1
|
Penagini F, Lonoce L, Abbattista L, Silvera V, Rendo G, Cococcioni L, Dilillo D, Calcaterra V, Zuccotti GV. Dual biological therapy and small molecules in pediatric inflammatory bowel disease. Pharmacol Res 2023; 196:106935. [PMID: 37748559 DOI: 10.1016/j.phrs.2023.106935] [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: 05/22/2023] [Revised: 09/18/2023] [Accepted: 09/19/2023] [Indexed: 09/27/2023]
Abstract
Inflammatory bowel diseases (IBDs) including Crohn's disease (CD), ulcerative colitis (UC) and inflammatory bowel disease unclassified (IBD-U) are chronic inflammatory disorders which can affect the gastrointestinal tract. Anti-tumor necrosis factors antibodies (anti-TNFα) such as infliximab (IFX) and adalimumab (ADA) are the first line biological therapy for severe or complicated IBDs in pediatric age. Second line therapeutic options as vedolizumab (VDZ) and ustekinumab (UST) are currently used off-label in pediatric age. Furthermore, despite optimization of biologics, a great proportion of patients may fail to respond to biologic agents (up to 30%) or lose response over the time (around 50%) hence these patients may be left without another valid therapeutic option. Consequently, several efforts have been made in the last years in order to develop new drugs and to contrive new therapeutic strategies. Small molecule drugs (SMDs) and combination therapy with either two biologic agents or with a SMD and a biological agent have recently been proposed. Data on safety and efficacy of these new therapeutic options are limited. The objective of the present review is to summarize the most up-to-date available literature in pediatric IBD.
Collapse
Affiliation(s)
- Francesca Penagini
- Department of Pediatrics, "Vittore Buzzi" Children's Hospital, Milano, Italy.
| | - Luisa Lonoce
- Department of Pediatrics, "Vittore Buzzi" Children's Hospital, Milano, Italy
| | - Luisa Abbattista
- Department of Pediatrics, "Vittore Buzzi" Children's Hospital, Milano, Italy
| | - Valentina Silvera
- Department of Pediatrics, "Vittore Buzzi" Children's Hospital, Milano, Italy
| | - Giulia Rendo
- Department of Pediatrics, "Vittore Buzzi" Children's Hospital, Milano, Italy
| | - Lucia Cococcioni
- Department of Pediatrics, "Vittore Buzzi" Children's Hospital, Milano, Italy
| | - Dario Dilillo
- Department of Pediatrics, "Vittore Buzzi" Children's Hospital, Milano, Italy
| | - Valeria Calcaterra
- Department of Pediatrics, "Vittore Buzzi" Children's Hospital, Milano, Italy; Pediatric and Adolescent Unit, Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy
| | - Gian Vincenzo Zuccotti
- Department of Pediatrics, "Vittore Buzzi" Children's Hospital, Milano, Italy; Department of Biomedical and Clinical Science "L. Sacco", University of Milano, Milano, Italy
| |
Collapse
|
2
|
Cheli S, Savino D, De Silvestri A, Norsa L, Sansotta N, Penagini F, Dilillo D, Panceri R, Cattaneo D, Clementi E, Zuin G. Correction to: One year of experience with combined pharmacokinetic/pharmacogenetic monitoring of anti-TNF alpha agents: a retrospective study. Pharmacogenomics J 2023; 23:140. [PMID: 37231043 DOI: 10.1038/s41397-023-00311-0] [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] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Affiliation(s)
- Stefania Cheli
- Unit of Clinical Pharmacology, ASST Fatebenefratelli Sacco, University Hospital, Milano, Italy
| | - Diego Savino
- Unit of Clinical Pharmacology, ASST Fatebenefratelli Sacco, University Hospital, Milano, Italy
| | - Annalisa De Silvestri
- Clinical Epidemiology and Biometry Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Lorenzo Norsa
- Pediatric Hepatology, Gastroenterology and Transplantation Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Naire Sansotta
- Pediatric Hepatology, Gastroenterology and Transplantation Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Francesca Penagini
- Pediatric Department, "Vittore Buzzi" Children's Hospital, University of Milan, Milano, Italy
| | - Dario Dilillo
- Pediatric Department, "Vittore Buzzi" Children's Hospital, University of Milan, Milano, Italy
| | - Roberto Panceri
- Pediatrics, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Dario Cattaneo
- Unit of Clinical Pharmacology, ASST Fatebenefratelli Sacco, University Hospital, Milano, Italy
| | - Emilio Clementi
- Scientific Institute IRCCS Eugenio Medea, Bosisio Parini, Italy.
- Clinical Pharmacology Unit, Department of Biomedical and Clinical Sciences, L. Sacco University Hospital, Università degli Studi di Milano, Milan, Italy.
| | - Giovanna Zuin
- Pediatrics, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| |
Collapse
|
3
|
Cheli S, Savino D, De Silvestri A, Norsa L, Sansotta N, Penagini F, Dilillo D, Panceri R, Cattaneo D, Clementi E, Zuin G. One year of experience with combined pharmacokinetic/pharmacogenetic monitoring of anti-TNF alpha agents: a retrospective study. Pharmacogenomics J 2023; 23:112-118. [PMID: 37016150 DOI: 10.1038/s41397-023-00304-z] [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] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 03/15/2023] [Accepted: 03/20/2023] [Indexed: 04/06/2023]
Abstract
Anti-tumor necrosis factor alpha (anti-TNFα) inhibitors are used extensively for the management of moderate to severe inflammatory bowel disease (IBD) in both adult and pediatric patients. Unfortunately, not all patients show an optimal response to induction therapy, while others lose their response over time for reasons yet poorly understood. We report on a pharmacokinetic/pharmacogenetic approach to monitor the therapy with anti-TNFα in a real-world cohort of seventy-nine pediatric patients affected by IBD that was analyzed retrospectively. We evaluated plasma concentrations of infliximab, adalimumab, and related anti-drug antibodies (ADAs), and single nucleotide polymorphisms (SNPs) in genes involved in immune processes and inflammation on the anti-TNFα response. We found a significant association between the SNP in TNFα promoter (-308G>A) and clinical remission without steroids in patients on infliximab therapy. Additionally, a potential connection between HLA-DQA1*05 genetic variant carriers and a higher risk of anti-TNFα immunogenicity emerged.
Collapse
Affiliation(s)
- Stefania Cheli
- Unit of Clinical Pharmacology, ASST Fatebenefratelli Sacco, University Hospital, Milano, Italy
| | - Diego Savino
- Unit of Clinical Pharmacology, ASST Fatebenefratelli Sacco, University Hospital, Milano, Italy
| | - Annalisa De Silvestri
- Clinical Epidemiology and Biometry Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Lorenzo Norsa
- Pediatric Hepatology, Gastroenterology and Transplantation Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Naire Sansotta
- Pediatric Hepatology, Gastroenterology and Transplantation Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Francesca Penagini
- Pediatric Department, "Vittore Buzzi" Children's Hospital, University of Milan, Milano, Italy
| | - Dario Dilillo
- Pediatric Department, "Vittore Buzzi" Children's Hospital, University of Milan, Milano, Italy
| | - Roberto Panceri
- Pediatrics, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Dario Cattaneo
- Unit of Clinical Pharmacology, ASST Fatebenefratelli Sacco, University Hospital, Milano, Italy
| | - Emilio Clementi
- Scientific Institute IRCCS Eugenio Medea, Bosisio Parini, Italy.
- Clinical Pharmacology Unit, Department of Biomedical and Clinical Sciences, L. Sacco University Hospital, Università degli Studi di Milano, Milan, Italy.
| | - Giovanna Zuin
- Pediatrics, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| |
Collapse
|
4
|
Borsani B, Biganzoli G, Penagini F, Bosetti A, Pendezza E, Perico V, Biganzoli E, Verduci E, Zuccotti GV. Resting energy expenditure in children and adolescents with cerebral palsy: accuracy of available prediction formulas and development of population-specific methods. Front Pediatr 2023; 11:1097152. [PMID: 37681200 PMCID: PMC10481865 DOI: 10.3389/fped.2023.1097152] [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: 11/13/2022] [Accepted: 07/26/2023] [Indexed: 09/09/2023] Open
Abstract
Introduction Energy requirements are difficult to estimate in children with cerebral palsy (CP). Resting energy expenditure (REE), necessary to implement personalized nutritional interventions, is most commonly estimated using prediction formulae since indirect calorimetry, the reference method, is not available in all nutrition units. The aims of the present study were: (1) to evaluate the accuracy of the most commonly used REE prediction formulae developed for healthy children, in children with CP; (2) to assess the accuracy of the REE population-specific formula for CP children proposed in our preliminary report; (3) to develop new population-specific methods. Methods REE was measured by indirect calorimetry in 100 children and adolescents with spastic quadriplegic cerebral palsy (SQCP) and estimated on the basis of predictive formulas selected by the clinicians [World Health Organization (WHO), Harris-Benedict, Schofield weight, Schofield weight & height, Oxford, Mifflin formulae and a population-specific formula for CP children developed in our preliminary report]. Results 100 children with SQCP (35 girls, 35%) classified as level V according to gross motor function classification system (GMFCS-V); 64% with oral nutrition, 29% total enteral nutrition (nasogastric tube feeding, percutaneous endoscopic gastrostomy, percutaneous endoscopic transgastric jejunostomy) and 7% mixed nutrition. The median (IQR) REE was 41.96 (17.5) kcal/kg/day.Statistical analysis highlighted a proportional bias between the indirect calorimetry and all considered predictive formulae for REE determination. By studying the relationship between the bias and the mean values of REE, specific conversion equations were obtained. With a pre-specified model having as predictors the variable weight and the variable Triceps Skinfold (TSF) and, as response the variable REE measured by indirect calorimetry, a predictive nomogram was developed to estimate the REE in this population of children. Conclusions We suggest using predictive formulae for healthy children with caution, and where possible carrying out indirect calorimetry to assess REE in children with CP. However, we propose a new tool which could be developed to become an additional help for assessment of REE in the clinical practice.Future objectives will be to obtain a larger sample size, in a multicenter perspective study, to build a specific predictive model for the REE of the studied population.
Collapse
Affiliation(s)
- Barbara Borsani
- Department of Pediatrics, “V. Buzzi” Children’s Hospital, University of Milan, Milan, Italy
| | - Giacomo Biganzoli
- Medical Statistics Unit, Department of Biomedical and Clinical Sciences L. Sacco, “Luigi Sacco” University Hospital, Università degli Studi di Milano, Milan, Italy
| | - Francesca Penagini
- Department of Pediatrics, “V. Buzzi” Children’s Hospital, University of Milan, Milan, Italy
| | - Alessandra Bosetti
- Department of Pediatrics, “V. Buzzi” Children’s Hospital, University of Milan, Milan, Italy
| | - Erica Pendezza
- Department of Pediatrics, “V. Buzzi” Children’s Hospital, University of Milan, Milan, Italy
| | - Veronica Perico
- Department of Pediatrics, “V. Buzzi” Children’s Hospital, University of Milan, Milan, Italy
| | - Elia Biganzoli
- Department of Clinical Sciences and Community Health & DSRC, University of Milan, Milan, Italy
| | - Elvira Verduci
- Department of Pediatrics, “V. Buzzi” Children’s Hospital, University of Milan, Milan, Italy
| | - Gian Vincenzo Zuccotti
- Department of Pediatrics, “V. Buzzi” Children’s Hospital, University of Milan, Milan, Italy
| |
Collapse
|
5
|
Cheli S, Savino D, Penagini F, Zuccotti G, Zuin G, Clementi E, Cattaneo D. Therapeutic Drug Monitoring of Anti-TNFα Inhibitors: A Matter of Cut-Off Ranges. Pharmaceutics 2023; 15:1834. [PMID: 37514022 PMCID: PMC10386140 DOI: 10.3390/pharmaceutics15071834] [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] [Received: 06/06/2023] [Revised: 06/21/2023] [Accepted: 06/24/2023] [Indexed: 07/30/2023] Open
Abstract
Therapeutic drug monitoring (TDM) is a useful tool for optimising the use of anti-TNFα inhibitors in patients with inflammatory bowel diseases (IBDs). Recently, point-of-care methods for the quantification of drug levels and anti-drug antibodies (ADAs) have been developed to overcome the limitations of conventional enzyme-linked immunoabsorbent assays (ELISAs). Here, we evaluated the performance, interchangeability, and agreement between an automated ELISA-based immunoassay (CHORUS Promonitor) and the lateral flow assay (RIDA®QUICK) for the quantification of infliximab (IFX, n = 65) and adalimumab (ADM, n = 58) plasma levels in IBD patients. Thirty-two samples for IFX and twenty-three samples for ADM that tested positively for the presence of ADAs were also used. Overall, data analysis showed a good agreement of ADM trough concentrations (R2 = 0.75) between the two assays as well as for ADA measurement (K > 0.8). However, IFX levels highlighted a weak correlation (R2 = 0.58) between the two kits, with the RIDA®QUICK assay overestimating IFX plasma values by 30% when compared to the CHORUS Promonitor kit. Results from this study show that the two assays are not quantitatively and qualitatively interchangeable due to substantial discrepancies in some results. Accordingly, the same assay should be used for the longitudinal follow-up of IBD patients.
Collapse
Affiliation(s)
- Stefania Cheli
- Unit of Clinical Pharmacology, ASST Fatebenefratelli Sacco, University Hospital, 20157 Milano, Italy
| | - Diego Savino
- Unit of Clinical Pharmacology, ASST Fatebenefratelli Sacco, University Hospital, 20157 Milano, Italy
| | - Francesca Penagini
- Pediatric Department, "Vittore Buzzi" Children's Hospital, University of Milan, 20154 Milan, Italy
| | - Gianvincenzo Zuccotti
- Pediatric Department, "Vittore Buzzi" Children's Hospital, University of Milan, 20154 Milan, Italy
| | - Giovanna Zuin
- Pediatrics, IRCCS San Gerardo dei Tintori Foundation, 20900 Monza, Italy
| | - Emilio Clementi
- Scientific Institute IRCCS Eugenio Medea, 23842 Bosisio Parini, Italy
- Clinical Pharmacology Unit, Department of Biomedical and Clinical Sciences, L. Sacco University Hospital, Università degli Studi di Milano, 20122 Milan, Italy
| | - Dario Cattaneo
- Unit of Clinical Pharmacology, ASST Fatebenefratelli Sacco, University Hospital, 20157 Milano, Italy
| |
Collapse
|
6
|
Lionetti E, Pjetraj D, Gatti S, Catassi G, Bellantoni A, Boffardi M, Cananzi M, Cinquetti M, Francavilla R, Malamisura B, Montuori M, Zuccotti G, Cristofori F, Gaio P, Passaro T, Penagini F, Testa A, Trovato CM, Catassi C. Prevalence and detection rate of celiac disease in Italy: Results of a SIGENP multicenter screening in school-age children. Dig Liver Dis 2023; 55:608-613. [PMID: 36682923 DOI: 10.1016/j.dld.2022.12.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [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: 10/29/2022] [Revised: 12/19/2022] [Accepted: 12/28/2022] [Indexed: 01/24/2023]
Abstract
BACKGROUND Celiac disease is a common lifelong disorder. Recent studies indicate that the number of clinically detected cases has increased over the last decades, however little is known about changes in the prevalence and the detection rate of celiac disease. AIM To evaluate the current prevalence and detection rate of celiac disease in Italy by a multicenter, mass screening study on a large sample of school-age children. METHODS children aged 5-11 years were screened at school by HLA-DQ2 and -DQ8 determination on a drop of blood in six Italian cities; total serum IgA and IgA anti-transglutaminase were determined in children showing HLA-DQ2 and/or -DQ8 positivity. Diagnosis of celiac disease was confirmed according to the European guidelines. RESULTS 5994 children were eligible, 4438 participated and 1873 showed predisposing haplotypes (42.2%, 95% CI=40.7-43.7). The overall prevalence of celiac disease was 1.65% (95% CI, 1.34%-2.01%). Only 40% of celiac children had been diagnosed prior to the school screening. Symptoms evoking celiac disease were as common in celiac children as in controls. CONCLUSION In this multicenter study the prevalence of celiac disease in school-age Italian children was one of the highest in the world. Determination of HLA predisposing genotypes is an easy and fast first-level screening test for celiac disease. Without a mass screening strategy, 60% of celiac patients remain currently undiagnosed in Italy.
Collapse
Affiliation(s)
- Elena Lionetti
- Division of Pediatrics and Center for Celiac Research, DISCO Department, Marche Polytechnic University, Ancona, Italy
| | - Dorina Pjetraj
- Division of Pediatrics and Center for Celiac Research, DISCO Department, Marche Polytechnic University, Ancona, Italy
| | - Simona Gatti
- Division of Pediatrics and Center for Celiac Research, DISCO Department, Marche Polytechnic University, Ancona, Italy
| | - Giulia Catassi
- Pediatric Gastroenterology and Liver Unit, Department of Maternal and Child Health, Sapienza-University of Rome, Rome, Italy
| | - Antonella Bellantoni
- Department of Pediatrics, Bianchi-Melacrino Morelli Hospital, Reggio Calabria, Italy
| | - Massimo Boffardi
- Pediatric Unit and Center for Celiac Disease - University Hospital of Salerno, Campus of Cava de' Tirreni, Italy
| | - Mara Cananzi
- Unit of Pediatric Gastroenterology, Digestive Endoscopy, Hepatology and Care of the Child with Liver Transplantation, Dpt. of Women's and Children's Health, University Hospital of Padova, Italy
| | - Mauro Cinquetti
- Department of Pediatrics, "G. Fracastoro" Hospital, AULSS9 Verona, Italy
| | - Ruggiero Francavilla
- Pediatric Section, Department of Interdisciplinary Medicine, University of Bari, Italy
| | - Basilio Malamisura
- Pediatric Unit and Center for Celiac Disease - University Hospital of Salerno, Campus of Cava de' Tirreni, Italy
| | - Monica Montuori
- Pediatric Gastroenterology and Liver Unit, Department of Maternal and Child Health, Sapienza-University of Rome, Rome, Italy
| | - Gianvincenzo Zuccotti
- Department of Pediatrics, Vittore Buzzi Children's Hospital, University of Milan, Italy
| | - Fernanda Cristofori
- Pediatric Section, Department of Interdisciplinary Medicine, University of Bari, Italy
| | - Paola Gaio
- Unit of Pediatric Gastroenterology, Digestive Endoscopy, Hepatology and Care of the Child with Liver Transplantation, Dpt. of Women's and Children's Health, University Hospital of Padova, Italy
| | - Tiziana Passaro
- Pediatric Unit and Center for Celiac Disease - University Hospital of Salerno, Campus of Cava de' Tirreni, Italy
| | - Francesca Penagini
- Department of Pediatrics, Vittore Buzzi Children's Hospital, University of Milan, Italy
| | - Alessandra Testa
- Clinical Biochemistry Unit, National Research Council, Reggio Calabria, Italy
| | - Chiara Maria Trovato
- Hepatology Gastroenterology and Nutrition Unit, "Bambino Gesù" Children Hospital, Rome, Italy
| | - Carlo Catassi
- Division of Pediatrics and Center for Celiac Research, DISCO Department, Marche Polytechnic University, Ancona, Italy.
| |
Collapse
|
7
|
Penagini F, Calcaterra V, Dilillo D, Vandoni M, Gianolio L, Gatti A, Rendo G, Giuriato M, Cococcioni L, De Silvestri A, Zuccotti G. Self-Perceived Physical Level and Fitness Performance in Children and Adolescents with Inflammatory Bowel Disease. Children (Basel) 2022; 9:children9091399. [PMID: 36138708 PMCID: PMC9497882 DOI: 10.3390/children9091399] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 09/13/2022] [Accepted: 09/13/2022] [Indexed: 01/18/2023]
Abstract
Background: Inflammatory bowel disease (IBD) patients show a higher risk of developing metabolic and cardiovascular diseases due to the presence of systemic low-grade chronic inflammation. Exercise can improve cardiovascular fitness and modulate the inflammatory processes. We evaluated the physical activity (PA) level and the fitness performance of children and adolescents with IBD. Patients and methods: We considered 54 pediatric patients with IBD (14.6 ± 2.2; 22 M), including CD (n = 27) UC (n = 24) and IBD unclassified (n = 3), and 70 healthy children. In all children, the Physical Activity Questionnaire (PAQ-C) and the International Fitness Enjoyment Scale were self-reported and recorded. Results: PAQ-C showed significant difference in PA levels in patients with IBD compared to controls (p < 0.001). A decrease in general fitness (p = 0.003), cardiorespiratory fitness (p = 0.002), strength (p = 0.01), speed agility (p = 0.003), and flexibility (p = 0.01) were also detected between patients and controls. Speed agility was related to age (p = 0.02) and BMI z-score (p = 0.01), and flexibility to BMI z-score (p = 0.05). We noted a correlation between PA levels and physician global assessment (p = 0.021) and activity disease severity (p = 0.025). Conclusions: A poorer PA level and poor physical competence were found in patients with IBD compared to healthy children and adolescents. Monitored exercise could provide multiple benefits at both physical and psychological levels.
Collapse
Affiliation(s)
- Francesca Penagini
- Pediatric Department, “Vittore Buzzi” Children’s Hospital, 20154 Milan, Italy
| | - Valeria Calcaterra
- Pediatric Department, “Vittore Buzzi” Children’s Hospital, 20154 Milan, Italy
- Department of Internal Medicine, University of Pavia, 27100 Pavia, Italy
| | - Dario Dilillo
- Pediatric Department, “Vittore Buzzi” Children’s Hospital, 20154 Milan, Italy
| | - Matteo Vandoni
- Laboratory of Adapted Motor Activity (LAMA), Department of Public health, Experimental Medicine and Forensic Science, University of Pavia, 27100 Pavia, Italy
| | - Laura Gianolio
- Pediatric Department, “Vittore Buzzi” Children’s Hospital, 20154 Milan, Italy
| | - Alessandro Gatti
- Laboratory of Adapted Motor Activity (LAMA), Department of Public health, Experimental Medicine and Forensic Science, University of Pavia, 27100 Pavia, Italy
| | - Giulia Rendo
- Pediatric Department, “Vittore Buzzi” Children’s Hospital, 20154 Milan, Italy
| | - Matteo Giuriato
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37100 Verona, Italy
- Faculty of Physical Culture, Unit of Molecular Biology, Department of Health and Natural Sciences, Gdansk University of Physical Education and Sport, 80070 Gdansk, Poland
| | - Lucia Cococcioni
- Pediatric Department, “Vittore Buzzi” Children’s Hospital, 20154 Milan, Italy
| | - Annalisa De Silvestri
- Biometry & Clinical Epidemiology, Scientific Direction, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Gianvincenzo Zuccotti
- Pediatric Department, “Vittore Buzzi” Children’s Hospital, 20154 Milan, Italy
- Department of Biomedical and Clinical Science, University of Milano, 20157 Milano, Italy
- Correspondence:
| |
Collapse
|
8
|
Sampietro GM, Colombo F, Frontali A, Baldi C, Conti L, Dilillo D, Penagini F, Nebuloni M, D'Addio F, Fiorina P, Maconi G, Corsi F, Zuccotti G, Ardizzone S, Foschi D. Strictureplasties performed by laparoscopic approach for complicated Crohn's disease. A prospective, observational, cohort study. Dig Liver Dis 2021; 53:1286-1293. [PMID: 33627296 DOI: 10.1016/j.dld.2021.01.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 11/17/2020] [Revised: 01/24/2021] [Accepted: 01/28/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Laparoscopy is considered the best surgical approach for Crohn's Disease (CD), and strictureplasty a reliable alternative to intestinal resection. Nevertheless, their association has never been evaluated. AIM To investigate feasibility and safety of conventional (SP) and non-conventional (NCSP) strictureplasties, using laparoscopy, for complicated CD. METHODS Starting January 2008, a prospective cohort study was performed, in consecutive, unselected patients, undergoing primary surgery for CD (Group-A). The residential database (CD-CARD) was used for the retrospective extraction of control patients (Group-B). Univariate and multi-variate analysis of pre-operative characteristics, intra-operative findings, morbidity, and intra-abdominal septic complications (IASCs) was performed. RESULTS Between January 2008 and December 2019, 331 patients received 162 SPs, 138 NCSPs, and 373 resections (Group-A). From the CD-CARD, 227 control patients received 159 SPs, 117 NCSPs, and 271 resections (Group-B) (ns). Preoperatively, Group-A presented batter nutritional status and received more biological therapies, Group-B more steroids. Group-A presented less abdominal abscesses, planned ostomies, minor complications, shorter operating time and hospitalization than Group-B, but similar major complications, IASCs and anastomotic leaks. IASCs were related to older age, elevated inflammatory indices, and preoperative treatment with high-risk drugs. CONCLUSIONS SP and NCSP are feasible by laparoscopy, with low morbidity rate, confirming the advantages of both minimally invasive and conservative surgery.
Collapse
Affiliation(s)
- Gianluca M Sampietro
- Division of General and HPB Surgery, ASST Rhodense - Rho, Corso Europa, 250, 20017 - Rho, Milan, Italy.
| | - Francesco Colombo
- Division of General Surgery, ASST Fatebenefratelli - Sacco, Milan, Italy
| | - Alice Frontali
- Division of General Surgery, ASST Fatebenefratelli - Sacco, Milan, Italy; Department of Colorectal Surgery, Pôle des Maladies de l'Appareil Digestif (PMAD), Assistance Publique - Hôpiteau de Paris (AP-HP), Beaujon Hospital, University Denis Diderot, Paris, France
| | - Caterina Baldi
- Division of General and HPB Surgery, ASST Rhodense - Rho, Corso Europa, 250, 20017 - Rho, Milan, Italy
| | - Lorenzo Conti
- Division of General Surgery, ASST Fatebenefratelli - Sacco, Milan, Italy
| | - Dario Dilillo
- Children's University Hospital, ASST Fatebenefratelli - Sacco, Milan, Italy
| | - Francesca Penagini
- Children's University Hospital, ASST Fatebenefratelli - Sacco, Milan, Italy
| | - Manuela Nebuloni
- Division of Pathology, ASST Fatebenefratelli - Sacco, Milan, Italy; Department of Biomedical and Clinical Science "Luigi Sacco", University of Milan, Italy
| | - Francesca D'Addio
- Department of Biomedical and Clinical Science "Luigi Sacco", University of Milan, Italy; International Center for T1D, Pediatric Clinical Research Center Fondazione Romeo ed Enrica Invernizzi, Department of Biomedical and Clinical Science "Luigi Sacco", University of Milan, Italy
| | - Paolo Fiorina
- Department of Biomedical and Clinical Science "Luigi Sacco", University of Milan, Italy; Division of Endocrinology, ASST Fatebenefratelli - Sacco, Milan, Italy; Nephrology Division, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States; International Center for T1D, Pediatric Clinical Research Center Fondazione Romeo ed Enrica Invernizzi, Department of Biomedical and Clinical Science "Luigi Sacco", University of Milan, Italy
| | - Giovanni Maconi
- Department of Biomedical and Clinical Science "Luigi Sacco", University of Milan, Italy; Division of Gastroenterology, ASST Fatebenefratelli - Sacco, Milan, Italy
| | - Fabio Corsi
- Department of Biomedical and Clinical Science "Luigi Sacco", University of Milan, Italy; Breast Unit, Surgery Department, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
| | - Gianvincenzo Zuccotti
- Children's University Hospital, ASST Fatebenefratelli - Sacco, Milan, Italy; Department of Biomedical and Clinical Science "Luigi Sacco", University of Milan, Italy; International Center for T1D, Pediatric Clinical Research Center Fondazione Romeo ed Enrica Invernizzi, Department of Biomedical and Clinical Science "Luigi Sacco", University of Milan, Italy
| | - Sandro Ardizzone
- Department of Biomedical and Clinical Science "Luigi Sacco", University of Milan, Italy; Division of Gastroenterology, ASST Fatebenefratelli - Sacco, Milan, Italy
| | - Diego Foschi
- Department of Biomedical and Clinical Science "Luigi Sacco", University of Milan, Italy
| |
Collapse
|
9
|
Penagini F, Leone A, Borsani B, Bosetti A, Dilillo D, Rendo G, Calcaterra V, Bertoli S, Mora S, Battezzati A, Bedogni G, Zuccotti GV. Predictive Fat Mass Equations for Children With Inflammatory Bowel Disease. J Pediatr Gastroenterol Nutr 2021; 73:e98-e104. [PMID: 34091539 PMCID: PMC10237347 DOI: 10.1097/mpg.0000000000003188] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 05/17/2021] [Indexed: 12/10/2022]
Abstract
OBJECTIVE Evaluate accuracy of skinfold thicknesses and body mass index (BMI) for the prediction of fat mass percentage (FM%) in paediatric inflammatory bowel disease (IBD) and to develop population-specific formulae based on anthropometry for estimation of FM%. METHODS IBD children (n = 30) and healthy controls (HCs, n = 144) underwent anthropometric evaluation and dual-energy X-ray absorptiometry (DEXA) scan, as the clinical reference for measurement of body composition. Body FM% estimated with skinfolds thickness was compared with FM% measured with DEXA. By means of 4 prediction models, population specific formulae for estimation of FM% were developed. RESULTS No significant difference in terms of FM% measured by DEXA was found between IBD population and HCs (FM% 29.6% vs 32.2%, P = 0.108). Triceps skinfold thickness (TSF, Model 2) was better than BMI (Model 1) at predicting FM% (82% vs 68% of variance). The sum of 2 skinfolds (biceps + triceps; SF2, Model 3) showed an improvement in the prediction of FM% as compared with TSF, Model 2 (86% vs 82% of variance). The sum of 4 skinfolds (biceps + triceps + suprailiac + subscapular; Model 4) showed further improvement in the prediction of FM% as compared with SF2 (88% vs 86% of variance). CONCLUSIONS The sum of 4 skinfolds is the most accurate in predicting FM% in paediatric IBD. The sum of 2 skinfolds is less accurate but more feasible and less prone to error. The newly developed population-specific formulae could be a valid tool for estimation of body composition in IBD population and an alternative to DEXA measurement.
Collapse
Affiliation(s)
| | - Alessandro Leone
- International Center for the Assessment of Nutritional Status (ICANS), Department of Food, Environmental and Nutritional Sciences
| | - Barbara Borsani
- Department of Pediatrics, “V. Buzzi” Children's Hospital, University of Milan, Milan
| | - Alessandra Bosetti
- Department of Pediatrics, “V. Buzzi” Children's Hospital, University of Milan, Milan
| | - Dario Dilillo
- Department of Pediatrics, “V. Buzzi” Children's Hospital, University of Milan, Milan
| | - Giulia Rendo
- Department of Pediatrics, “V. Buzzi” Children's Hospital, University of Milan, Milan
| | - Valeria Calcaterra
- Department of Pediatrics, “V. Buzzi” Children's Hospital, University of Milan, Milan
- Pediatric and Adolescent Unit, Department of Internal Medicine, University of Pavia, Pavia
| | - Simona Bertoli
- International Center for the Assessment of Nutritional Status (ICANS), Department of Food, Environmental and Nutritional Sciences
| | - Stefano Mora
- Pediatric Bone Densitometry Service and Laboratory of Pediatric Endocrinology, IRCCS San Raffaele Institute, Milan
| | - Alberto Battezzati
- International Center for the Assessment of Nutritional Status (ICANS), Department of Food, Environmental and Nutritional Sciences
| | - Giorgio Bedogni
- Clinical Epidemiology Unit, Liver Research Center, Basovizza, Trieste, Italy
| | | |
Collapse
|
10
|
Gatti S, Del Baldo G, Catassi G, Faragalli A, Aloi M, Bramuzzo M, D'Arcangelo G, Felici E, Fuoti M, Lega S, Panceri R, Pastore M, Penagini F, Gesuita R, Catassi C. Factors associated with quality of life in Italian children and adolescents with IBD. Sci Rep 2021; 11:18076. [PMID: 34508152 PMCID: PMC8433211 DOI: 10.1038/s41598-021-97661-1] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 08/09/2021] [Indexed: 12/13/2022] Open
Abstract
Improving the quality of life (QoL) is crucial in the management of pediatric inflammatory bowel disease (IBD). We aimed to (1) Validate the IMPACT-III questionnaire in Italian IBD children; (2) explore factors associated to QoL in pediatric IBD. Internal consistency, concurrent validity, discriminant validity and reproducibility of the Italian version of the IMPACT-III questionnaire was measured in IBD children/adolescents in 8 centers. Associations between patient and disease characteristics and the IMPACT-III domains were analyzed through quantile regression analysis. The IMPACT-III questionnaire, collected in 282 children with IBD (median age: 14.8 years; IQR 12.4–16.4) showed a median total score of 76 (IQR 67–83). Female gender, active disease and age were negatively associated with the total IMPACT-III score. Specifically, female gender was negatively associated with the Bowel/Systemic Symptoms, Emotional and Treatment domain scores, while disease activity was significantly associated with Bowel Symptoms and Treatment/Interventions reported QoL. The IMPACT- III showed good internal consistency (Cronbach’s alpha coefficient = 0.87, 95% CI 0.85–0.89) and reproducibility (Concordance Correlation Coefficient = 0.66, 95% CI 0.57–0.74). In Italian children with IBD active disease, female gender and adolescence are associated to a worse QoL, indicating the need of more attention in this subgroup of young patients. IMPACT-III questionnaire is a reliable instrument to measure QoL in Italian children.
Collapse
Affiliation(s)
- Simona Gatti
- Department of Pediatrics, Polytechnic University of Marche, G. Salesi Children's Hospital, Via Corridoni 11, 60123, Ancona, Italy.
| | - Giada Del Baldo
- Department of Pediatrics, Polytechnic University of Marche, G. Salesi Children's Hospital, Via Corridoni 11, 60123, Ancona, Italy
| | - Giulia Catassi
- Department of Maternal and Child Health, Pediatric Gastroenterology and Liver Unit, Umberto I Hospital, Sapienza University of Rome, Viale del Policlinico 105, 00161, Rome, Italy
| | - Andrea Faragalli
- Centre of Epidemiology and Biostatistics, Università Politecnica delle Marche, Via Tronto 10/a, 60126, Ancona, Italy
| | - Marina Aloi
- Department of Maternal and Child Health, Pediatric Gastroenterology and Liver Unit, Umberto I Hospital, Sapienza University of Rome, Viale del Policlinico 105, 00161, Rome, Italy
| | - Matteo Bramuzzo
- Digestive Endoscopy and Nutrition Unit, Institute of Child and Maternal Health, IRCCS "Burlo Garofolo", Via dell'Istria 65, 34137, Trieste, Italy
| | - Giulia D'Arcangelo
- Department of Maternal and Child Health, Pediatric Gastroenterology and Liver Unit, Umberto I Hospital, Sapienza University of Rome, Viale del Policlinico 105, 00161, Rome, Italy
| | - Enrico Felici
- Pediatrics and Pediatric Emergency Unit "U.Bosio" Center for Pediatric Digestive Diseases, The Children Hospital, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Spalto Marengo 46, 15121, Alessandria, Italy
| | - Maurizio Fuoti
- Gastroenterology and GI Endoscopy, University Department of Pediatrics, Children's Hospital, Piazzale Spedali Civili 1, 25123, Brescia, Italy
| | - Sara Lega
- Digestive Endoscopy and Nutrition Unit, Institute of Child and Maternal Health, IRCCS "Burlo Garofolo", Via dell'Istria 65, 34137, Trieste, Italy
| | - Roberto Panceri
- Clinica Pediatrica, Università Milano Bicocca, Fondazione MBBM, Ospedale San Gerardo, Via Cadore, 20900, Monza, Italy
| | - Maria Pastore
- IRCCS Casa Sollievo della Sofferenza-Pediatria, Viale Padre Pio, 7d, 71013, San Giovanni Rotondo, Italy
| | - Francesca Penagini
- Clinica Pediatrica, Ospedale dei Bambini "V. Buzzi", Università degli Studi di Milano, Via Lodovico Castelvetro 32, 20154, Milano, Italy
| | - Rosaria Gesuita
- Centre of Epidemiology and Biostatistics, Università Politecnica delle Marche, Via Tronto 10/a, 60126, Ancona, Italy
| | - Carlo Catassi
- Department of Pediatrics, Polytechnic University of Marche, G. Salesi Children's Hospital, Via Corridoni 11, 60123, Ancona, Italy
| |
Collapse
|
11
|
Mura E, Masnada S, Antonello C, Parazzini C, Izzo G, Garau J, Sproviero D, Cereda C, Orcesi S, Veggiotti P, Zuccotti G, Dilillo D, Penagini F, Tonduti D. Ruxolitinib in Aicardi-Goutières syndrome. Metab Brain Dis 2021; 36:859-863. [PMID: 33721182 DOI: 10.1007/s11011-021-00716-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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: 01/26/2021] [Accepted: 03/10/2021] [Indexed: 12/31/2022]
Abstract
Aicardi-Goutières Syndrome (AGS) is a monogenic leukodystrophy with pediatric onset, clinically characterized by a variable degree of neurologic impairment. It belongs to a group of condition called type I interferonopathies that are characterized by abnormal overproduction of interferon alpha, an inflammatory cytokine which action is mediated by the activation of two of the four human Janus Kinases. Thanks to an ever-increasing knowledge of the molecular basis and pathogenetic mechanisms of the disease, Janus Kinase inhibitors (JAKIs) have been proposed as a treatment option for selected interferonopathies. Here we reported the 24 months follow-up of the fifth AGS patient treated with ruxolitinib described so far in literature. The treatment was globally well tolerated; clinical examinations and radiological images demonstrated a progressively improving course. It is however to note that patients presenting with mild and spontaneously improving course have been reported. Large natural history studies on AGS spectrum are strongly required in order to get a better understanding of the results emerging from ongoing therapeutic trials on such rare disease.
Collapse
Affiliation(s)
- Eleonora Mura
- Department of Pediatric Neurology, V. Buzzi Children's Hospital, Via Castelvetro 32, 20154, Milan, Italy
- C.O.A.L.A (Center for diagnosis and treatment of leukodystrophies), V. Buzzi Children's Hospital, Via Castelvetro 32, 20154, Milan, Italy
| | - Silvia Masnada
- Department of Pediatric Neurology, V. Buzzi Children's Hospital, Via Castelvetro 32, 20154, Milan, Italy
- C.O.A.L.A (Center for diagnosis and treatment of leukodystrophies), V. Buzzi Children's Hospital, Via Castelvetro 32, 20154, Milan, Italy
| | - Clara Antonello
- C.O.A.L.A (Center for diagnosis and treatment of leukodystrophies), V. Buzzi Children's Hospital, Via Castelvetro 32, 20154, Milan, Italy
- Department of Pediatric Orthopedics, V. Buzzi Children's Hospital, Via Castelvetro 32, 20154, Milan, Italy
| | - Cecilia Parazzini
- C.O.A.L.A (Center for diagnosis and treatment of leukodystrophies), V. Buzzi Children's Hospital, Via Castelvetro 32, 20154, Milan, Italy
- Department of Pediatric Radiology and Neuroradiology, V. Buzzi Children's Hospital, Via Castelvetro 32, 20154, Milan, Italy
| | - Giana Izzo
- C.O.A.L.A (Center for diagnosis and treatment of leukodystrophies), V. Buzzi Children's Hospital, Via Castelvetro 32, 20154, Milan, Italy
- Department of Pediatric Radiology and Neuroradiology, V. Buzzi Children's Hospital, Via Castelvetro 32, 20154, Milan, Italy
| | - Jessica Garau
- Genomic and Post-Genomic Center, IRCCS Mondino Foundation, Via Mondino 2, 27100, Pavia, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, Via Bassi 21, 27100, Pavia, Italy
| | - Daisy Sproviero
- Genomic and Post-Genomic Center, IRCCS Mondino Foundation, Via Mondino 2, 27100, Pavia, Italy
| | - Cristina Cereda
- Genomic and Post-Genomic Center, IRCCS Mondino Foundation, Via Mondino 2, 27100, Pavia, Italy
| | - Simona Orcesi
- Department of Brain and Behavioral Sciences, University of Pavia, Via Bassi 21, 27100, Pavia, Italy
- Department of Child Neurology and Psychiatry, IRCCS Mondino Foundation, Via Mondino 2, 27100, Pavia, Italy
| | - Pierangelo Veggiotti
- Department of Pediatric Neurology, V. Buzzi Children's Hospital, Via Castelvetro 32, 20154, Milan, Italy
- C.O.A.L.A (Center for diagnosis and treatment of leukodystrophies), V. Buzzi Children's Hospital, Via Castelvetro 32, 20154, Milan, Italy
- Department of Biomedical and Clinical Science "L. Sacco", University of Milan, Via Giovanni Battista Grassi 74, 20157, Milan, Italy
| | - Gianvincenzo Zuccotti
- C.O.A.L.A (Center for diagnosis and treatment of leukodystrophies), V. Buzzi Children's Hospital, Via Castelvetro 32, 20154, Milan, Italy
- Department of Biomedical and Clinical Science "L. Sacco", University of Milan, Via Giovanni Battista Grassi 74, 20157, Milan, Italy
- Department of Pediatrics, V. Buzzi Children's Hospital, Via Castelvetro 32, 20154, Milan, Italy
| | - Dario Dilillo
- C.O.A.L.A (Center for diagnosis and treatment of leukodystrophies), V. Buzzi Children's Hospital, Via Castelvetro 32, 20154, Milan, Italy
- Department of Pediatrics, V. Buzzi Children's Hospital, Via Castelvetro 32, 20154, Milan, Italy
| | - Francesca Penagini
- C.O.A.L.A (Center for diagnosis and treatment of leukodystrophies), V. Buzzi Children's Hospital, Via Castelvetro 32, 20154, Milan, Italy
- Department of Pediatrics, V. Buzzi Children's Hospital, Via Castelvetro 32, 20154, Milan, Italy
| | - Davide Tonduti
- Department of Pediatric Neurology, V. Buzzi Children's Hospital, Via Castelvetro 32, 20154, Milan, Italy.
- C.O.A.L.A (Center for diagnosis and treatment of leukodystrophies), V. Buzzi Children's Hospital, Via Castelvetro 32, 20154, Milan, Italy.
| |
Collapse
|
12
|
Abstract
OBJECTIVE The purpose of the paper is to examine the current state of the art about epidemiology, diagnosis, and treatment of this infection. METHODS A review of the literature was performed through a PubMed search of original articles, case reports, and reviews using the key words "brain abscess," "cerebral abscess," "brain infection," "intracranial suppuration," "otogenic brain abscess," "otitis complications," and "sinusitis complications." RESULTS Pediatric brain abscess is a rare but serious infection, often involving patients with specific risk factors and burdened by a high risk of morbidity and mortality. Brain abscess incidence and mortality decreased over the years, thanks to improved antibiotic therapy, new neurosurgical techniques, and the wide spread of vaccinations. There are no guidelines for the adequate diagnostic-therapeutic pathway in the management of brain abscesses; therefore, conflicting data emerge from the literature. In the future, multicentric prospective studies should be performed in order to obtain stronger evidences about brain abscesses management. Over the next few years, changes in epidemiology could be observed because of risk factors changes.
Collapse
Affiliation(s)
- Chiara Mameli
- Department of Pediatrics, V. Buzzi Childrens' Hospital, University of Milan, Milan, Italy.
| | - Teresa Genoni
- Department of Pediatrics, V. Buzzi Childrens' Hospital, University of Milan, Milan, Italy
| | - Cristina Madia
- Department of Pediatrics, V. Buzzi Childrens' Hospital, University of Milan, Milan, Italy
| | - Chiara Doneda
- Pediatric Radiology and Neuroradiology Unit, Children Hospital V. Buzzi, Milan, Italy
| | - Francesca Penagini
- Department of Pediatrics, V. Buzzi Childrens' Hospital, University of Milan, Milan, Italy
| | - Gianvincenzo Zuccotti
- Department of Pediatrics, V. Buzzi Childrens' Hospital, University of Milan, Milan, Italy
| |
Collapse
|
13
|
Dilillo D, Zuccotti GV, Galli E, Meneghin F, Dell'Era A, Penagini F, Colella G, Lewindon P, Carmagnola S, Farina E, Ardizzone S, Maconi G. Noninvasive testing in the management of children with suspected inflammatory bowel disease. Scand J Gastroenterol 2019; 54:586-591. [PMID: 31032665 DOI: 10.1080/00365521.2019.1604799] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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] [Indexed: 02/04/2023]
Abstract
Objective: To assess the accuracy of noninvasive parameters, fecal calprotectin (FC), increased bowel wall thickening (BWT) at intestinal ultrasound (IUS) and blood inflammatory indexes (BII), alone or in combination, as diagnostic tools for inflammatory bowel disease (IBD) in pediatric patients. Methods: Retrospective data were collected on consecutive children (age 2-18 years) referred to our pediatric gastroenterology clinic, for recurrent abdominal pain and/or altered bowel habit from 2007 to 2013. Subjects who had diagnostic workup: laboratory tests (FC, BII, white blood cell (WBC), C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR)) and IUS as initial assessment were eligible. Subjects with known gastrointestinal (GI) diseases, or signs or symptoms highly suggestive for organic diseases necessitating prompt endoscopy (e.g., perianal disease or rectal bleeding), or who had recently performed endoscopy were excluded. The accuracy of noninvasive tests for detecting IBD was assessed using endoscopic and/or radiological investigations, performed in subsequent clinical follow up, as reference gold standard. Results: Seventy-seven patients (mean age 11.3, 44 males) were included, 23 (29.9%) with a final diagnosis of IBD. As single tests, FC gave the highest sensitivity (96%) but lower specificity (72%) and IUS highest specificity (96%) with lower sensitivity (70%). The combination of FC + IUS showed excellent accuracy for detecting children with IBD with positive predictive value: 100%; negative predictive value: 88.5%. The probability of IBD in children with normal FC, BII and IUS was 0.09%. Conclusions: FC and increased BWT at IUS are accurate to guide reassurance or proceeding with further invasive procedures for detecting IBD in children with mild GI symptoms.
Collapse
Affiliation(s)
- Dario Dilillo
- a Department of Pediatrics , V. Buzzi Children's Hospital, University of Milan , Milan , Italy
| | - Gian Vincenzo Zuccotti
- a Department of Pediatrics , V. Buzzi Children's Hospital, University of Milan , Milan , Italy
| | - Erica Galli
- a Department of Pediatrics , V. Buzzi Children's Hospital, University of Milan , Milan , Italy
| | - Fabio Meneghin
- b Department of Pediatrics , L. Sacco Hospital, University of Milan , Milan , Italy
| | - Alessandra Dell'Era
- c Department of Biomedical and Clinical Sciences, Gastroenterology Unit , L. Sacco Hospital, University of Milan , Milan , Italy
| | - Francesca Penagini
- a Department of Pediatrics , V. Buzzi Children's Hospital, University of Milan , Milan , Italy
| | - Giacomo Colella
- b Department of Pediatrics , L. Sacco Hospital, University of Milan , Milan , Italy
| | - Peter Lewindon
- d Department of Gastroenterology , Royal Children's Hospital , Brisbane , Australia
| | - Stefania Carmagnola
- c Department of Biomedical and Clinical Sciences, Gastroenterology Unit , L. Sacco Hospital, University of Milan , Milan , Italy
| | - Elisa Farina
- c Department of Biomedical and Clinical Sciences, Gastroenterology Unit , L. Sacco Hospital, University of Milan , Milan , Italy
| | - Sandro Ardizzone
- c Department of Biomedical and Clinical Sciences, Gastroenterology Unit , L. Sacco Hospital, University of Milan , Milan , Italy
| | - Giovanni Maconi
- c Department of Biomedical and Clinical Sciences, Gastroenterology Unit , L. Sacco Hospital, University of Milan , Milan , Italy
| |
Collapse
|
14
|
Scarpato E, Auricchio R, Penagini F, Campanozzi A, Zuccotti GV, Troncone R. Efficacy of the gluten free diet in the management of functional gastrointestinal disorders: a systematic review on behalf of the Italian Society of Paediatrics. Ital J Pediatr 2019; 45:9. [PMID: 30635010 PMCID: PMC6329096 DOI: 10.1186/s13052-019-0606-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 05/08/2018] [Accepted: 01/03/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Functional gastrointestinal disorders (FGIDs) are characterized by chronic/recurrent gastrointestinal symptoms not related to organic disorders. Due to the limited treatment options and to the perception of subjects with FGIDs suffering from a food intolerance, in recent years there has been an increase in the self-prescription of elimination diets, especially gluten free diet (GFD), for the treatment of these disorders. For this reason, we decided to perform this systematic review with the aim to evaluate the available evidence on the effects of a GFD on gastrointestinal symptoms, in subjects with FGIDs. METHODS Cochrane Library and MEDLINE (via PubMed) databases were searched, from inception to March 2018, using the MeSH terms "functional gastrointestinal disorder OR irritable bowel syndrome AND gluten". We included all the clinical trials published in English and evaluating the effects of a GFD in subjects with FGIDs diagnosed according to the Rome II, III, and IV criteria. RESULTS Eleven trials were eligible (3 prospective trials, 8 single or double-blind placebo-controlled trials), with 10/11 trials including adult subjects with irritable bowel syndrome (IBS) or FGIDs. Most of the prospective studies found an effect of GFD on gastrointestinal symptoms control. Nevertheless, 1 trial failed to find an association between gluten and GI symptoms when FODMAPs (fermentable oligosaccharides, disaccharides, monosaccharides and polyols) content was simultaneously reduced in the diet, and 2 trials reported a worsening of symptoms during placebo administration. The results of the different trials are difficult to compare due to discrepancies in the study protocols regarding the amount and type of gluten administered, the duration of the gluten challenge, the type of placebo used, and the duration of the challenge itself. CONCLUSIONS According to our results, gluten may contribute to the occurrence of gastrointestinal symptoms in patients with FGIDs, particularly in those with IBS. Nevertheless, the results of the currently available trials are difficult to compare due to the lack of standardization in the study designs. For this reason, it is still not possible to recommend the use of the GFD in the routine management of FGIDs.
Collapse
Affiliation(s)
- Elena Scarpato
- Department of Translational Medical Sciences - Section of Paediatrics, University of Naples Federico II, via Pansini 5, 80131, Naples, Italy
| | - Renata Auricchio
- Department of Translational Medical Sciences - Section of Paediatrics, University of Naples Federico II, via Pansini 5, 80131, Naples, Italy
| | - Francesca Penagini
- Department of Pediatrics, University of Milan, V. Buzzi Children's Hospital, via Castelvetro 32, 20154, Milan, Italy
| | - Angelo Campanozzi
- Pediatrics, Department of Medical and Surgical Sciences, University of Foggia, via Luigi Pinto 1, 71100, Foggia, Italy
| | - Gian Vincenzo Zuccotti
- Department of Pediatrics, University of Milan, V. Buzzi Children's Hospital, via Castelvetro 32, 20154, Milan, Italy
| | - Riccardo Troncone
- Department of Translational Medical Sciences - Section of Paediatrics, University of Naples Federico II, via Pansini 5, 80131, Naples, Italy.
| |
Collapse
|
15
|
Penagini F, Borsani B, Maruca K, Giosia V, Bova S, Mastrangelo M, Zuccotti GV, Mora S. Short-Term Vitamin D3 Supplementation in Children with Neurodisabilities: Comparison of Two Delivery Methods. Horm Res Paediatr 2018; 88:281-284. [PMID: 28898870 DOI: 10.1159/000479690] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [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: 04/12/2017] [Accepted: 07/19/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Vitamin D deficiency is common in children with neurodisabilities. Oral vitamin D3 may not be absorbed appropriately due to dysphagia and tube feeding. The aim of this study was to compare efficacy of vitamin D3 buccal spray with that of oral drops. METHODS Twenty-four children with neurodisabilities (5-17 years) and vitamin D deficiency (25(OH)D ≤20 ng/mL) were randomized to receive vitamin D3 buccal spray 800 IU/daily (n = 12) or oral drops 750 IU/daily (n = 12) for 3 months during winter. RESULTS Both groups had a significant increase in 25(OH)D (z = 150; p < 0.0001). The differences between baseline and final parathyroid hormone measurements did not reach significance in both groups. Markers of bone formation and resorption did not change significantly in both groups. The satisfaction with the formulation was significantly higher in the patients using spray. CONCLUSION Vitamin D3 supplementation with buccal spray and oral drops are equally effective in short-term treatment of vitamin D deficiency in children with neurodisabilities. Buccal spray may be more acceptable by the patients.
Collapse
Affiliation(s)
- Francesca Penagini
- Department of Pediatrics, University of Milan, "V. Buzzi" Children's Hospital, Milan, Italy
| | - Barbara Borsani
- Department of Pediatrics, University of Milan, "V. Buzzi" Children's Hospital, Milan, Italy
| | - Katia Maruca
- Laboratory of Pediatric Endocrinology, Division of Genetics and Cell Biology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Valeria Giosia
- Department of Pediatrics, University of Milan, "V. Buzzi" Children's Hospital, Milan, Italy
| | - Stefania Bova
- Pediatric Neurology Unit, "V. Buzzi" Children's Hospital, Milan, Italy
| | | | - Gian Vincenzo Zuccotti
- Department of Pediatrics, University of Milan, "V. Buzzi" Children's Hospital, Milan, Italy
| | - Stefano Mora
- Laboratory of Pediatric Endocrinology, Division of Genetics and Cell Biology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| |
Collapse
|
16
|
D'Auria E, Bergamini M, Staiano A, Banderali G, Pendezza E, Penagini F, Zuccotti GV, Peroni DG. Baby-led weaning: what a systematic review of the literature adds on. Ital J Pediatr 2018; 44:49. [PMID: 29724233 PMCID: PMC5934812 DOI: 10.1186/s13052-018-0487-8] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 04/12/2018] [Indexed: 12/20/2022] Open
Abstract
The term weaning describes the time period in which a progressive reduction of breastfeeding or the feeding of infant-formula takes place while the infant is gradually introduced to solid foods. It is a crucial time in an infant’s life as not only does it involve with a great deal of rapid change for the child, but it is also associated with the development of food preferences, eating behaviours and body weight in childhood and also in adolescence and adulthood. Therefore, how a child is weaned may have an influence later, on the individual’s entire life. Babies are traditionally first introduced to solid foods using spoon-feeding, in most countries. Beside to traditional approach, an alternative method, promoting infant self-feeding from six months of age, called baby-led weaning or “auto-weaning”, has grown in popularity. This approach causes concern to healthy professionals and parents themselves as data from observational studies pointed out to a potential risk of iron and energy inadequacy as well as choking risk. Aim of this systematic review was to critically examine the current evidence about baby-led weaning approach and to explore the need for future research. A systematic search was conducted in Cochrane library databases and DARE (Database of Abstract of Reviews of Effects), EMBASE and MEDLINE in the period 2000–2018 (up to March 1st) to address some key questions on baby-led weaning. Prisma guidelines for systematic reviews has been followed. After the inclusion/exclusion process, we included for analysis of evidence 12 articles, 10 observational cross-sectional studies and 2 randomized controlled trials. Pooling of results from very different outcomes in the studies included was not possible. Both randomized trials have potential bias; therefore, the quality of the evidence is low. There are still major unresolved issues about baby-led weaning that require answers from research and that should be considered when advices are requested from health professionals by parents willing to approach this method.
Collapse
Affiliation(s)
- Enza D'Auria
- Department of Pediatrics, Ospedale dei Bambini V. Buzzi, University of Milan, Milan, Italy.
| | | | - Annamaria Staiano
- Dipartimento di Scienze Mediche Traslazionali, Università degli Studi di Napoli Federico II, Naples, Italy
| | - Giuseppe Banderali
- Department of Pediatrics ASST Santi Paolo e Carlo Hospital, Department of Health Science, University of Milan, Milan, Italy
| | - Erica Pendezza
- Department of Pediatrics, Ospedale dei Bambini V. Buzzi, University of Milan, Milan, Italy
| | - Francesca Penagini
- Department of Pediatrics, Ospedale dei Bambini V. Buzzi, University of Milan, Milan, Italy
| | - Gian Vincenzo Zuccotti
- Department of Pediatrics, Ospedale dei Bambini V. Buzzi, University of Milan, Milan, Italy
| | - Diego Giampietro Peroni
- Department of Clinical and Experimental Medicine, Section of Paediatrics, University of Pisa, Pisa, Italy
| | | |
Collapse
|
17
|
Penagini F, Borsani B, Bosetti A, Mameli C, Dilillo D, Ramponi G, Motta F, Bedogni G, Zuccotti GV. Resting energy expenditure in children with cerebral palsy: Accuracy of available prediction formulae and development of a population-specific formula. Clin Nutr ESPEN 2018; 25:44-49. [PMID: 29779817 DOI: 10.1016/j.clnesp.2018.04.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 03/18/2018] [Accepted: 04/03/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND AIMS Energy requirements are difficult to estimate in children with cerebral palsy (CP). Resting energy expenditure (REE), necessary for personalized nutritional intervention, is most commonly estimated using prediction formulae because the reference method, i.e. indirect calorimetry (IC), is not available in all Nutrition Units. The main aim of the present study was to evaluate the accuracy of the most commonly used REE prediction formulae in children with CP. The secondary aim was to develop a new population-specific formula for the estimation of REE in children with CP. METHODS REE was measured by IC in 54 children and adolescents with spastic quadriplegic cerebral palsy (SQCP) and estimated from the five most commonly used prediction formulae, i.e. the World Health Organization (WHO), Harris-Benedict, Schofield weight, Schofield weight & height, and Oxford formulae. RESULTS The mean (standard deviation, SD) difference between the estimated and measured REE was 64 (238) kcal/day for the WHO formula, 79 (226) kcal/day for the Schofield weight formula, 79 (223) kcal/day for the Schofield weight and height formula, 55 (226) kcal/day for the Oxford formula, 37 (224) kcal/day for the Harris-Benedict formula and 0 (213) kcal/day for the purposely developed population-specific formula. Owing to the large SD of the bias, none of these formulae can be reliably applied at the individual level to estimate REE. CONCLUSIONS The most commonly used REE prediction formulas are inaccurate at both the population and individual level in children with SQCP. A purposely developed population-specific formula, despite being accurate at the population level, does not perform better than the most commonly used REE formulae at the individual level.
Collapse
Affiliation(s)
- Francesca Penagini
- Department of Pediatrics, "V. Buzzi" Children's Hospital, University of Milan, Via Castelvetro 32, 20154 Milan, Italy.
| | - Barbara Borsani
- Pediatric Nutrition Unit, "V. Buzzi" Children's Hospital, University of Milan, Via Castelvetro 32, 20154 Milan, Italy
| | - Alessandra Bosetti
- Pediatric Nutrition Unit, "V. Buzzi" Children's Hospital, University of Milan, Via Castelvetro 32, 20154 Milan, Italy
| | - Chiara Mameli
- Department of Pediatrics, "V. Buzzi" Children's Hospital, University of Milan, Via Castelvetro 32, 20154 Milan, Italy
| | - Dario Dilillo
- Department of Pediatrics, "V. Buzzi" Children's Hospital, University of Milan, Via Castelvetro 32, 20154 Milan, Italy
| | - Giulia Ramponi
- Department of Pediatrics, "V. Buzzi" Children's Hospital, University of Milan, Via Castelvetro 32, 20154 Milan, Italy
| | - Francesco Motta
- Pediatric Orthopedic Unit, "V. Buzzi" Children's Hospital, Via Castelvetro 32, 20154 Milan, Italy
| | - Giorgio Bedogni
- Clinical Epidemiology Unit, Liver Research Center, Building Q, AREA Science Park, Strada Statale 14 km 163.5, 34012, Basovizza, Trieste, Italy
| | - Gian Vincenzo Zuccotti
- Department of Pediatrics, "V. Buzzi" Children's Hospital, University of Milan, Via Castelvetro 32, 20154 Milan, Italy
| |
Collapse
|
18
|
Mameli C, Brunetti D, Colombo V, Bedogni G, Schneider L, Penagini F, Borsani B, Zuccotti GV. Combined use of a wristband and a smartphone to reduce body weight in obese children: randomized controlled trial. Pediatr Obes 2018; 13:81-87. [PMID: 27900849 DOI: 10.1111/ijpo.12201] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Revised: 09/10/2016] [Accepted: 10/17/2016] [Indexed: 01/09/2023]
Abstract
BACKGROUND Technological instruments may help control paediatric obesity. OBJECTIVE We tested whether a personalized programme based on the energy expenditure obtained from a wristband (WB) and the energy intake obtained from a smartphone application (APP) is superior to a standard approach at promoting weight loss. METHODS We performed a randomized controlled trial in obese children aged 10-17 years. The experimental (EXP) and control (CTR) groups were given a low-energy diet and a prescription for physical activity. The EXP group was equipped with a WB and an APP and given personalized feedback every 7 days. The main outcome was weight loss at 3 months. RESULTS The mean (standard deviation) z-score of body mass index at the enrollment was 2.20 (0.47) in the EXP (n = 16 out of 23) and 2.09 (0.34) in the CTR group (n = 14 out of 20) of children who completed the trial. The mean (95%CI) difference in weight loss at 3 months was 0.07 kg (95%CI: 2.81 to 2.96) for EXP vs. the CTR. CONCLUSION A personalized lifestyle programme based on a WB and an APP was not superior to a standard lifestyle programme at promoting weight loss in obese children.
Collapse
Affiliation(s)
- C Mameli
- Department of Pediatrics, Children's Hospital Vittore Buzzi, University of Milan, Milan, Italy
| | - D Brunetti
- Department of Pediatrics, Children's Hospital Vittore Buzzi, University of Milan, Milan, Italy
| | - V Colombo
- Department of Pediatrics, Children's Hospital Vittore Buzzi, University of Milan, Milan, Italy
| | - G Bedogni
- Clinical Epidemiology Unit, Liver Research Center, Basovizza, Trieste, Italy
| | - L Schneider
- Department of Pediatrics, Luigi Sacco Hospital, Milan, Italy
| | - F Penagini
- Department of Pediatrics, Children's Hospital Vittore Buzzi, University of Milan, Milan, Italy
| | - B Borsani
- Department of Pediatrics, Children's Hospital Vittore Buzzi, University of Milan, Milan, Italy
| | - G V Zuccotti
- Department of Pediatrics, Children's Hospital Vittore Buzzi, University of Milan, Milan, Italy
| |
Collapse
|
19
|
Penagini F, Abbattista L, Borsani B, Ramponi G, D’Auria E, Zuccotti GV. Iron deficiency and iron deficiency anemia in children aged 6–36 months: Is there room for improvement of screening, prophylaxis and treatment? Pharmacol Res 2018; 128:61-62. [DOI: 10.1016/j.phrs.2017.12.012] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 12/12/2017] [Accepted: 12/12/2017] [Indexed: 10/18/2022]
|
20
|
Werkstetter KJ, Korponay-Szabó IR, Popp A, Villanacci V, Salemme M, Heilig G, Lillevang ST, Mearin ML, Ribes-Koninckx C, Thomas A, Troncone R, Filipiak B, Mäki M, Gyimesi J, Najafi M, Dolinšek J, Dydensborg Sander S, Auricchio R, Papadopoulou A, Vécsei A, Szitanyi P, Donat E, Nenna R, Alliet P, Penagini F, Garnier-Lengliné H, Castillejo G, Kurppa K, Shamir R, Hauer AC, Smets F, Corujeira S, van Winckel M, Buderus S, Chong S, Husby S, Koletzko S. Accuracy in Diagnosis of Celiac Disease Without Biopsies in Clinical Practice. Gastroenterology 2017. [PMID: 28624578 DOI: 10.1053/j.gastro.2017.06.002] [Citation(s) in RCA: 153] [Impact Index Per Article: 21.9] [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] [Indexed: 02/06/2023]
Abstract
BACKGROUND & AIMS The guidelines of the European Society of Pediatric Gastroenterology, Hepatology, and Nutrition allow for diagnosis of celiac disease without biopsies in children with symptoms and levels of immunoglobulin A against tissue-transglutaminase (TGA-IgA) 10-fold or more the upper limit of normal (ULN), confirmed by detection of endomysium antibodies (EMA) and positivity for HLA-DQ2/DQ8. We performed a large, international prospective study to validate this approach. METHODS We collected data from consecutive pediatric patients (18 years or younger) on a gluten-containing diet who tested positive for TGA-IgA from November 2011 through May 2014, seen at 33 pediatric gastroenterology units in 21 countries. Local centers recorded symptoms; measurements of total IgA, TGA, and EMA; and histopathology findings from duodenal biopsies. Children were considered to have malabsorption if they had chronic diarrhea, weight loss (or insufficient gain), growth failure, or anemia. We directly compared central findings from 16 antibody tests (8 for TGA-IgA, 1 for TGA-IgG, 6 for IgG against deamidated gliadin peptides, and 1 for EMA, from 5 different manufacturers), 2 HLA-DQ2/DQ8 tests from 2 manufacturers, and histopathology findings from the reference pathologist. Final diagnoses were based on local and central results. If all local and central results were concordant for celiac disease, cases were classified as proven celiac disease. Patients with only a low level of TGA-IgA (threefold or less the ULN) but no other results indicating celiac disease were classified as no celiac disease. Central histo-morphometry analyses were performed on all other biopsies and cases were carefully reviewed in a blinded manner. Inconclusive cases were regarded as not having celiac disease for calculation of diagnostic accuracy. The primary aim was to determine whether the nonbiopsy approach identifies children with celiac disease with a positive predictive value (PPV) above 99% in clinical practice. Secondary aims included comparing performance of different serological tests and to determine whether the suggested criteria can be simplified. RESULTS Of 803 children recruited for the study, 96 were excluded due to incomplete data, low level of IgA, or poor-quality biopsies. In the remaining 707 children (65.1% girls; median age, 6.2 years), 645 were diagnosed with celiac disease, 46 were found not to have celiac disease, and 16 had inconclusive results. Findings from local laboratories of TGA-IgA 10-fold or more the ULN, a positive result from the test for EMA, and any symptom identified children with celiac disease (n = 399) with a PPV of 99.75 (95% confidence interval [CI], 98.61-99.99); the PPV was 100.00 (95% CI, 98.68-100.00) when only malabsorption symptoms were used instead of any symptom (n = 278). Inclusion of HLA analyses did not increase accuracy. Findings from central laboratories differed greatly for patients with lower levels of antibodies, but when levels of TGA-IgA were 10-fold or more the ULN, PPVs ranged from 99.63 (95% CI, 98.67-99.96) to 100.00 (95% CI, 99.23-100.00). CONCLUSIONS Children can be accurately diagnosed with celiac disease without biopsy analysis. Diagnosis based on level of TGA-IgA 10-fold or more the ULN, a positive result from the EMA tests in a second blood sample, and the presence of at least 1 symptom could avoid risks and costs of endoscopy for more than half the children with celiac disease worldwide. HLA analysis is not required for accurate diagnosis. Clinical Trial Registration no: DRKS00003555.
Collapse
Affiliation(s)
- Katharina Julia Werkstetter
- Dr. von Hauner Children's Hospital, Department of Pediatrics, University Hospital, LMU Munich, Munich, Germany
| | - Ilma Rita Korponay-Szabó
- Celiac Disease Center Heim Pál Children's Hospital, Budapest and Department of Pediatrics, University of Debrecen, Debrecen, Hungary; Center for Child Health Research, University of Tampere and Tampere University Hospital, Tampere, Finland
| | - Alina Popp
- Center for Child Health Research, University of Tampere and Tampere University Hospital, Tampere, Finland; University of Medicine and Pharmacy "Carol Davila" and National Institute for Mother and Child Health "Alessandrescu-Rusescu," Bucharest, Romania
| | | | | | - Gabriele Heilig
- Dr. von Hauner Children's Hospital, Department of Pediatrics, University Hospital, LMU Munich, Munich, Germany
| | | | - Maria Luisa Mearin
- Department of Pediatrics, Leiden University Medical Center, Leiden, the Netherlands
| | - Carmen Ribes-Koninckx
- Department of Pediatric Gastroenterology and Hepatology, La Fe University Hospital, Valencia, Spain
| | - Adrian Thomas
- Department of Pediatric Gastroenterology, Royal Manchester Children's Hospital, Manchester, United Kingdom
| | - Riccardo Troncone
- Department of Translational Medical Sciences & European Laboratory for the Investigation of Food-Induced Diseases, University Federico II, Naples, Italy
| | - Birgit Filipiak
- Dr. von Hauner Children's Hospital, Department of Pediatrics, University Hospital, LMU Munich, Munich, Germany
| | - Markku Mäki
- Center for Child Health Research, University of Tampere and Tampere University Hospital, Tampere, Finland
| | - Judit Gyimesi
- Celiac Disease Center Heim Pál Children's Hospital, Budapest and Department of Pediatrics, University of Debrecen, Debrecen, Hungary
| | - Mehri Najafi
- Department of Pediatric Gastroenterology & Hepatology, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Jernej Dolinšek
- Department of Pediatrics, University Medical Center (UMC), Maribor, Slovenia
| | | | - Renata Auricchio
- Department of Translational Medical Sciences & European Laboratory for the Investigation of Food-Induced Diseases, University Federico II, Naples, Italy
| | - Alexandra Papadopoulou
- Division of Gastroenterology, Hepatology and Nutrition, First Department of Pediatrics, Children's Hospitals "Agia Sophia," University of Athens, Athens, Greece
| | - Andreas Vécsei
- Gastroenterology Outpatient Clinic, St. Anna Children's Hospital, Medical University Vienna, Vienna, Austria
| | - Peter Szitanyi
- Department of Pediatrics and Adolescent Medicine, First Faculty of Medicine and General Teaching Hospital, Charles University, Prague, Czech Republic
| | - Ester Donat
- Department of Pediatric Gastroenterology and Hepatology, La Fe University Hospital, Valencia, Spain
| | - Rafaella Nenna
- Department of Pediatrics, Sapienza University of Rome, Rome, Italy
| | | | - Francesca Penagini
- Department of Pediatric Gastroenterology, Addenbrookes Hospital, Cambridge, United Kingdom
| | - Hélène Garnier-Lengliné
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Hôpital Necker-Enfants Malades, Paris, France
| | - Gemma Castillejo
- Department of Pediatric Gastroenterology and Nutrition, Hospital Universitari Sant Joan, Reus, Spain
| | - Kalle Kurppa
- Center for Child Health Research, University of Tampere and Tampere University Hospital, Tampere, Finland
| | - Raanan Shamir
- Institute of Gastroenterology, Nutrition and Liver Diseases, Schneider Children's Medical Center of Israel, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Françoise Smets
- Université Catholique de Louvain, IREC, PEDI, Cliniques universitaires Saint Luc, Brussels, Belgium
| | - Susana Corujeira
- Department of Pediatric Gastroenterology, Hospital S. João, Porto, Portugal
| | - Myriam van Winckel
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Ghent University Hospital, Ghent, Belgium
| | - Stefan Buderus
- Department of Pediatrics, St. Marien Hospital, Bonn, Germany
| | - Sonny Chong
- Queen Mary's Hospital for Children, Carshalton, United Kingdom
| | - Steffen Husby
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark
| | - Sibylle Koletzko
- Dr. von Hauner Children's Hospital, Department of Pediatrics, University Hospital, LMU Munich, Munich, Germany.
| | | |
Collapse
|
21
|
Penagini F, Dilillo D, Borsani B, Cococcioni L, Galli E, Bedogni G, Zuin G, Zuccotti GV. Nutrition in Pediatric Inflammatory Bowel Disease: From Etiology to Treatment. A Systematic Review. Nutrients 2016; 8:nu8060334. [PMID: 27258308 PMCID: PMC4924175 DOI: 10.3390/nu8060334] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [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: 02/14/2016] [Revised: 05/17/2016] [Accepted: 05/27/2016] [Indexed: 12/11/2022] Open
Abstract
Nutrition is involved in several aspects of pediatric inflammatory bowel disease (IBD), ranging from disease etiology to induction and maintenance of disease. With regards to etiology, there are pediatric data, mainly from case-control studies, which suggest that some dietary habits (for example consumption of animal protein, fatty foods, high sugar intake) may predispose patients to IBD onset. As for disease treatment, exclusive enteral nutrition (EEN) is an extensively studied, well established, and valid approach to the remission of pediatric Crohn’s disease (CD). Apart from EEN, several new nutritional approaches are emerging and have proved to be successful (specific carbohydrate diet and CD exclusion diet) but the available evidence is not strong enough to recommend this kind of intervention in clinical practice and new large experimental controlled studies are needed, especially in the pediatric population. Moreover, efforts are being made to identify foods with anti-inflammatory properties such as curcumin and long-chain polyunsaturated fatty acids n-3, which can possibly be effective in maintenance of disease. The present systematic review aims at reviewing the scientific literature on all aspects of nutrition in pediatric IBD, including the most recent advances on nutritional therapy.
Collapse
Affiliation(s)
- Francesca Penagini
- Pediatric Department, "V. Buzzi" Children's Hospital, University of Milan, Via Castelvetro 32, 20154 Milan, Italy.
| | - Dario Dilillo
- Pediatric Department, "V. Buzzi" Children's Hospital, University of Milan, Via Castelvetro 32, 20154 Milan, Italy.
| | - Barbara Borsani
- Pediatric Department, "V. Buzzi" Children's Hospital, University of Milan, Via Castelvetro 32, 20154 Milan, Italy.
| | - Lucia Cococcioni
- Pediatric Department, "V. Buzzi" Children's Hospital, University of Milan, Via Castelvetro 32, 20154 Milan, Italy.
| | - Erica Galli
- Pediatric Department, "V. Buzzi" Children's Hospital, University of Milan, Via Castelvetro 32, 20154 Milan, Italy.
| | - Giorgio Bedogni
- Clinical Epidemiology Unit, Liver Research Center, Basovizza, 34012 Trieste, Italy.
| | - Giovanna Zuin
- Pediatric Department, "V. Buzzi" Children's Hospital, University of Milan, Via Castelvetro 32, 20154 Milan, Italy.
| | - Gian Vincenzo Zuccotti
- Pediatric Department, "V. Buzzi" Children's Hospital, University of Milan, Via Castelvetro 32, 20154 Milan, Italy.
| |
Collapse
|
22
|
Mameli C, Fabiano V, Daprai L, Bedogni G, Faccini M, Garlaschi ML, Penagini F, Dilillo D, Torresani E, Gramegna M, Zuccotti GV. A longitudinal study of streptococcus pneumoniae carriage in healthy children in the 13-valent pneumococcal conjugate vaccine era. Hum Vaccin Immunother 2016; 11:811-7. [PMID: 25751237 DOI: 10.1080/21645515.2015.1010945] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [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: 01/27/2023] Open
Abstract
Few epidemiological data are available after the introduction of the 13-valent pneumococcal vaccine (PCV13) in 2010. We performed repeat nasopharyngeal swabs and evaluated the serotype distribution of Streptococcus pneumoniae (SP) and its association with PCV13 vaccine status in healthy Italian children aged 3-59 months. SP serotypes were assessed by the Quellung reaction. 618 children appropriately (28%) or incompletely (72%) vaccinated for age with PCV13 were available at baseline (T0). 515 were re-evaluated at 6 months from baseline (T6) and 436 at 12 months from baseline (T12). The percentage of appropriately vaccinated subjects at T0, T6 and T12 was 28%, 67% and 92%, respectively. Random effects logistic regression models with robust 95% confidence intervals was used to estimate the time-related changes in SP and PCV13 carriage and marginal probabilities were obtained from such models. The age-corrected probability of SP carriage was 0.31 (95% CI 0.22 - 0.41) at T0, 0.32 (0.24 - 0.40) at T6 and 0.28 (0.20 - 0.35) at T12. The probability of PCV13 serotypes carriage was 0.025 (0.001 - 0.050) at T0, 0.018 (0.001 - 0.039) at T6 and 0.010 (0.001 - 0.023) at T12. A decrease in PCV13 serotypes and a shift in non-PCV13 serotypes colonization was observed. In particular, the 15A serotype accounted for 4%, 8% and 23% of SP isolates at T0, T6 and T12, respectively. In conclusion, the benefits of the PCV13 vaccination on SP carriage increase with increasing coverage rates. The shift of SP isolates toward non-PCV13 serotypes needs to be studied further.
Collapse
Affiliation(s)
- Chiara Mameli
- a Department of Pediatrics; Children's Hospital "V. Buzzi" ; University of Milan ; Milan , Italy
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
23
|
Pogliani L, Cerini C, Penagini F, Duca P, Mameli C, Zuccotti GV. Cerebral ultrasound abnormalities in offsprings of women with C677T homozygous mutation in the MTHFR gene: a prospective study. World J Pediatr 2015; 11:134-40. [PMID: 24974211 DOI: 10.1007/s12519-014-0490-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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] [Received: 05/21/2014] [Accepted: 12/15/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND Perinatal stroke is a common cause of neurologic disability. Being clinically under-recognized, its true incidence is not known. Maternal thrombophilia is likely to be a predisposing factor. To date, a general consensus for evaluation of babies born to mothers with genetic thrombotic predisposition is missing. This study was undertaken to assess the frequency of cerebral abnormalities in the offspring of women with homozygous C677T mutation in the MTHFR gene, and to seek for association with additional maternal or pregnancy risk factors. METHODS Mother-infant pairs were consecutively recruited from October 2006 through February 2013. Neonates underwent a thorough physical examination at birth, and a cerebral ultrasound examination (cUS) was performed within 24 hours of their life. In neonates with major cerebral lesions, a thrombophilia panel test was obtained. Follow-up cUS was performed in babies with major or minor cerebral abnormalities. RESULTS Ninety-one neonates (47 males) were enrolled. By cUS, abnormalities were detected in 18 (19.8%) neonates. Twelve neonates were diagnosed with a minor lesion; a major ischemic/hemorrhagic lesion was found in 6 neonates. There were a neat male preponderance and significant associations with a history of suspected miscarriage, maternal coagulation factors gene mutations, and reduced protein S or protein C activity. CONCLUSIONS Our data confirmed a high incidence of cerebral abnormalities in neonates born to women with C677T homozygous mutation in the MTHFR gene. cUS at birth proved to be an effective screening tool or a diagnostic test, that should be routinely performed in babies born to mothers with known thrombotic predisposition.
Collapse
Affiliation(s)
- Laura Pogliani
- Department of Pediatrics, University of Milan, 74 GB Grassi, Milan, IT, 20157, Italy
| | | | | | | | | | | |
Collapse
|
24
|
Giacomet V, Penagini F, Trabattoni D, Viganò A, Rainone V, Bernazzani G, Bonardi CM, Clerici M, Bedogni G, Zuccotti GV. Safety and immunogenicity of a quadrivalent human papillomavirus vaccine in HIV-infected and HIV-negative adolescents and young adults. Vaccine 2014; 32:5657-61. [PMID: 25149430 DOI: 10.1016/j.vaccine.2014.08.011] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [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] [Received: 05/12/2014] [Revised: 08/07/2014] [Accepted: 08/08/2014] [Indexed: 12/18/2022]
Abstract
Human papillomavirus (HPV) infection is highly prevalent and can lead to cancer; the development of safe and efficacious vaccines for HPV is a major public health concern. The two licensed HPV vaccines contain recombinant virus-like particles of HPV 16 and 18; one of such vaccines also protects against HPV types 6 and 11 which cause genital warts. We determined safety and immunogenicity of quadrivalent HPV vaccine in HIV-infected and HIV-negative adolescents and young adults, aged 13-27 years. The seroconversion rate, assessed by antibody titers, 1 month after the administration of the third vaccine dose was 0.85 (95% CI 0.75-0.95) in the HIV-infected group and 0.91 (0.83-0.99) in the HIV-negative subjects (p=0.52). The vaccine was generally safe and well tolerated; the most common side effect was local pain and the most frequent systemic side effect was headache. This is the first report on response to HPV vaccination in both female and male HIV-infected adolescents and young adults and highlights that this population may benefit from HPV immunoprophylaxis. Further studies are needed to examine the long term efficacy of this vaccine in HIV-infected individuals.
Collapse
Affiliation(s)
- Vania Giacomet
- Department of Pediatrics, Luigi Sacco Hospital, University of Milan, Italy
| | - Francesca Penagini
- Department of Pediatrics, Luigi Sacco Hospital, University of Milan, Italy
| | - Daria Trabattoni
- Department of Immunology, Luigi Sacco Hospital, University of Milan, Italy
| | - Alessandra Viganò
- Department of Pediatrics, Luigi Sacco Hospital, University of Milan, Italy.
| | - Veronica Rainone
- Department of Immunology, Luigi Sacco Hospital, University of Milan, Italy
| | - Giada Bernazzani
- Department of Pediatrics, Luigi Sacco Hospital, University of Milan, Italy
| | | | - Mario Clerici
- Department of Immunology, Luigi Sacco Hospital, University of Milan, Italy; Don C Gnocchi Foundation, IRCCS, Milan, Italy
| | - Giorgio Bedogni
- Clinical Epidemiology Unit, Liver Research Center, Basovizza, Trieste, Italy
| | | |
Collapse
|
25
|
Rainone V, Trabattoni D, Penagini F, Fabiano V, Calascibetta F, Giacomet V, Vigano A, Clerici M, Zuccotti GV. HPV vaccination in HIV+ adolescents and young adults induces strong HPV-specific immune responses. BMC Infect Dis 2014. [PMCID: PMC4221045 DOI: 10.1186/1471-2334-14-s2-p93] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
|
26
|
Giacomet V, Penagini F, Erba P, Nello FD, Nannini P, Pisanelli S, Ramponi G, Zuccotti GV. Neurocysticercosis in a 14-year-old boy in Italy: An unexpected case. Asian Pacific Journal of Tropical Disease 2013. [DOI: 10.1016/s2222-1808(13)60078-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
27
|
Giacomet V, Manfredini V, Fabiano V, Penagini F, Zuccotti GV. Fever and ascites underlying abdominal aspergillosis in a 3-year-old boy. Pediatr Int 2012; 54:311-2. [PMID: 22507165 DOI: 10.1111/j.1442-200x.2012.03587.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
28
|
Viganò A, Bedogni G, Manfredini V, Giacomet V, Cerini C, di Nello F, Penagini F, Caprio C, Zuccotti GV. Long-term renal safety of tenofovir disoproxil fumarate in vertically HIV-infected children, adolescents and young adults: a 60-month follow-up study. Clin Drug Investig 2011; 31:407-15. [PMID: 21528939 DOI: 10.2165/11590400-000000000-00000] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
BACKGROUND AND OBJECTIVE Sporadic cases of renal toxicity have been reported in HIV-infected children treated with tenofovir disoproxil fumarate (TDF). We assessed the long-term renal safety of TDF in a cohort of vertically HIV-infected children, adolescents and young adults. METHODS We evaluated 26 HIV-infected children, adolescents and young adults, aged 4.9-17.4 years at baseline, every 6 months for 60 consecutive months. At the baseline visit, they had an undetectable viral load and a good immune reconstitution and were being treated with lamivudine, stavudine and a protease inhibitor (PI). At the same visit, stavudine was replaced with TDF and the PI with efavirenz. Serum creatinine, estimated glomerular filtration rate (GFR), urine protein to creatinine ratio, serum phosphate, ratio of the maximum rate of tubular phosphate reabsorption to the GFR (TmPO(4)/GFR), urine glucose, and urine α(1)-microglobulin to creatinine ratio were used as markers of renal function. The outcome-time relationships were studied using generalized estimating equations (GEEs). In addition to time (continuous, ten equally spaced intervals), sex, age at baseline and CD4+ T-cell count were used as covariates. RESULTS A moderate reduction in GFR was observed only once in an underweight female patient. There was no occurrence of proteinuria, hypophosphataemia or glycosuria. Moreover, TmPO(4)/GFR was stable and the urine α(1)-microglobulin to creatinine ratio was always within normal limits. CONCLUSION TDF had an excellent renal safety profile in HIV-infected children, adolescents and young adults regularly followed up for 60 months.
Collapse
Affiliation(s)
- Alessandra Viganò
- Department of Paediatrics, L. Sacco Hospital, University of Milan, Milan, Italy.
| | | | | | | | | | | | | | | | | |
Collapse
|
29
|
Pogliani L, Spiri D, Penagini F, Nello FD, Duca P, Zuccotti GV. Headache in children and adolescents aged 6-18 years in northern Italy: prevalence and risk factors. Eur J Paediatr Neurol 2011; 15:234-40. [PMID: 21177128 DOI: 10.1016/j.ejpn.2010.11.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [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] [Received: 04/25/2010] [Revised: 11/08/2010] [Accepted: 11/19/2010] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Aim of this study is to examine the epidemiology of paediatric headache and periodic syndromes in a school population and to evaluate the co-existence of environmental predisposing conditions. DESIGN AND METHODS A 60-item questionnaire was completed by a school-based sample (n = 1536, ages 6-18 years). Diagnostic assessment of primary headache and periodic syndromes was established in first section; predisposing conditions in the second section; while the third section quantified the frequency of self medication and identified drugs most frequently used. RESULTS Headache was reported by 62.1% of subjects. Socioeconomic status, composition of family unit and nutrition habits in the first year of life did not appear significantly different in subjects with headache compared to healthy controls. A good sleep quality was found in 95.2% of healthy controls, in 89.4% of children with occasional headache. Recurrent abdominal pain, motor weakness and car sickness was significantly higher in primary headache group compared to occasional headache. Depressive/anxious traits were significantly higher in primary headache and occasional headache groups than in healthy controls. The frequency of aggressive traits was also higher in children with primary headache compared to occasional headache and healthy control subjects. 72.5% of subjects with primary headache and 58.4% of children with occasional headache assumed medicines to relieve pain. Paracetamol was the most frequently assumed drug. CONCLUSIONS Our data show a more frequent occurrence of anxious/depressive profile in children suffering from primary headache. In agreement with literature data, this research points out that self-treatment is a relevant problem in paediatric headache.
Collapse
Affiliation(s)
- Laura Pogliani
- Department of Pediatrics, L. Sacco Hospital, University of Milan, Milan, Italy
| | | | | | | | | | | |
Collapse
|
30
|
Pogliani L, Penagini F, Dilillo D, Zuccotti G. Sepsis-like cerebrovascular event in a newborn with MTHFR homozygous mutation. Pediatr Int 2010; 52:499-500. [PMID: 20723128 DOI: 10.1111/j.1442-200x.2010.03147.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
31
|
Abstract
We report a case of neonatal withdrawal syndrome after in utero exposure to paroxetine 20 mg/day. The infant's symptoms, such as poor neonatal adaptation, respiratory distress, decerebrate posturing, irritability and tremors, commenced soon after birth and persisted for 5 days. All neonates exposed to antidepressants, particularly serotonin reuptake inhibitors (SSRIs), during the last trimester should be followed-up closely for adverse symptoms.
Collapse
Affiliation(s)
- Laura Pogliani
- L Sacco Hospital, Department of Pediatrics, Milan, Italy
| | | | | | | | | |
Collapse
|