents (91.7%) reported that colic is diagnosed predominantly by clinical examination. Above 63%, of pediatricians surveyed, believed that the colic prevalence rate was >40%, which is greater than the 20% rate reported in worldwide surveys. Yet, most of the responding physicians (73%) prefer to simply reassure parents rather than prescribe a therapeutic agent. Most physicians were either neutral (58%) or did not endorse (18.4%) colic prophylaxis. Of those who prescribed formulae for non-breastfed children, a majority (64.3%) chose “Comfort” formulae over hydrolyzed or lactose-free formulae or formulae with probiotics. Conclusions The results of this survey suggest that a substantial proportion of responding physicians from the selected MENA countries do not advocate for prophylaxis of colic. The findings of this survey suggest that more educational efforts are required to increase awareness of the strong body of evidence supporting the efficacy of probiotics in the prevention and management of infantile colic. Electronic supplementary material The online version of this article (10.1186/s12887-017-0939-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Flavia Indrio
- Department of Pediatric University of Bari Ospedale Pediatrico Giovanni XXIII Hospital, Via Amendola 270, 70126, Bari, Italy.
| | - Mohamad Miqdady
- Hepatology & Nutrition Division, Pediatric Gastroenterology, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
| | - Fahd Al Aql
- King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Joseph Haddad
- Department of Pediatrics, Saint George University Hospital, Balamand University, Beirut, Lebanon
| | - Berkouk Karima
- Department of Pediatrics, Bab El Oued Hospital, Algiers, Algeria
| | - Katayoun Khatami
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Mofid Children Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nehza Mouane
- Gastroenterology Nutrition Department, Children Hospital Ibn Sina, University Mohammed V Faculty of Medicine, Rabat, Morocco
| | | | | | | | - Gamal Samy
- Department of Child Health and Nutrition, Institute of Postgraduate Childhood Studies, Ain Shams University, Cairo, Egypt
| | - Silvio Tafuri
- Department of Pediatric University of Bari Ospedale Pediatrico Giovanni XXIII Hospital, Via Amendola 270, 70126, Bari, Italy
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Indrio F, Riezzo G, Tafuri S, Ficarella M, Carlucci B, Bisceglia M, Polimeno L, Francavilla R. Probiotic Supplementation in Preterm: Feeding Intolerance and Hospital Cost. Nutrients 2017; 9:nu9090965. [PMID: 28858247 PMCID: PMC5622725 DOI: 10.3390/nu9090965] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 08/25/2017] [Accepted: 08/28/2017] [Indexed: 12/21/2022] Open
Abstract
We hypothesized that giving the probiotic strain Lactobacillus reuteri (L. reuteri) DSM 17938 to preterm, formula-fed infants would prevent an early traumatic intestinal inflammatory insult modulating intestinal cytokine profile and reducing the onset of feeding intolerance. Newborn were randomly allocated during the first 48 h of life to receive either daily probiotic (108 colony forming units (CFUs) of L. reuteri DSM 17938) or placebo for one month. All the newborns underwent to gastric ultrasound for the measurement of gastric emptying time. Fecal samples were collected for the evaluation of fecal cytokines. Clinical data on feeding intolerance and weight gain were collected. The costs of hospital stays were calculated. The results showed that the newborns receiving L. reuteri DSM 17938 had a significant decrease in the number of days needed to reach full enteral feeding (p < 0.01), days of hospital stay (p < 0.01), and days of antibiotic treatment (p < 0.01). Statistically significant differences were observed in pattern of fecal cytokine profiles. The anti-inflammatory cytokine interleukin (IL)-10, was increased in newborns receiving L. reuteri DSM 17938. Pro-inflammatory cytokines: IL-17, IL-8, and tumor necrosis factor (TNF)-alpha levels were increased in newborns given placebo. Differences in the gastric emptying and fasting antral area (FAA) were also observed. Our study demonstrates an effective role for L. reuteri DSM 17938 supplementation in preventing feeding intolerance and improving gut motor and immune function development in bottle-fed stable preterm newborns. Another benefit from the use of probiotics is the reducing cost for the Health Care service.
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Affiliation(s)
- Flavia Indrio
- Department of Pediatric, Aldo Moro University of Bari, Ospedale Pediatrico Giovanni XXIII via Amendola 276, 70125 Bari, Italy.
| | - Giuseppe Riezzo
- Laboratory of Nutritional Physiopathology, National Institute for Digestive Diseases, Istituto di Ricerca e Cura a Carattere Scientifico (I.R.C.C.S.), Saverio de Bellis, 70013 Castellana Grotte (BA), Italy.
| | - Silvio Tafuri
- Department of Biomedical Sciences and Human Oncology, Section of Hygiene, Aldo Moro University of Bari, 70125 Bari, Italy.
| | - Maria Ficarella
- Department of Pediatric, Aldo Moro University of Bari, Ospedale Pediatrico Giovanni XXIII via Amendola 276, 70125 Bari, Italy.
| | - Barbara Carlucci
- Division of Neonatology, Ospedale Perrino, 72100 Brindisi, Italy.
| | - Massimo Bisceglia
- Department of Pediatrics, Neonatology Division San Giovanni di Dio Hospital, 88900 Crotone, Italy.
| | - Lorenzo Polimeno
- Department of Organ Transplantation, Gastroenterology Section, University Aldo Moro Bari, 70125 Bari, Italy.
| | - Ruggiero Francavilla
- Department of Pediatric, Aldo Moro University of Bari, Ospedale Pediatrico Giovanni XXIII via Amendola 276, 70125 Bari, Italy.
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Steutel NF, Benninga MA, Langendam MW, Korterink JJ, Indrio F, Szajewska H, Tabbers MM. Developing a core outcome set for infant colic for primary, secondary and tertiary care settings: a prospective study. BMJ Open 2017; 7:e015418. [PMID: 28554931 PMCID: PMC5729993 DOI: 10.1136/bmjopen-2016-015418] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE Infant colic (IC) is defined as recurrent and prolonged crying without an obvious cause or evidence of failure to thrive or illness. It is a common problem with a prevalence of 5%-25%. The unknown aetiology results in a wide variety in interventions and use of heterogeneous outcome measures across therapeutic trials. Our aim was to develop a core outcome set (COS) for IC to facilitate and improve evidence synthesis. DESIGN AND SETTING Prospective study design; primary, secondary and tertiary care. METHODS The COS was developed using a modified Delphi technique. First, healthcare professionals (HCPs) and parents of infants with IC were asked to list up to five outcomes they considered relevant in the treatment of IC. Outcomes mentioned by >10% of participants were forwarded to a shortlist. In the second round, outcomes on this shortlist were rated and prioritised. The final COS was defined in a face-to-face expert meeting of paediatricians. RESULTS F of invited stakeholders (133 HCPs and 55 parents of infants with IC) completed both Delphi rounds. Duration of crying, family stress, sleeping time of infant, quality of life (of family), discomfort of infant and hospital admission/duration were rated as most important outcomes in IC, framing the final COS. CONCLUSIONS The use of this COS should serve as a minimum of outcomes to be measured and reported. This will benefit evidence synthesis, by enhancing homogeneity of outcomes, and enable evaluation of success in therapeutic trials on IC. Researchers are strongly encouraged to use this COS when setting up a clinical trial in primary, secondary and/or tertiary care or performing a systematic review on IC.
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Affiliation(s)
- Nina F Steutel
- Department of Paediatric Gastroenterology and Nutrition, Emma Children's Hospital, Academic Medical Centre, Amsterdam, The Netherlands
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Centre, Amsterdam, The Netherlands
| | - Marc A Benninga
- Department of Paediatric Gastroenterology and Nutrition, Emma Children's Hospital, Academic Medical Centre, Amsterdam, The Netherlands
| | - Miranda W Langendam
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Centre, Amsterdam, The Netherlands
| | - Judith J Korterink
- Department of Paediatric Gastroenterology and Nutrition, Emma Children's Hospital, Academic Medical Centre, Amsterdam, The Netherlands
| | - Flavia Indrio
- Department of Paediatrics, Giovanni XXIII Hospital, University of Bari, Bari, Italy
| | - Hania Szajewska
- Department of Paediatrics, The Medical University of Warsaw, Warsaw, Poland
| | - Merit M Tabbers
- Department of Paediatric Gastroenterology and Nutrition, Emma Children's Hospital, Academic Medical Centre, Amsterdam, The Netherlands
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Indrio F, Martini S, Francavilla R, Corvaglia L, Cristofori F, Mastrolia SA, Neu J, Rautava S, Russo Spena G, Raimondi F, Loverro G. Epigenetic Matters: The Link between Early Nutrition, Microbiome, and Long-term Health Development. Front Pediatr 2017; 5:178. [PMID: 28879172 PMCID: PMC5572264 DOI: 10.3389/fped.2017.00178] [Citation(s) in RCA: 115] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Accepted: 08/07/2017] [Indexed: 12/18/2022] Open
Abstract
Epigenetic modifications are among the most important mechanisms by which environmental factors can influence early cellular differentiation and create new phenotypic traits during pregnancy and within the neonatal period without altering the deoxyribonucleic acid sequence. A number of antenatal and postnatal factors, such as maternal and neonatal nutrition, pollutant exposure, and the composition of microbiota, contribute to the establishment of epigenetic changes that can not only modulate the individual adaptation to the environment but also have an influence on lifelong health and disease by modifying inflammatory molecular pathways and the immune response. Postnatal intestinal colonization, in turn determined by maternal flora, mode of delivery, early skin-to-skin contact and neonatal diet, leads to specific epigenetic signatures that can affect the barrier properties of gut mucosa and their protective role against later insults, thus potentially predisposing to the development of late-onset inflammatory diseases. The aim of this review is to outline the epigenetic mechanisms of programming and development acting within early-life stages and to examine in detail the role of maternal and neonatal nutrition, microbiota composition, and other environmental factors in determining epigenetic changes and their short- and long-term effects.
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Affiliation(s)
- Flavia Indrio
- Department of Pediatrics, Aldo Moro University, Bari, Italy
| | - Silvia Martini
- Neonatology and Neonatal Intensive Care Unit, St. Orsola-Malpighi Hospital, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | | | - Luigi Corvaglia
- Neonatology and Neonatal Intensive Care Unit, St. Orsola-Malpighi Hospital, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | | | - Salvatore Andrea Mastrolia
- Department of Biomedical Science and Human Oncology, Section of Obstetrics and Gynecology, Aldo Moro University, Bari, Italy
| | - Josef Neu
- Division of Neonatology, Department of Pediatrics, University of Florida, Gainesville, FL, United States
| | - Samuli Rautava
- Department of Pediatrics, University of Turku, Turku University Hospital, Turku, Finland
| | - Giovanna Russo Spena
- Division of Neonatology, Department of Translational Medical Sciences, University "Federico II" di Napoli, Naples, Italy
| | - Francesco Raimondi
- Division of Neonatology, Department of Translational Medical Sciences, University "Federico II" di Napoli, Naples, Italy
| | - Giuseppe Loverro
- Department of Biomedical Science and Human Oncology, Section of Obstetrics and Gynecology, Aldo Moro University, Bari, Italy
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Aceti A, Gori D, Barone G, Callegari ML, Fantini MP, Indrio F, Maggio L, Meneghin F, Morelli L, Zuccotti G, Corvaglia L. Probiotics and Time to Achieve Full Enteral Feeding in Human Milk-Fed and Formula-Fed Preterm Infants: Systematic Review and Meta-Analysis. Nutrients 2016; 8:nu8080471. [PMID: 27483319 PMCID: PMC4997384 DOI: 10.3390/nu8080471] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Revised: 07/17/2016] [Accepted: 07/26/2016] [Indexed: 12/31/2022] Open
Abstract
Probiotics have been linked to a reduction in the incidence of necrotizing enterocolitis and late-onset sepsis in preterm infants. Recently, probiotics have also proved to reduce time to achieve full enteral feeding (FEF). However, the relationship between FEF achievement and type of feeding in infants treated with probiotics has not been explored yet. The aim of this systematic review and meta-analysis was to evaluate the effect of probiotics in reducing time to achieve FEF in preterm infants, according to type of feeding (exclusive human milk (HM) vs. formula). Randomized-controlled trials involving preterm infants receiving probiotics, and reporting on time to reach FEF were included in the systematic review. Trials reporting on outcome according to type of feeding (exclusive HM vs. formula) were included in the meta-analysis. Fixed-effect or random-effects models were used as appropriate. Results were expressed as mean difference (MD) with 95% confidence interval (CI). Twenty-five studies were included in the systematic review. In the five studies recruiting exclusively HM-fed preterm infants, those treated with probiotics reached FEF approximately 3 days before controls (MD −3.15 days (95% CI −5.25/−1.05), p = 0.003). None of the two studies reporting on exclusively formula-fed infants showed any difference between infants receiving probiotics and controls in terms of FEF achievement. The limited number of included studies did not allow testing for other subgroup differences between HM and formula-fed infants. However, if confirmed in further studies, the 3-days reduction in time to achieve FEF in exclusively HM-fed preterm infants might have significant implications for their clinical management.
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Affiliation(s)
- Arianna Aceti
- Neonatology and Neonatal Intensive Care Unit, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, S.Orsola-Malpighi Hospital, Bologna 40138, Italy.
- Task Force on Probiotics of the Italian Society of Neonatology, Milan 20126, Italy.
| | - Davide Gori
- Task Force on Probiotics of the Italian Society of Neonatology, Milan 20126, Italy.
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna 40138, Italy.
| | - Giovanni Barone
- Task Force on Probiotics of the Italian Society of Neonatology, Milan 20126, Italy.
- Neonatal Unit, Catholic University, Rome 00168, Italy.
| | - Maria Luisa Callegari
- Task Force on Probiotics of the Italian Society of Neonatology, Milan 20126, Italy.
- Institute of Microbiology, UCSC, Piacenza 29122, Italy.
| | - Maria Pia Fantini
- Task Force on Probiotics of the Italian Society of Neonatology, Milan 20126, Italy.
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna 40138, Italy.
| | - Flavia Indrio
- Task Force on Probiotics of the Italian Society of Neonatology, Milan 20126, Italy.
- Department of Pediatrics, Aldo Moro University, Bari 70124, Italy.
- Study Group of Neonatal Gastroenterology and Nutrition of the Italian Society of Neonatology, Milan 20126, Italy.
| | - Luca Maggio
- Task Force on Probiotics of the Italian Society of Neonatology, Milan 20126, Italy.
- Neonatal Unit, Catholic University, Rome 00168, Italy.
- Study Group of Neonatal Gastroenterology and Nutrition of the Italian Society of Neonatology, Milan 20126, Italy.
| | - Fabio Meneghin
- Task Force on Probiotics of the Italian Society of Neonatology, Milan 20126, Italy.
- Division of Neonatology, Children Hospital V. Buzzi, ICP, Milan 20154, Italy.
| | - Lorenzo Morelli
- Task Force on Probiotics of the Italian Society of Neonatology, Milan 20126, Italy.
- Institute of Microbiology, UCSC, Piacenza 29122, Italy.
| | - Gianvincenzo Zuccotti
- Task Force on Probiotics of the Italian Society of Neonatology, Milan 20126, Italy.
- Department of Pediatrics, Children Hospital V. Buzzi, University of Milan, Milan 20154, Italy.
| | - Luigi Corvaglia
- Neonatology and Neonatal Intensive Care Unit, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, S.Orsola-Malpighi Hospital, Bologna 40138, Italy.
- Task Force on Probiotics of the Italian Society of Neonatology, Milan 20126, Italy.
- Study Group of Neonatal Gastroenterology and Nutrition of the Italian Society of Neonatology, Milan 20126, Italy.
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Indrio F, Di Mauro A, Di Mauro A, Riezzo G, Panza R, Cavallo L, Francavilla R. Prevention of functional gastrointestinal disorders in neonates: clinical and socioeconomic impact. Benef Microbes 2016; 6:195-8. [PMID: 25609653 DOI: 10.3920/bm2014.0078] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Infantile colic, gastro-oesophageal reflux and constipation are the most common functional gastrointestinal disorders (FGIDs) affecting infants during the first months of life. Despite infantile colic, functional constipation and regurgitation had a self-limited pattern, they are considered a risk factor for developing different disorders later in life. The pathophysiology of these functional diseases is still controversial but there is growing evidence that an abnormal gut microbiota colonisation may play a crucial role. An early probiotic supplementation could determine a change in colonisation and may represent a new strategy for preventing FGIDs.
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Affiliation(s)
- F Indrio
- Pediatric Unit, Department of Biomedical Science and Human Oncology, University of Bari 'Aldo Moro', Giovanni XXIII Hospital, Via Amendola 270, 70126 Bari, Italy
| | - A Di Mauro
- Pediatric Unit, Department of Biomedical Science and Human Oncology, University of Bari 'Aldo Moro', Giovanni XXIII Hospital, Via Amendola 270, 70126 Bari, Italy
| | - A Di Mauro
- Pediatric Unit, Department of Biomedical Science and Human Oncology, University of Bari 'Aldo Moro', Giovanni XXIII Hospital, Via Amendola 270, 70126 Bari, Italy
| | - G Riezzo
- Laboratory of Experimental Physiopathology, IRCCS, Via F. Valente 4, 70013 Castellana Grotte, Italy
| | - R Panza
- Pediatric Unit, Department of Biomedical Science and Human Oncology, University of Bari 'Aldo Moro', Giovanni XXIII Hospital, Via Amendola 270, 70126 Bari, Italy
| | - L Cavallo
- Pediatric Unit, Department of Biomedical Science and Human Oncology, University of Bari 'Aldo Moro', Giovanni XXIII Hospital, Via Amendola 270, 70126 Bari, Italy
| | - R Francavilla
- Pediatric Unit, Department of Biomedical Science and Human Oncology, University of Bari 'Aldo Moro', Giovanni XXIII Hospital, Via Amendola 270, 70126 Bari, Italy
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