Correction: Incidence and Associated Factors of Infantile Colic in Thai Infants

[This corrects the article on p. 276 in vol. 25, PMID: 35611375.].

Incidence and Associated Factors of Infantile Colic in Thai Infants

Purpose

Infantile colic, a common functional gastrointestinal condition, causes distress and frustration in families. Its prevalence and incidence vary from community to community. The purpose of our study was to demonstrate the incidence of and factors associated with infantile colic in Thai infants.

Methods

We conducted a prospective analytic study to explore the incidence and factors associated with infantile colic in 386 Thai infants aged between one month and six months. Caregivers were interviewed using a questionnaire about infants' symptoms of colic based on the definition from the Rome IV criteria. Family background and potential precipitating factors of colic were also evaluated.

Results

The incidence of colic in infants younger than 6 months was 6.5%. All infants' colic started within 12 weeks of life and lasted approximately 6 weeks. Sex, gestational age, birth weight, delivery route, birth order, family factors, and parental factors were not correlated with the occurrence of colic. Infants who were exclusively breastfed for the first 2 months of life had a lower incidence of infantile colic than those who were mixed- or formula-fed (odds ratio=3.0; 95% confidence intervals=1.3 to 7.2).

Conclusion

The incidence of infantile colic in Thai infants in our study was 6.5%, which is similar to that in other reports. Being exclusively breastfed for the first two months was the only risk factor in our cohort.

Impact of synbiotics on gut microbiota during early life: a randomized, double-blind study

Human milk is considered the optimal nutrition for infants and found to contain significant numbers of viable bacteria. The aim of the study was to assess the effects of a specific synbiotic combination at doses closer to the bacterial cells present in human milk, on intestinal bifidobacteria proportions (relative abundance), reduction of potential pathogens and gut physiological conditions. A clinical study was conducted in 290 healthy infants aged from 6 to 19 weeks. Infants received either a control infant formula or one of the two investigational infant formulas (control formula with 0.8 g/100 ml scGOS/lcFOS and Bifidobacterium breve M-16V at either 1 × 10⁴ cfu/ml or 1 × 10⁶ cfu/ml). Exclusively breastfed infants were included as a reference. Analyses were performed on intention-to-treat groups and all-subjects-treated groups. After 6 weeks of intervention, the synbiotics at two different doses significantly increased the bifidobacteria proportions in healthy infants. The synbiotic supplementation also decreased the prevalence (infants with detectable levels) and the abundance of C. difficile. Closer to the levels in the breastfed reference group, fecal pH was significantly lower while l-lactate concentrations and acetate proportions were significantly higher in the synbiotic groups. All formulas were well tolerated and all groups showed a comparable safety profile based on the number and severity of adverse events and growth. In healthy infants, supplementation of infant-type bifidobacterial strain B. breve M-16V, at a dose close to bacterial numbers found in human milk, with scGOS/lcFOS (9:1) created a gut environment closer to the breastfed reference group. This specific synbiotic mixture may also support gut microbiota resilience during early life.

Clinical Trial Registration This clinical study named Color Synbiotics Study, was registered in ClinicalTrials.gov on 18 March 2013. Registration number is NCT01813175. https://clinicaltrials.gov/ct2/show/NCT01813175.

Elevated serum periostin is associated with liver stiffness and clinical outcome in biliary atresia

OBJECTIVE

To analyze serum periostin and liver stiffness in postoperative biliary atresia (BA).

METHODS

A total of 60 BA patients and 14 controls were enrolled. Serum periostin levels were analyzed by ELISA. Liver stiffness measurement was determined by transient elastography.

RESULTS

Biliary atresia patients had significantly higher periostin and liver stiffness values than controls. Serum periostin levels were remarkably increased in BA patients with jaundice compared to those without jaundice. Moreover, serum periostin was correlated with liver stiffness.

CONCLUSIONS

Serum periostin was associated with liver stiffness in BA. Thus, serum periostin has potential as a parameter reflecting the severity in BA.

Cost-benefit analysis of the probiotic treatment of children hospitalized for acute diarrhea in Bangkok, Thailand

We studied the cost-benefit of using probiotics (Lactobacillus acidophilus and Bifidobacterium bifidum) in the treatment of 106 children hospitalized with acute diarrhea using a double-blind randomized, placebo-controlled trial. The median length of hospital stay was significantly shorter in the probiotics group than in the controlled group (2 versus 3 days, p=0.049), but the median duration of diarrhea and direct medical costs were not significantly different (4 versus 5 days, p=0.068 and 4,418.75 versus 4,778.75 Thai Baht, p=0.342). Taking into consideration parental income loss, a non-significant lower expense was seen in the probiotics group (6,800.33 versus 7,970.92 Thai Baht, p=0.177). A greater cost-benefit with the probiotic treatment is probable, but was not statistically significant in this small study. In conclusion, the probiotics tested shortened the duration of hospitalization of children with diarrhea but the total expenses were not different.

Rapunzel syndrome in a Thai girl with an asymptomatic abdominal mass: a case report

Rapunzel syndrome is an uncommon form of trichobezoar (a collection of ingested hair in the stomach that fails to pass through the intestine) with an extension of hair into the small bowel. The authors report in the present article a case of Rapunzel syndrome in a 10-year-old Thai girl with an asymptomatic abdominal mass incidentally detected during a hospital visit. She did not have nausea, vomiting, abdominal pain, weight loss, or any other symptoms. A movable, firm and smooth epigastric mass 10 x 12 cm in size was found upon examination. Eventually the trichobezoar mass was surgically removed after a failed endoscopic removal.

Prevalence and risk factors of dyspepsia in Thai schoolchildren

BACKGROUND AND OBJECTIVE

Dyspepsia is a common form of chronic abdominal pain in children and adolescents. Although it is usually functional or non-organic in origin, it disturbs daily activities, school attendance and the child's wellbeing. The authors evaluated prevalence and factors associated with dyspepsia among schoolchildren by comparing life-style of dyspeptic children with their asymptomatic peers.

MATERIAL AND METHOD

Total 1181 schoolchildren (mean age 14.7 +/- 1.8 years) were recruited from three schools in Bangkok. Data on dyspeptic symptoms were collected by using a questionnaire based on Rome III classification system. Potential precipitating factors for dyspepsia and life-style related to dyspepsia were also explored in the questionnaire.

RESULTS

Dyspepsia was reported in 24.0% of the subjects. Prevalence was significantly higher in girls than in boys (27.0% vs. 20.0% p = 0.006). There was no difference between the comparison groups in terms of school test scores, past medical illness, parental marital status, parental income, number of siblings,frequency of stool and spicy food, carbonated beverage or dairy product consumption. The dyspepsia group had higher percentage of family history of peptic ulcer (odds ratio [OR] = 2.5 [95% CI = 1.7 to 3.7]), history of taking medicine (OR 1.7 [1 .0 to 2.9]), alcohol consumption (OR 2.4 [1.0 to 5.7]), severe stress (OR = 3.4 [1.2 to 9.9]) and extreme stress (OR = 3.9 [1.3 to 12.0]).

CONCLUSION

Prevalence of self-reported dyspepsia among schoolchildren in this survey was similar to those previously reported; with family history of peptic ulcer, history of taking medicine, alcohol consumption, stresses in life as potential risk factors.

Insulin-like growth factor-1 (IGF-1) in children with postoperative biliary atresia: a cross-sectional study

Biliary atresia is the leading cause of chronic infantile cholestasis which eventually leads to cirrhosis. Re-establishment of biliary drainage by Kasai portoenterostomy and liver transplantation for end-stage liver disease has favorably altered the clinical outcome. However, growth failure, one of the major complications of chronic liver disease, remains a major problem. The aim of the study is to evaluate growth, nutritional status and serum growth factor IGF-1 in children with biliary atresia after Kasai operation and at comparing these data between the groups with successful and unsuccessful operation. Fifty-four children with postoperative biliary atresia were evaluated for their clinical outcome, height, blood biochemistry related nutritional status and serum IGF-1. Height and serum IGF-1 were expressed as standard deviation score (SDS) to minimize the influence of age. With 44.4% of the enrolled patients the operation had been unsuccessful and jaundice persisted. The mean age of children with jaundice in comparison with the jaundice free groups was not significantly different (42.0 and 49.9 months, p = 0.458). In jaundice-free patients, hematocrit, serum albumin, calcium and phosphorus were normal and significantly higher. In the successful Kasai group, the height SDS and serum IGF-1 SDS were within the normal range and significantly higher (height SDS 0.2 +/-1.0 vs. -0.9 +/- 1.2, p < 0.01 and IGF-1 SDS 0.5 +/- 2.2 vs. -1.3 +/- 1.0, p < 0.01). The mean IGF-1 SDS in the failed Kasai group was less than -1. Children with good outcome of postoperative biliary atresia showed better growth, better nutritional status and higher serum IGF-1 levels when compared to those with unsuccessful operation.

Galactosemia in Thai patient at Phramongkutklao Hospital: a case report

Galactosemia is a rare autosomal recessive disorder of galactose metabolism, which occurs as a consequence of a deficiency of one of these three enzymes: galactokinase, galactose-1-phosphate uridyltransferase, and uridine diphosphate galactose-4-epimerase, leading to elevated level of galactose and its metabolites in blood. The presented case was a 2-month-old, Thai female infant with persistent cholestatic jaundice, bilateral posterior subcapsular cataracts, and hepatomegaly. Laboratory investigations showed slightly elevated serum aminotransferase, and increased urinary excretion of galactose, galactitol and galactonate (by urine gas chromatography/mass spectrometry). These findings indicated an error in galactose metabolism. Soy-based formula was introduced to the patient. Clinical and laboratory results were improved after a few months of treatment. Genetic counseling was provided to the family for 25% of recurrence risk. Prenatal diagnosis is not established in Thailand.

Acute gastroenteritis in children : what role for antibacterials?

The aim of this article is to define the currently accepted role of antibacterials in the treatment of acute gastroenteritis in children. Most cases of acute gastroenteritis in children are viral, self-limited, and need only supportive treatment. Appropriate fluid and electrolyte therapy, with close attention to nutrition, remain central to therapy.Antibacterial therapy serves as an adjunct, to shorten the clinical course, eradicate causative organisms, reduce transmission, and prevent invasive complications. Selection of antibacterials to use in acute bacterial gastroenteritis is based on clinical diagnosis of the likely pathogen prior to definitive laboratory results. Antibacterial therapy should be restricted to specific bacterial pathogens and disease presentations. In general, infections with Shigella spp. and Vibrio cholera should usually be treated with antibacterials, while antibacterials are only used in severe unresponsive infections with Salmonella, Yersinia, Aeromonas, Campylobacter, Plesiomonas spp., and Clostridium difficile. Antibacterials should be avoided in enterohemorrhagic Escherichia coli infection. However, empiric therapy may be appropriate in the presence of a severe illness with bloody diarrhea and stool leucocytes, particularly in infancy and the immunocompromised. The benefits and risks of adverse drug reactions should be weighed before prescribing antibacterials. Moreover, a major concern is the emergence of antibacterial-resistant strains due to the widespread use of antibacterial agents.

Increasing incidence of Crohn's disease in Victorian children

BACKGROUND

The incidence of Crohn's disease has been increasing in Western communities, but there are no published studies which have examined this change in children in Australia. The centralization of pediatric gastroenterology services in Victoria provides an opportunity to examine these changes within one state.

METHODS

We undertook a retrospective study over a 31-year period of all children aged 16 years or less initially diagnosed with Crohn's disease at either the Royal Children's Hospital, or Monash Medical Center, Melbourne, Victoria.

RESULTS

We identified 351 patients who met the diagnostic criteria between 1971 and 2001. The incidence of Crohn's disease in children aged 16 years or less rose from 0.128 to 2.0 per 100,000 per year over the three decades (r = 0.964, P < 0.01). There was a disproportionate over-representation of children from an urban background (incidence rate ratio 1.66, 95% CI 1.28-2.16). Children currently being diagnosed had on average a lower erythrocyte sedimentation rate (ESR) and higher albumin than in previous decades. The use of flexible endoscopy has increased markedly (1970s: 60%; 1990s: 96%, P < 0.05) and the proportion of children recognized at diagnosis with upper gastrointestinal and colonic involvement has increased significantly.

CONCLUSION

There has been a significant increase in the incidence of Crohn's disease in Victorian children. The pattern of disease has also changed with colonic disease now more frequent, and inflammatory indices less abnormal. The increased use of endoscopy has established the frequent involvement of the upper gastrointestinal tract.