1
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Vandenplas Y, De Greef E, Hauser B, Huysentruyt K. Allergy to an extensive rice hydrolysate. The first case report. Acta Paediatr 2024; 113:1015-1016. [PMID: 38348723 DOI: 10.1111/apa.17161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 02/05/2024] [Accepted: 02/08/2024] [Indexed: 04/11/2024]
Affiliation(s)
- Yvan Vandenplas
- KidZ Health Castle, UZ Brussel, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Elisabeth De Greef
- KidZ Health Castle, UZ Brussel, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Bruno Hauser
- KidZ Health Castle, UZ Brussel, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Koen Huysentruyt
- KidZ Health Castle, UZ Brussel, Vrije Universiteit Brussel (VUB), Brussels, Belgium
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2
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van den Akker CHP, Embleton ND, Lapillonne A, Mihatsch WA, Salvatore S, Canani RB, Dinleyici EC, Domellöf M, Guarino A, Gutiérrez-Castrellón P, Hojsak I, Indrio F, Mosca A, Orel R, van Goudoever JHB, Weizman Z, Mader S, Zimmermann LJI, Shamir R, Vandenplas Y, Szajewska H. Reevaluating the FDA's warning against the use of probiotics in preterm neonates: A societal statement by ESPGHAN and EFCNI. J Pediatr Gastroenterol Nutr 2024. [PMID: 38572770 DOI: 10.1002/jpn3.12204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 02/14/2024] [Accepted: 03/14/2024] [Indexed: 04/05/2024]
Abstract
The recent advisory issued by the United States Food and Drug Administration, cautioning against the routine administration of probiotics in preterm neonates, has sparked a lively debate within the scientific community. This commentary presents a perspective from members of the Special Interest Group on Gut Microbiota and Modifications within the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) and other authors who contributed to the ESPGHAN position paper on probiotics for preterm infants, as well as representatives from the European Foundation for the Care of Newborn Infants. We advocate for a more nuanced and supportive approach to the use of certain probiotics in this vulnerable population, balancing the demonstrated benefits and risks.
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Affiliation(s)
- Chris H P van den Akker
- Department of Pediatrics-Neonatology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development, and Amsterdam Gastroenterology Endocrinology Metabolism Research Institutes, Amsterdam, The Netherlands
| | - Nicholas D Embleton
- Neonatal Unit, Royal Victoria Infirmary, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Alexandre Lapillonne
- Department of Neonatology, APHP Necker University Hospital, Paris Cite University, Paris, France
- Department of Pediatrics, Children's Nutrition Research Center, Baylor College of Medicine, Houston, Texas, USA
| | - Walter A Mihatsch
- Department of Pediatrics, Ulm University, Ulm, Germany
- Department of Health Management, Neu-Ulm University of Applied Sciences, Neu-Ulm, Germany
- Department of Pediatrics, Zollernalb Klinikum, Balingen, Germany
| | - Silva Salvatore
- Department of Medicine and Technological Innovation, Pediatrics, Hospital "F. Del Ponte", University of Insubria, Varese, Italy
| | - Roberto B Canani
- Department of Translational Medical Science and the ImmunoNutritionLab at the Ceinge Research Center and Task Force on Microbiome Studies, University of Naples Federico II, Naples, Italy
| | - Ener C Dinleyici
- Department of Pediatrics, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Magnus Domellöf
- Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden
| | - Alfredo Guarino
- Department of Translational Medical Science, Section of Pediatrics, University of Naples Federico II, Naples, Italy
| | | | - Iva Hojsak
- Department of Pediatrics, University of Zagreb Medical School, Children's Hospital Zagreb, Zagreb, Croatia
| | - Flavia Indrio
- Department of Experimental Medicine, Pediatric Section, Medical School MedTech, University of Salento, Lecce, Italy
| | - Alexis Mosca
- Department Pediatric Gastroenterology and Nutrition, Robert-Debré Hospital, APHP, Paris, France
| | - Rok Orel
- Department of Gastroenterology, Hepatology and Nutrition, University Medical Center Ljubljana, University Children's Hospital Ljubljana, Medical Faculty, University of Ljubljana, Ljubeljana, Slovenia
| | - Johannes Hans B van Goudoever
- Department of Pediatrics, Amsterdam UMC, Emma Children's Hospital, University of Amsterdam, Amsterdam, The Netherlands
| | - Zvi Weizman
- Faculty of Health Sciences, Ben-Gurion University, Beer-Sheva, Israel
| | - Silke Mader
- European Foundation for the Care of Newborn Infants (EFCNI), Munich, Germany
| | - Luc J I Zimmermann
- European Foundation for the Care of Newborn Infants (EFCNI), Munich, Germany
- Department of Pediatrics, School for Oncology and Reproduction (GROW), Maastricht UMC+, Maastricht, The Netherlands
| | - Raanan Shamir
- Institute for Gastroenterology, Nutrition and Liver Diseases, Schneider Children's Medical Center, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yvan Vandenplas
- Department of Pediatrics, UZ Brussel, KidZ Health Castle, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Hania Szajewska
- Department of Pediatrics, The Medical University of Warsaw, Warsaw, Poland
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De Crem C, Van Winckel M, Vandenplas Y, Raaijmakers A. Self-reported prescribing behaviour of vitamin D prophylaxis in healthy children by Belgian paediatricians. Eur J Clin Nutr 2024; 78:295-300. [PMID: 38172347 DOI: 10.1038/s41430-023-01387-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 11/27/2023] [Accepted: 12/01/2023] [Indexed: 01/05/2024]
Abstract
There is currently no consensus on the guidelines for vitamin D prophylaxis in healthy children. The purpose of this study was to investigate the prescribing behaviour of vitamin D prophylaxis among Belgian paediatricians. Between June and September 2022, a questionnaire was distributed by email to all Belgian paediatricians who are a member of at least one of three scientific or professional organisations, as well as to the heads of every Belgian paediatric or neonatal hospital ward. We analysed 426 completed questionnaires. All regions, age categories and subspecialties were represented. Vitamin D prophylaxis is always or frequently recommended by 98% of paediatricians. Fifty-eight per cent of paediatricians advise vitamin D prophylaxis up to the age of six years and 66% of paediatricians advise a daily dose of 400 IU. In nearly every hospital in Belgium (96%), there is a specific protocol for vitamin D prophylaxis for newborns; but not for the paediatric unit (only 30%). Nearly all Belgian paediatricians prescribe vitamin D prophylaxis to infants. Although not recommended by guidelines, 25(OH)D is frequently measured by paediatricians. Practices regarding duration and dosing of vitamin D prophylaxis show large variability. Most neonatal wards do have a protocol, whereas most paediatric wards do not.
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Affiliation(s)
- Charlotte De Crem
- Paediatrician in training, MD, Paediatric Intensive Care Unit, University Hospital Ghent, 9000, Ghent, East-Flanders, Belgium
| | - Myriam Van Winckel
- Paediatric Gastroenterology, University Hospital Ghent, 9000, Ghent, East-Flanders, Belgium
| | - Yvan Vandenplas
- Vrije Universiteit Brussel (VUB), UZ Brussel, KidZ Health Castle, Brussels, Belgium
| | - Anke Raaijmakers
- General Paediatrics, Hospital Network Antwerp, 2170, Merksem, Antwerp, Belgium.
- Department of Paediatric Nephrology, Sydney Children's Hospital, Randwick, NSW, Australia.
- UNSW School of Women's and Children's Health, Randwick Clinical Campus, Randwick, NSW, Australia.
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Vandenplas Y, Rosen R. Response to Letter: Gastro-esophageal reflux and cow's milk allergy. J Pediatr Gastroenterol Nutr 2024; 78:748-749. [PMID: 38291772 DOI: 10.1002/jpn3.12121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 12/23/2023] [Indexed: 02/01/2024]
Affiliation(s)
- Yvan Vandenplas
- Vrije Universiteit Brussel (VUB), UZ Brussel, KidZ Health Castle, Brussels, Belgium
| | - Rachel Rosen
- Aerodigestive Center, Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, Massachusetts, USA
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Darma A, Sumitro KR, Muhardi L, Vandenplas Y, Hegar B. Rome IV Clinical Criteria and Management of Functional Constipation: Indonesian Health Care Professionals' Perspective. Pediatr Gastroenterol Hepatol Nutr 2024; 27:125-135. [PMID: 38510582 PMCID: PMC10948964 DOI: 10.5223/pghn.2024.27.2.125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 10/30/2023] [Accepted: 11/25/2023] [Indexed: 03/22/2024] Open
Abstract
Purpose The updated ROME IV criteria for functional constipation (FC) in children were published in 2016. However, information on the use of these criteria is scarce. This study aimed to report the frequency of the use of the ROME IV criteria by Indonesian pediatricians and general practitioners (GPs) in FC management in infants and toddlers. Methods An anonymous cross-sectional online survey was conducted between November 2021 and March 2022. Results A total of 248 respondents (183 pediatricians and 65 GPs) from 24 Indonesian provinces completed the survey. Most respondents reported an estimated prevalence of FC to be less than 5% both in infants and toddlers. On average, only 64.6% of respondents frequently used the ROME IV criteria. Pediatricians used the ROME IV criteria more often than GPs did (p<0.001). The most frequently used criteria were painful or hard bowel movements (75.0%) and ≤2 defecations/week (71.4%). Lactulose as a laxative was the preferred treatment choice, followed by changing the standard formula to a specific nutritional formula. Most of the respondents carried out parenteral reassurance and education. Normal growth, as a marker of good digestion and absorption function, and normal stool consistency and frequency were the most reported indicators of gut health. Conclusion The ROME IV criteria for functional constipation are not extensively used by pediatricians and GPs in Indonesia. Laxatives and specific nutritional formulas were the most used management approaches in infants and toddlers. Medical education, especially for general practitioners, should be updated.
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Affiliation(s)
- Andy Darma
- Department of Child Health, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
- Department of Child Health, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Khadijah Rizky Sumitro
- Department of Child Health, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
- Department of Child Health, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
| | | | - Yvan Vandenplas
- Vrije Universiteit Brussel (VUB), UZ Brussel, KidZ Health Castle, Brussels, Belgium
| | - Badriul Hegar
- Department of Child Health, Dr. Cipto Mangunkusumo Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
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Vandenplas Y, Orsi M, Benninga M, Gatcheco F, Rosen R, Thomson M. Infant gastroesophageal reflux disease management consensus. Acta Paediatr 2024; 113:403-410. [PMID: 38116947 DOI: 10.1111/apa.17074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 12/12/2023] [Indexed: 12/21/2023]
Abstract
AIM Infant gastroesophageal reflux is mostly benign; however, when associated with complications like failure to thrive, it may be indicative of gastroesophageal reflux disease. There are currently several unmet needs pertaining to the management of infant gastroesophageal reflux (disease). Reflux in infants is mostly composed of breast milk or formula, so this population is significantly different to older children and adults. The objective of this Delphi consensus was to establish recommendations based on published literature and the experience of clinical experts in paediatric gastroenterology in the context of infant gastroesophageal reflux (disease). METHODS The Delphi methodology was used to obtain a consensus on 18 statements relating to clinical aspects of infant gastroesophageal reflux (disease). RESULTS The expert panel comprising paediatric gastroenterology clinical specialists reached a consensus for all statements by means of an online, anonymised voting system. CONCLUSION It was highlighted that there is generally low awareness of or adherence to guidelines in clinical practice and that acid suppression therapy should not be indicated for non-acid reflux, which constitutes a significant proportion of total gastroesophageal reflux episodes among infants. Furthermore, it was emphasised that there is an unmet medical need for therapy for some symptomatic infants with non-acid reflux disease.
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Affiliation(s)
- Yvan Vandenplas
- Department of Pediatrics, Vrije Universiteit Brussel (VUB), UZ Brussel, KidZ Health Castle, Brussels, Belgium
| | - Marina Orsi
- Pediatric Gastroenterology, Hepatology & Transplant Unit, Hospital Italiano of Buenos Aires, Buenos Aires, Argentina
| | - Marc Benninga
- Department of Pediatric Gastroenterology and Nutrition, Amsterdam UMC, University of Amsterdam, Emma Children's Hospital, Amsterdam, The Netherlands
| | - Felizardo Gatcheco
- Department of Pediatrics, Manila Central University Hospital, Caloocan, Philippines
| | - Rachel Rosen
- Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Mike Thomson
- Centre for Paediatric Gastroenterology, Sheffield Children's Hospital, Weston Bank, Sheffield, UK
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Van de Walle L, Vandenplas Y, Toelen J, Raaijmakers A. Vitamin D Status in Belgian Children: A Regional Study. Nutrients 2024; 16:657. [PMID: 38474785 DOI: 10.3390/nu16050657] [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: 01/18/2024] [Revised: 02/20/2024] [Accepted: 02/23/2024] [Indexed: 03/14/2024] Open
Abstract
Background: Vitamin D deficiency is the most frequent cause of impaired skeletal growth, and can lead to the development of nutritional rickets. The aim of this study was to evaluate the vitamin D status in a large group of children aged 0-18 years. Methods: We collected laboratory data on vitamin D levels from children who underwent blood sampling between 2014 and 2021. Results: We included 14,887 samples. In this group, 17.7% were vitamin D severely deficient (<12 ng/mL), 25.2% were insufficient (12-20 ng/mL), and another large proportion (28.3%) was borderline (20-30 ng/mL). Sufficient levels (>30 ng/mL) were met in 28.8% of children. We observed no association between gender and vitamin D status (p = 0.132). Adolescents aged 13-18 years (n = 3342) had the highest prevalence of severe vitamin D deficiency (24.9%). Vitamin D levels were higher in summer/autumn compared to winter/spring. Conclusions: Vitamin D deficiency/insufficiency has a high prevalence in children, mostly in children above 7 years of age. Many of these children (over 80%) do not meet the 30 ng/mL sufficiency threshold. It is essential that Belgian Health Authorities are aware of this high prevalence, as the current Belgian recommendation suggests ceasing vitamin D supplementation at the age of six. Additional research is required to investigate the consequences of our findings, and what specific approach is needed to achieve normal vitamin D levels in children aged 0 to 18 years.
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Affiliation(s)
- Louise Van de Walle
- Department of Development and Regeneration, University of Leuven, 3000 Leuven, Belgium
| | - Yvan Vandenplas
- KidZ Health Castle, UZ Brussel, Vrije Universiteit Brussel (VUB), 1090 Brussels, Belgium
| | - Jaan Toelen
- Department of Development and Regeneration, University of Leuven, 3000 Leuven, Belgium
- Department of General Pediatrics, University Hospitals Leuven, 3000 Leuven, Belgium
| | - Anke Raaijmakers
- Department of Paediatric Nephrology, Sydney Children's Hospital Randwick, Sydney Children's Hospital Network, Randwick, NSW 2031, Australia
- Randwick Clinical Campus, School of Women's and Children's Health, University of New South Wales, Randwick, NSW 2031, Australia
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Vandenplas Y, Broekaert I, Domellöf M, Indrio F, Lapillonne A, Pienar C, Ribes-Koninckx C, Shamir R, Szajewska H, Thapar N, Thomassen RA, Verduci E, West C. An ESPGHAN Position Paper on the Diagnosis, Management, and Prevention of Cow's Milk Allergy. J Pediatr Gastroenterol Nutr 2024; 78:386-413. [PMID: 38374567 DOI: 10.1097/mpg.0000000000003897] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 06/25/2023] [Indexed: 07/27/2023]
Abstract
A previous guideline on cow's milk allergy (CMA) developed by the European Society of Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) was published in 2012. This position paper provides an update on the diagnosis, treatment, and prevention of CMA with focus on gastrointestinal manifestations. All systematic reviews and meta-analyses regarding prevalence, pathophysiology, symptoms, and diagnosis of CMA published after the previous ESPGHAN document were considered. Medline was searched from inception until May 2022 for topics that were not covered in the previous document. After reaching consensus on the manuscript, statements were formulated and voted on each of them with a score between 0 and 9. A score of ≥6 was arbitrarily considered as agreement. Available evidence on the role of dietary practice in the prevention, diagnosis, and management of CMA was updated and recommendations formulated. CMA in exclusively breastfed infants exists, but is uncommon and suffers from over-diagnosis. CMA is also over-diagnosed in formula and mixed fed infants. Changes in stool characteristics, feeding aversion, or occasional spots of blood in stool are common and in general should not be considered as diagnostic of CMA, irrespective of preceding consumption of cow's milk. Over-diagnosis of CMA occurs much more frequently than under-diagnosis; both have potentially harmful consequences. Therefore, the necessity of a challenge test after a short diagnostic elimination diet of 2-4 weeks is recommended as the cornerstone of the diagnosis. This position paper contains sections on nutrition, growth, cost, and quality of life.
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Affiliation(s)
- Yvan Vandenplas
- Vrije Universiteit Brussel (VUB), UZ Brussel, KidZ Health Castle, Brussels, Belgium
| | - Ilse Broekaert
- Department of Paediatrics, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Magnus Domellöf
- Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden
| | - Flavia Indrio
- Department of Medical and Surgical Science, University of Foggia, Foggia, Italy
| | - Alexandre Lapillonne
- Neonatal Intensive Care Unit, Necker-Enfants Malades Hospital, Paris University, Paris, France
- CNRC, Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - Corina Pienar
- Department of Pediatrics, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania
| | - Carmen Ribes-Koninckx
- Gastroenterology and Hepatology & Instituto de Investigacion Sanitaria, La Fe University Hospital, Valencia, Spain
| | - Raanan Shamir
- Institute of Gastroenterology, Nutrition and Liver Diseases, Schneider Children's Medical Center, Lea and Arieh Pickel Chair for Pediatric Research, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Hania Szajewska
- Department of Paediatrics, The Medical University of Warsaw, Warsaw, Poland
| | - Nikhil Thapar
- Gastroenterology, Hepatology and Liver Transplant, Queensland Children's Hospital, Brisbane, Australia
- School of Medicine, University of Queensland, Brisbane, Australia
- Woolworths Centre for Child Nutrition Research, Queensland University of Technology, Brisbane, Australia
- UCL Great Ormond Street Institute of Child Health, London, UK
| | - Rut Anne Thomassen
- Department of Paediatric Medicine, Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
| | - Elvira Verduci
- Department of Paediatrics, Vittore Buzzi Children's Hospital, University of Milan, Milan, Italy
| | - Christina West
- Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden
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Jankiewicz M, Ahmed F, Bajerova K, Carvajal Roca ME, Dupont C, Huysentruyt K, Kuitunen M, Meyer R, Pancheva R, Koninckx CR, Salvatore S, Shamir R, Staiano A, Vandenplas Y, Szajewska H. Cow's Milk-related Symptom Score (CoMiSS) values in presumed healthy European infants aged 6-12 months: a cross-sectional study. Eur J Pediatr 2024; 183:707-713. [PMID: 37973640 PMCID: PMC10912251 DOI: 10.1007/s00431-023-05334-0] [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: 08/02/2023] [Revised: 11/07/2023] [Accepted: 11/08/2023] [Indexed: 11/19/2023]
Abstract
The Cow's Milk-related Symptom Score (CoMiSS) is an awareness tool for evaluating cow's milk-related symptoms. Previous studies have focused on providing CoMiSS values for healthy and symptomatic infants aged 0-6 months. However, there is a notable gap in the literature concerning CoMiSS values for infants older than 6 months. This cross-sectional study aimed to determine CoMiSS values in presumed healthy infants who have completed 6 months and are up to 12 months old, hereafter referred to as 6 to 12 months old. Physicians from six European countries prospectively determined CoMiSS values in infants attending well-child clinics. Exclusion criteria included preterm delivery, acute or chronic disease, and the consumption of a therapeutic formula, dietary supplements (except vitamins), or medication. The following information was collected: gestational age, gender, age, type of feed (breast milk or infant formula), and complementary feeding. Descriptive statistics were summarized with mean and standard deviation for normally distributed continuous variables, median and IQR for non-normally distributed variables, and differences in CoMiSS values were analyzed with appropriate tests. Data from 609 infants were obtained. The overall median (Q1-Q3) CoMiSS values were 3 (1-5). Significant differences were found across age groups (p < 0.001), but not across groups based on gender (p = 0.551) or feeding type (p = 0.880). Conclusions: This study provided CoMiSS values in presumed healthy infants aged 6-12 months. Additional studies should be conducted to establish the use of CoMiSS to assess cow's milk-related symptoms in infants 6 months and older. What is Known: • The Cow's Milk-related Symptom Score (CoMiSS) is an awareness tool for evaluating symptoms related to cow's milk. • CoMiSS values for presumed healthy infants aged 0-6 months infants are already available. What is New: • CoMiSS values in European infants aged 6-12 months are provided. • These CoMiSS values differed across various age groups but not across groups based on gender or feeding type.
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Affiliation(s)
- Mateusz Jankiewicz
- Department of Paediatrics, The Medical University of Warsaw, Żwirki I Wigury 63A, 02-091, Warsaw, Poland
| | - Fatme Ahmed
- Department of Hygiene and Epidemiology, Faculty of Public Health, Medical University of Varna, Varna, Bulgaria
- Research Group NutriLect, Department of Neuroscience, Research Institute, Medical University "Prof. Dr. Paraskev Stoyanov", Varna, Bulgaria
| | - Katerina Bajerova
- Department of Pediatrics, University Hospital Brno and Masaryk's University, Brno, Czech Republic
- Department of Internal Medicine, Geriatrics and Practical Medicine, University Hospital Brno and Masaryk´S University, Brno, Czech Republic
| | | | - Christophe Dupont
- Ramsay Group, France Et Clinique Marcel Sembat, Paris Descartes University, Boulogne-Billancourt, Paris, France
| | - Koen Huysentruyt
- Vrije Universiteit Brussel (VUB), UZ Brussels, KidZ Health Castle, Laarbeeklaan 101, Brussels, Belgium
| | - Mikael Kuitunen
- Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Rosan Meyer
- Department Paediatrics, Imperial College London, London, SW7 2BX, UK
- Department Dietetics, Winchester University, Winchester, SO23 4NR, UK
- Department Medicine, KU Leuven, Louvain, Belgium
| | - Rouzha Pancheva
- Department of Hygiene and Epidemiology, Faculty of Public Health, Medical University of Varna, Varna, Bulgaria
- Research Group NutriLect, Department of Neuroscience, Research Institute, Medical University "Prof. Dr. Paraskev Stoyanov", Varna, Bulgaria
| | - Carmen Ribes Koninckx
- Pediatric Gastroenterology, La Fe University Hospital, Instituto de Investigation Sanitaria La FE Valencia, Valencia, Spain
| | - Silvia Salvatore
- Department of Paediatrics, University of Insubria, Varese, Italy
| | - Raanan Shamir
- Institute of Gastroenterology, Nutrition and Liver Diseases, Schneider Children's Medical Center, Lea and Arieh Pickel for Pediatric Research, Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Annamaria Staiano
- Department of Translational Medical Science, Section of Pediatrics, University Federico II, Naples, Italy
| | - Yvan Vandenplas
- Vrije Universiteit Brussel (VUB), UZ Brussels, KidZ Health Castle, Laarbeeklaan 101, Brussels, Belgium
| | - Hania Szajewska
- Department of Paediatrics, The Medical University of Warsaw, Żwirki I Wigury 63A, 02-091, Warsaw, Poland.
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10
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Vandenplas Y, Meyer RM, Huysentruyt K. Food allergy: Prevention and treatment of Cow's milk allergy. Clin Nutr ESPEN 2024; 59:9-20. [PMID: 38220412 DOI: 10.1016/j.clnesp.2023.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 11/08/2023] [Indexed: 01/16/2024]
Affiliation(s)
- Yvan Vandenplas
- Paediatric Gastroenterology, KidZ Health Castle, UZ Brussel, Vrije Universiteit Brussel (VUB), Brussels, Belgium.
| | - Rosan M Meyer
- Imperial College, London, United Kingdom; Winchester University, Winchester, United Kingdom
| | - Koen Huysentruyt
- Paediatric Gastroenterology, KidZ Health Castle, UZ Brussel, Vrije Universiteit Brussel (VUB), Brussels, Belgium
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11
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Dinleyici M, Pérez-Brocal V, Arslanoglu S, Aydemir O, Sevuk Ozumut S, Tekin N, Vandenplas Y, Moya A, Dinleyici EC. Composition of Microbiota in Transient and Mature Human Milk: Significant Changes in Large for Gestational Age Group. Nutrients 2024; 16:208. [PMID: 38257101 PMCID: PMC10818272 DOI: 10.3390/nu16020208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 01/03/2024] [Accepted: 01/06/2024] [Indexed: 01/24/2024] Open
Abstract
The composition of the human milk (HM) microbiota and, consequently, the microorganisms that are passed on to the infant through breastfeeding, can be influenced by various factors such as the mother's health and diet, gestational age, delivery mode, lactation stage, method of infant feeding, and geographical location. The aim of the Human Milk-Gest Study was to compare the microbiota of transient (postpartum 7-15 days) and mature HM (postpartum 45-90 days) of 44 mothers, and to investigate any potential changes associated with preterm birth, mode of delivery, and birth weight in relation to gestational age. The data were classified into five study groups: normal spontaneous delivery-term (NS-T) newborns, cesarean delivery-term (CS-T) newborns, preterm (PT) newborns (with a gestational age of less than 37 weeks), small for gestational age (SGA) newborns, and large for gestational age (LGA) newborns. An analysis of differential abundance was conducted using ANCOM-BC to compare the microbial genera between transient and mature HM samples as well as between other study groups. A significant difference was detected between HM samples at different sampling times and between the study groups (p < 0.01). In transient HM samples, Ralstonia, Burkholderiaceae_uc, and Pelomonas were significantly dominant in the LGA group compared to the NS-T, CS-T, PT, and SGA groups. In mature HM samples, Burkholderiaceae_uc, Ralstonia, Pelomonas, and Klebsiella were significantly dominant in the LGA group compared to the NS-T, CS-T, and PT groups, while Ralstonia, Burkholderiaceae_uc, and Pelomonas were significantly dominant in the LGA group compared to the SGA group. Differences were also detected between the transient and mature HM samples in the CS-T, PT, SGA, and LGA groups, but no differences occurred in the NS-T groups. In conclusion, we showed that Ralstonia, Burkholderiaceae_uc, and Pelomonas were significantly dominant in the LGA group in transient HM and continued in mature HM. The body mass index (BMI) of the mothers in the LGA group was not >30 at conception, however, the maternal BMI at birth and maternal weight gain during pregnancy were higher than in the other groups. The nutritional composition of HM is specifically designed to meet infant nutritional requirements during early life. Evaluating the effects of HM microbiota on infant microbiota composition and short- and long-term health effects in larger studies would be useful.
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Affiliation(s)
- Meltem Dinleyici
- Department of Social Pediatrics, Faculty of Medicine, Eskisehir Osmangazi University, 26480 Eskisehir, Türkiye;
| | - Vicente Pérez-Brocal
- Department of Genomics and Health, Foundation for the Promotion of Health and Biomedical Research of Valencia Region (FISABIO-Public Health), 46020 Valencia, Spain; (V.P.-B.)
- CIBER in Epidemiology and Public Health (CIBEResp), 28029 Madrid, Spain
| | - Sertac Arslanoglu
- Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Medeniyet University, 34720 Istanbul, Türkiye
| | - Ozge Aydemir
- Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Eskisehir Osmangazi University, 26040 Eskisehir, Türkiye; (O.A.); (N.T.)
| | - Sibel Sevuk Ozumut
- Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Medeniyet University, 34720 Istanbul, Türkiye
| | - Neslihan Tekin
- Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Eskisehir Osmangazi University, 26040 Eskisehir, Türkiye; (O.A.); (N.T.)
| | - Yvan Vandenplas
- KidZ Health Castle, UZ Brussel, Vrije Unversiteit Brussel, 1090 Brussels, Belgium
| | - Andrés Moya
- Department of Genomics and Health, Foundation for the Promotion of Health and Biomedical Research of Valencia Region (FISABIO-Public Health), 46020 Valencia, Spain; (V.P.-B.)
- CIBER in Epidemiology and Public Health (CIBEResp), 28029 Madrid, Spain
- Institute for Integrative Systems Biology (I2SysBio), University of Valencia and Spanish National Research Council (CSIC-UVEG), 46980 Valencia, Spain
| | - Ener Cagri Dinleyici
- Department of Pediatrics, Faculty of Medicine, Eskisehir Osmangazi University, 26040 Eskisehir, Türkiye
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Abrahamse-Berkeveld M, Jespers SN, Khoo PC, Rigo V, Peeters SM, van Beek RH, Norbruis OF, Schoen S, Marintcheva-Petrova M, van der Beek EM, Stoelhorst GM, Vandenplas Y, Hokken-Koelega AC. Infant Milk Formula with Large, Milk Phospholipid-coated Lipid Droplets Enriched in Dairy Lipids Affects Body Mass Index Trajectories and Blood Pressure at School Age: Follow-up of a Randomized Controlled Trial. Am J Clin Nutr 2024; 119:87-99. [PMID: 37973475 DOI: 10.1016/j.ajcnut.2023.10.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 10/05/2023] [Accepted: 10/18/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Human milk comprises large fat globules enveloped by a native phospholipid membrane, whereas infant formulas contain small, protein-coated lipid droplets. Previous experimental studies indicated that mimicking the architecture of human milk lipid droplets in infant milk formula (IMF) alters lipid metabolism with lasting beneficial impact on later metabolic health. OBJECTIVES To evaluate in a follow-up (FU) study of a randomized, controlled trial whether a Concept IMF with large, milk phospholipid-coated lipid droplets enriched with dairy lipids beneficially impacts long-term body mass index (BMI in kg/m2) trajectories and blood pressure at school age. METHODS Fully formula-fed infants were randomly assigned to Concept IMF (n = 115) or Control IMF with conventional, small lipid droplets containing vegetable oils (n = 108) for the first 4 mo of age. A group of 88 breastfed infants served as a reference. During FU, anthropometrics were collected at 1, 3, 4, and 5 y of age, and blood pressure only at the last visit. RESULTS Compared to Control, Concept group children had consistently lower mean BMI values during FU, with the most marked difference at 1 y of age (difference in means -0.71 kg/m2, 95% confidence interval (CI): -1.13, -0.29; P = 0.001); mean values were close to the breastfed group (P > 0.05). Contrary, the mean BMI values of the Control group were higher compared with the breastfed group during FU from 1 to 5 y of age (differences in means from 0.59 to 0.96 kg/m2, respectively; P < 0.02). At 5 y of age, the Concept group had a lower mean diastolic and arterial blood pressure compared with the Control group; -4.3mm Hg (95% CI: -7.3, -1.3; P = 0.005) and -3.7 mm Hg (95% CI: -6.5, -0.9; P = 0.01), respectively. CONCLUSIONS Early life feeding of an innovative IMF with large, milk phospholipid-coated lipid droplets enriched with dairy lipids results in a BMI trajectory closer to breastfed infants and a lower blood pressure at school age. This trial was registered at the Dutch Trial Register as NTR3683 and NTR5538.
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Affiliation(s)
| | | | | | - Vincent Rigo
- Centre Hospitalier Régional de la Citadelle, Liège, Belgium
| | | | | | | | | | | | - Eline M van der Beek
- Department of Pediatrics, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
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Vandenplas Y, Meyer R, Nowak-Wegrzyn A, Salvatore S, Venter C, Vieira MC. The Remaining Challenge to Diagnose and Manage Cow's Milk Allergy: An Opinion Paper to Daily Clinical Practice. Nutrients 2023; 15:4762. [PMID: 38004156 PMCID: PMC10675216 DOI: 10.3390/nu15224762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 11/07/2023] [Accepted: 11/09/2023] [Indexed: 11/26/2023] Open
Abstract
Guidelines and recommendations for the diagnosis and management of cow's milk allergy (CMA) in childhood are based on scientific review of the available evidence. While this approach is the most rigorous, guidelines may not fully address all scenarios encountered by clinicians. Many symptoms of CMA overlap with other common childhood illnesses and are subjectively reported by the caregivers of the infant, as is the interpretation of the dietary interventions. Additionally, many healthcare professionals and caregivers do not follow the recommendations to perform an oral food challenge or reintroduction of cow's milk after a diagnostic elimination diet because (1) the infant is doing well and (2) the carer's fear of symptoms relapsing with this procedure. As a result, CMA in infants may be either under-diagnosed leading to reduced quality of life for families or over-diagnosed, resulting in unnecessary long-term elimination diets and increasing the risk for nutritional deficiencies. This paper discusses some of these controversial topics, focusing on misdiagnosis and mismanagement in clinical practice. The lack of objective diagnostic criteria can hamper the diagnosis and management of CMA in daily practice.
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Affiliation(s)
- Yvan Vandenplas
- UZ Brussel, KidZ Health Castle, Vrije Universiteit Brussel (VUB), 1090 Brussels, Belgium
| | - Rosan Meyer
- Department Paediatrics, Imperial College London, London SW7 2BX, UK
- Department Dietetics, Winchester University, Winchester SO23 4NR, UK
- Department Medicine, KU Leuven, 3001 Leuven, Belgium
| | - Anna Nowak-Wegrzyn
- Department of Pediatrics, NYU Grossman School of Medicine, Hassenfeld Children’s Hospital, New York, NY 10016, USA
- Department of Pediatrics, Gastroenterology and Nutrition, Collegium Medicum, University of Warmia and Mazury, 10-719 Olsztyn, Poland
| | - Silvia Salvatore
- Department of Pediatrics, Hospital “F. Del Ponte”, University of Insubria, 21100 Varese, Italy;
| | - Carina Venter
- Section of Pediatric Allergy and Immunology, Children’s Hospital Colorado, University of Colorado, Aurora, CO 80045, USA
| | - Mario C. Vieira
- Center for Pediatric Gastroenterology, Hospital Pequeno Príncipe, Curitiba 80250, Brazil;
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Bajerova K, Salvatore S, Dupont C, Kuitunen M, Meyer R, Ribes-Koninckx C, Shamir R, Szajewska H, Staiano A, Vandenplas Y. Cow's Milk-Related Symptom Score (CoMiSS): From Bristol to Brussels Stool Scale. J Pediatr Gastroenterol Nutr 2023; 77:618-622. [PMID: 37668589 PMCID: PMC10583930 DOI: 10.1097/mpg.0000000000003932] [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: 12/01/2022] [Accepted: 07/10/2023] [Indexed: 09/06/2023]
Abstract
OBJECTIVES The Cow's Milk-related Symptom Score (CoMISS) is an awareness tool for evaluating cow's milk-related symptoms in otherwise healthy infants <1 year of age. This study assessed whether replacing the Bristol Stool Form Scale (BSFS) with the Brussels Infants and Toddlers Stool Scale (BITSS) in non-toilet-trained infants would modify the overall CoMiSS and change the clinical approach regarding potential cow's milk allergy. METHODS Non-toilet-trained infants aged <13 months were assessed by CoMiSS using the 7 images from the BSFS (CoMiSS-BSFS) compared to the 4 images of stools from BITSS (CoMiSS-BITSS). The Wilcoxon signed-rank test and Pearson correlation coefficient were calculated. A post hoc analysis using identical tests was performed in subsets of CoMiSS-BSFS scores ≥10, ≥12, ≤5, and ≥6. RESULTS Eight hundred forty-four pairwise scores were collected. Applying the Wilcoxon test over the complete dataset, the difference between CoMiSS-BSFS and CoMiSS-BITSS was statistically significant ( P < 0.001). However, there was no significant difference in the subsets with CoMiSS-BSFS ≥10, ≥12, and ≥6 ( P = 0.84, P = 0.48, and P = 0.81, respectively). The significant difference remained restricted to the group with CoMiSS-BSFS ≤5, considered at low risk for CM-related symptoms ( P < 0.001). CONCLUSION Replacing BSFS with BITSS does not change the cutoff for awareness of possible CM-related symptoms and will not impact the use of CoMiSS in clinical practice. Changes in CoMiSS remained limited to the subgroup with a low risk for CM-related symptoms.
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Affiliation(s)
- Katerina Bajerova
- From the Department of Pediatrics, University Hospital Brno and Masaryk’s University, Brno, Czech Republic
- the Department of Internal Medicine, Geriatrics and Practical Medicine, University Hospital Brno and Masaryk’s University, Brno, Czech Republic
| | - Silvia Salvatore
- the Department of Paediatrics, University of Insubria, Varese, Italy
| | - Christophe Dupont
- Paris Descartes University, France et Clinique Marcel Sembat, Boulogne-Billancourt, Ramsay Group, France
| | - Mikael Kuitunen
- Children’s Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Rosan Meyer
- the Department of Paediatrics, Imperial College London, London, UK
- the Department of Dietetics, Winchester University, Winchester, UK
- the Department of Medicine, KU Leuven, Leuven, Belgium
| | - Carmen Ribes-Koninckx
- Pediatric Gastroenterology, La Fe University Hospital & La Fe Research Institute, Valencia, Spain
| | - Raanan Shamir
- Institute of Gastroenterology, Nutrition and Liver Diseases, Schneider Children’s Medical Center, Lea and AriehPickel Chair for Pediatric Research, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Hania Szajewska
- the Department of Paediatrics, The Medical University of Warsaw, Warsaw, Poland
| | - Annamaria Staiano
- the Department of Translational Medical Sciences, University of Naples “Federico II”, Napoli, Italy
| | - Yvan Vandenplas
- Vrije Universiteit Brussel (VUB), UZ Brussel, KidZ Health Castle, Brussels, Belgium
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Schipper L, Bartke N, Marintcheva-Petrova M, Schoen S, Vandenplas Y, Hokken-Koelega ACS. Infant formula containing large, milk phospholipid-coated lipid droplets and dairy lipids affects cognitive performance at school age. Front Nutr 2023; 10:1215199. [PMID: 37731397 PMCID: PMC10508340 DOI: 10.3389/fnut.2023.1215199] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 08/22/2023] [Indexed: 09/22/2023] Open
Abstract
Background Breastfeeding has been positively associated with infant and child neurocognitive development and function. Contributing to this effect may be differences between human milk and infant formula in the milk lipid composition and milk fat globule structure. Objective To evaluate the effects of an infant formula mimicking human milk lipid composition and milk fat globule structure on childhood cognitive performance. Methods In a randomized, controlled trial, healthy term infants received until 4 months of age either a Standard infant formula (n = 108) or a Concept infant formula (n = 115) with large, milk phospholipid coated lipid droplets and containing dairy lipids. A breastfed reference group (n = 88) was included. Erythrocyte fatty acid composition was determined at 3 months of age. Neurocognitive function was assessed as exploratory follow-up outcome at 3, 4, and 5 years of age using the Flanker test, Dimensional Change Card Sort (DCCS) test and Picture Sequence Memory test from the National Institutes of Health Toolbox Cognition Battery. Mann-Whitney U test and Fisher exact test were used to compare groups. Results Erythrocyte omega-6 to -3 long-chain polyunsaturated fatty acid ratio appeared to be lower in the Concept compared to the Standard group (P = 0.025). At age 5, only the Concept group was comparable to the Breastfed group in the highest reached levels on the Flanker test, and the DCCS computed score was higher in the Concept compared to the Standard group (P = 0.021). Conclusion These outcomes suggest that exposure to an infant formula mimicking human milk lipid composition and milk fat globule structure positively affects child neurocognitive development. Underlying mechanisms may include a different omega-3 fatty acid status during the first months of life. Clinical trial registration https://onderzoekmetmensen.nl/en/trial/28614, identifier NTR3683 and NTR5538.
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Affiliation(s)
| | - Nana Bartke
- Danone Nutricia Research, Utrecht, Netherlands
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16
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Bellaiche M, Tounian P, Oozeer R, Rocher E, Vandenplas Y. Digestive Tolerance and Safety of an Anti-Regurgitation Formula Containing Locust Bean Gum, Prebiotics and Postbiotics: A Real-World Study. Pediatr Gastroenterol Hepatol Nutr 2023; 26:249-265. [PMID: 37736220 PMCID: PMC10509020 DOI: 10.5223/pghn.2023.26.5.249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 06/20/2023] [Accepted: 07/20/2023] [Indexed: 09/23/2023] Open
Abstract
Purpose Infant regurgitation is associated with other functional gastrointestinal disorders and signs and symptoms that have a major impact on the quality of life of infants and their families. This study evaluated the safety, tolerance, and real-world effectiveness of an anti-regurgitation formula containing locust bean gum (LBG), prebiotics, and postbiotics to alleviate digestive symptoms beyond regurgitation. Methods This 3-month study involved infants with regurgitation requiring the prescription of an anti-regurgitation formula according to usual clinical practice. Outcomes included evaluation of the evolution of stool consistency and frequency; occurrence of colic, constipation, and diarrhea; and assessment of regurgitation severity. Infant crying, parental assessment of infant well-being, and parental satisfaction with the stool consistency were also evaluated. Results In total, 190 infants (average age: 1.9±1.1 months) were included. After three months, stool frequency and consistency remained within the normal physiological range, with 82.7% of infants passing one or two stools per day and 90.4% passing loose or formed stools. There was no significant increase in the number of infants with diarrhea, whereas a decrease was observed in the number of infants with constipation after 1 month (p=0.001) and with colic after both 1 and 3 months (p<0.001). Regurgitation severity and crying decreased and parental satisfaction with stool consistency, formula acceptability, infant well-being, and sleep quality increased. Monitoring of adverse events did not reveal any safety concerns. Conclusion Formulas containing LBG, prebiotics, and postbiotics were well tolerated and provided an effective strategy for managing infant regurgitation and gastrointestinal discomfort.
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Affiliation(s)
- Marc Bellaiche
- Department of Gastroenterology and Pediatric Nutrition, Hospital Robert-Debré, AP-HP, Paris, France
| | - Patrick Tounian
- Department of Pediatric Nutrition and Gastroenterology, Trousseau Hospital, AP-HP, Sorbonne Université, Paris, France
| | | | | | - Yvan Vandenplas
- KidZ Health Castle, UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium
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Vandecruys A, Huysentruyt K, Van De Maele K, Vandenplas Y. How Best to Estimate Insertion Length of Multichannel Intraluminal Impedance pH Probes in Children. J Pediatr 2023; 259:113449. [PMID: 37150291 DOI: 10.1016/j.jpeds.2023.113449] [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: 11/19/2022] [Revised: 03/17/2023] [Accepted: 04/30/2023] [Indexed: 05/09/2023]
Abstract
OBJECTIVE To assess the reliability of the KidZ Health Castle formula (KHC-F) to determine the correct probe position of a multichannel intraluminal impedance pH. STUDY DESIGN A retrospective cohort study was performed on 222 children between 1 month and 18 years of age undergoing multichannel intraluminal impedance pH. The primary outcome was the comparison of the pH sensor location determined by the KHC-F with the radiological target position. The margin of error was defined as 1 cm from the target position. Performance of the KHC-F and existing formulas was determined via the percentage with a correct position, mean error, 95% limits of agreement (Bland-Altman plots), and Spearman correlation. A post hoc analysis was performed with an updated KHC-F v2, subtracting -0.5 cm from the KHC-F. RESULTS Positioning with KHC-F was correct in two-thirds of the participants, with a very strong correlation (ρ = 0.91) with the target position. Bland-Altman plots showed good agreement between KHC-F and target position (mean error of -0.44 cm, lower limit -3.2 cm, upper limit 2.3 cm). A post hoc analysis with the KHC-F v2 showed a correct positioning in 74% of patients. Comparison with other formulas showed a stronger performance of KHC-F and KHC-F v2 on correct positioning, mean error, and 95% limits of agreement. CONCLUSIONS The KHC-F leads to reliable results. KHC-F v2 outperforms all other existing formulas in children, thereby reducing the need for repositioning and the amount of x-ray exposure. The age distribution of the sample may be a limitation, as well as the retrospective nature of the study.
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Affiliation(s)
- Amber Vandecruys
- Vrije Universiteit Brussel (VUB), UZ Brussel, KidZ Health Castle, Brussels, Belgium
| | - Koen Huysentruyt
- Vrije Universiteit Brussel (VUB), UZ Brussel, KidZ Health Castle, Brussels, Belgium
| | - Kristel Van De Maele
- Vrije Universiteit Brussel (VUB), UZ Brussel, KidZ Health Castle, Brussels, Belgium
| | - Yvan Vandenplas
- Vrije Universiteit Brussel (VUB), UZ Brussel, KidZ Health Castle, Brussels, Belgium.
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Kilic Yildirim G, Dinleyici M, Vandenplas Y, Dinleyici EC. Effects of synbiotic supplementation on intestinal microbiota composition in children and adolescents with exogenous obesity: (Probesity-2 trial). Gut Pathog 2023; 15:36. [PMID: 37474971 PMCID: PMC10360342 DOI: 10.1186/s13099-023-00563-y] [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: 04/21/2023] [Accepted: 07/12/2023] [Indexed: 07/22/2023] Open
Abstract
INTRODUCTION Gut microbiota manipulation may be a potential therapeutic target to reduce host energy storage. There is limited information about the effects of probiotics/synbiotics on intestinal microbiota composition in children and adolescents with obesity. The objective of this randomized double-blind placebo-controlled trial was to test the effects of a multispecies synbiotic on intestinal microbiota composition in children and adolescents with exogenous obesity. METHOD Children with exogenous obesity were managed with a standard diet and increased physical activity and were randomly allocated into two groups at a ratio of 1:1; the 1st group received synbiotic supplementation (probiotic mixture including Lactobacillus acidophilus, Lacticaseibacillus. rhamnosus, Bifidobacterium bifidum, Bifidobacterium longum, Enterococcus faecium (total 2.5 × 109 CFU/sachet) and fructo-oligosaccharides (FOS; 625 mg/sachet) for 12 weeks; the 2nd group received placebo once daily for 12 weeks. Fecal samples were obtained before and at the end of the 12-week intervention to characterize the changes in the gut microbiota composition. Detailed metagenomic and bioinformatics analyses were performed. RESULTS Before the intervention, there were no significant differences in alpha diversity indicators between the synbiotic and placebo groups. After 12 weeks of intervention, the observed taxonomic units and Chao 1 were lower in the synbiotic group than at baseline (p < 0.001 for both). No difference for alpha diversity indicators was observed in the placebo group between baseline and 12 weeks of intervention. At the phylum level, the intestinal microbiota composition of the study groups was similar at baseline. The major phyla in the synbiotic group were Firmicutes (66.7%) and Bacteroidetes (18.8%). In the synbiotic group, the Bacteroidetes phylum was higher after 12 weeks than at baseline (24.0% vs. 18.8%, p < 0.01). In the synbiotic group, the Firmicutes/Bacteroidetes ratio was 3.54 at baseline and 2.75 at 12 weeks of intervention (p < 0.05). In the placebo group, the Firmicutes/Bacteroidetes ratio was 4.70 at baseline and 3.54 at 12 weeks of intervention (p < 0.05). After 12 weeks of intervention, the Firmicutes/Bacteroidetes ratio was also lower in the synbiotic group than in the placebo group (p < 0.05). In the synbiotic group, compared with the baseline, we observed a statistically significant increase in the genera Prevotella (5.28-14.4%, p < 0.001) and Dialister (9.68-13.4%; p < 0.05). Compared to baseline, we observed a statistically significant increase in the genera Prevotella (6.4-12.4%, p < 0.01) and Oscillospira (4.95% vs. 5.70%, p < 0.001) in the placebo group. In the synbiotic group, at the end of the intervention, an increase in Prevotella, Coprococcus, Lachnospiraceae (at the genus level) and Prevotella copri, Coprococcus eutactus, Ruminococcus spp. at the species level compared to baseline (predominance of Eubacterium dolichum, Lactobacillus ruminis, Clostridium ramosum, Bulleidia moorei) was observed. At the end of the 12th week of the study, when the synbiotic and placebo groups were compared, Bacteroides eggerthi species were dominant in the placebo group, while Collinsella stercoris species were dominant in the synbiotic group. CONCLUSION This study is the first pediatric obesity study to show that a synbiotic treatment is associated with both changes intestinal microbiota composition and decreases in BMI. Trial identifier: NCT05162209 (www. CLINICALTRIALS gov).
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Affiliation(s)
- Gonca Kilic Yildirim
- Faculty of Medicine, Pediatrics Nutrition and Metabolism Unit, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Meltem Dinleyici
- Faculty of Medicine, Department of Social Pediatrics, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Yvan Vandenplas
- Vrije Unversiteit Brussel, UZ Brussel, KidZ Health Castle, Brussels, Belgium
| | - Ener Cagri Dinleyici
- Faculty of Medicine, Department of Pediatrics, Eskisehir Osmangazi University, Eskisehir, TR-26040, Turkey.
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Alatas FS, Pertiwi DWS, Kadim M, Dwipoerwantoro P, Oswari H, Hegar B, Vandenplas Y. Association Between Pediatric Gastroesophageal Reflux Disease Symptom and Quality of Life Questionnaire Score, Endoscopy and Biopsy in Children with Clinical Gastroesophageal Reflux Disease: A Prospective Study. Pediatr Gastroenterol Hepatol Nutr 2023; 26:173-180. [PMID: 37485025 PMCID: PMC10356974 DOI: 10.5223/pghn.2023.26.4.173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 02/19/2023] [Accepted: 05/10/2023] [Indexed: 07/25/2023] Open
Abstract
Purpose Gastro esophageal reflux disease (GERD) is a burdensome disease affecting many children. A clinical examination is reported to be unreliable to diagnose GERD in children. This study aimed to investigate the relationship between the Pediatric Gastroesophageal Reflux Disease Symptom and Quality of Life Questionnaire (PGSQ) and endoscopic and histopathological findings in children with symptoms suggesting GERD. Changes in the PGSQ score in children with esophagitis as response to one month therapy were recorded as secondary outcome. Methods This is a prospective cohort study in the pediatric outpatient clinic in an Indonesian tertiary hospital. Children aged 2-17 years old with clinical symptoms suspected of GERD are included in the study. Blinded endoscopic and histopathological examination was performed in all patients before one month proton pump inhibitors (PPI) therapy. The PGSQ information was collected at inclusion and after one month PPI treatment. Results Fifty-eight subjects were included. Esophagitis was found in 60.9% of subjects according to endoscopy and 58.6% according to histology. There was no significant relationship between the PGSQ score and endoscopic (p=0.781) nor biopsy (p=0.740) examinations. The PGSQ showed a low diagnostic value compared to endoscopy and biopsy (area under the curve [AUC] 0.477, p=0.477, 95% confidence interval [CI] 0.326-0.629 and AUC 0.474, p=0.740 (95% CI 0.321-0.627 respectively). The PGSQ improved significantly post one month of PPI treatment. Conclusion The PGSQ cannot be used to diagnose esophagitis in children with clinical symptoms suggesting GERD. However, the PGSQ can be used to monitor the treatment response in children with esophagitis.
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Affiliation(s)
- Fatima Safira Alatas
- Department of Child Health, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusomo Hospital, Jakarta, Indonesia
| | | | - Muzal Kadim
- Department of Child Health, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusomo Hospital, Jakarta, Indonesia
| | - Pramita Dwipoerwantoro
- Department of Child Health, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusomo Hospital, Jakarta, Indonesia
| | - Hanifah Oswari
- Department of Child Health, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusomo Hospital, Jakarta, Indonesia
| | - Badriul Hegar
- Department of Child Health, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusomo Hospital, Jakarta, Indonesia
| | - Yvan Vandenplas
- Vrije Universiteit Brussel, UZ Brussel, KidZ Health Castle, Brussels, Belgium
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20
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Santi T, Hegar B, Munasir Z, Prayitno A, Werdhani RA, Bandar INS, Jo J, Uswa R, Widia R, Vandenplas Y. Factors associated with parental intention to vaccinate their preschool children against COVID-19: a cross-sectional survey in urban area of Jakarta, Indonesia. Clin Exp Vaccine Res 2023; 12:240-248. [PMID: 37599811 PMCID: PMC10435772 DOI: 10.7774/cevr.2023.12.3.240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 04/07/2023] [Accepted: 04/12/2023] [Indexed: 08/22/2023] Open
Abstract
Purpose We reported a survey-based study assessing the parental intention to vaccinate children of 5 to 7 years old against coronavirus disease 2019 (COVID-19). The aim of this study is to assess factors influencing the parental intention to vaccinate their children against COVID-19. Materials and Methods This study adopted a cross-sectional design, held at the public health center of Senen district, Jakarta, Indonesia from November 1-30, 2022. The off-line questionnaires were distributed via the school administrator to all eligible parents. Factors associated with intention to vaccinate were analyzed with the regression logistic models. Results Of the 435 parents in this study, 215 had already vaccinated their children against COVID-19 (49.4%), and the overall intention of the participants to vaccinate was 69.7%. Factors associated with intention to vaccinate the children against COVID-19 were parental employment status, parental COVID-19 vaccine status and concern of contracting COVID-19. Parents who are employed, had completed vaccines with COVID-19 booster vaccine, and had concern of their children contracting COVID-19 were more likely to vaccinate their children (odds ratio [OR], 2.10; 95% confidence interval [CI], 1.22-3.69; p=0.011; OR, 2.15; 95% CI, 1.21-3.83; p=0.013; OR, 2.40; 95% CI, 1.34-4.30; p=0.004, respectively). Concern on the vaccine's side effects was negatively associated with the willingness to vaccinate. Conclusion This study showed that childhood COVID-19 vaccine only covered half of the population, with parental intentions for childhood COVID-19 vaccination being high, reaching almost two-thirds of the study participants. Factors influencing parental intentions were employment status, parental COVID-19 vaccine status, concerns about COVID-19 and concerns about vaccine side effects.
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Affiliation(s)
- Theresia Santi
- Doctoral Program in Medical Science, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Badriul Hegar
- Department of Child Health, Cipto Mangunkusumo Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Zakiudin Munasir
- Department of Child Health, Cipto Mangunkusumo Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Ari Prayitno
- Department of Child Health, Cipto Mangunkusumo Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Retno Asti Werdhani
- Department of Community Medicine, Cipto Mangunkkusumo Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | | | - Juandy Jo
- Mochtar Riady Institute for Nanotechnology, Tangerang, Indonesia
- Department of Biology, Faculty of Science and Technology, Universitas Pelita Harapan, Tangerang, Indonesia
| | - Ruswati Uswa
- Public Health Study Program, Faculty of Public Health, Universitas Indonesia, Jakarta, Indonesia
| | - Ratna Widia
- Public Health Study Program, Faculty of Public Health, Universitas Indonesia, Jakarta, Indonesia
| | - Yvan Vandenplas
- Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, KidZ Health Castle, Brussel, Belgium
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21
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Steurbaut L, Levy EI, De Geyter C, Buyse S, Vandenplas Y. A narrative review on the diagnosis and management of constipation in infants. Expert Rev Gastroenterol Hepatol 2023; 17:769-783. [PMID: 37501219 DOI: 10.1080/17474124.2023.2242255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [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: 01/27/2023] [Accepted: 07/25/2023] [Indexed: 07/29/2023]
Abstract
INTRODUCTION Functional constipation is one of the common disorders of gut-brain interaction in infancy, and decreases the quality of life of infants and parents. AREAS COVERED Relevant articles up to November 2022 were reviewed. We searched in PubMed, Google Scholar, and MEDLINE for guidelines, position papers, reviews, and randomized controlled trials on infant constipation. EXPERT OPINION Randomized controlled trials in this specific age group are mostly limited to trials with infant formula. The prevalence of infant constipation in formula-fed infants is decreasing, and can be associated with adaptations in formula composition. While the supplementation of infant formula with pro-, pre- and/or synbiotics decreases the prevalence of constipation, their efficacy in constipated infants is disappointing. There is limited evidence to support the addition of magnesium to infant formula to treat constipation. The evidence for the efficacy and safety of polyethylene glycol in children < 2 years has expanded over the past years. The administration of lactulose or polyethylene glycol is the preferred medical management, in case nutritional management does result in insufficient improvement.
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Affiliation(s)
- Laurine Steurbaut
- Vrije Universiteit Brussel (VUB), UZ Brussel, KidZ Health Castle, Brussels, Belgium
| | - Elvira Ingrid Levy
- Vrije Universiteit Brussel (VUB), UZ Brussel, KidZ Health Castle, Brussels, Belgium
- Department of Pediatrics, C.H.U. Saint-Pieter, Free University of Brussels, Brussels, Belgium
| | - Charlotte De Geyter
- Vrije Universiteit Brussel (VUB), UZ Brussel, KidZ Health Castle, Brussels, Belgium
| | | | - Yvan Vandenplas
- Vrije Universiteit Brussel (VUB), UZ Brussel, KidZ Health Castle, Brussels, Belgium
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22
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Meyer R, Venter C, Bognanni A, Szajewska H, Shamir R, Nowak-Wegrzyn A, Fiocchi A, Vandenplas Y. World Allergy Organization (WAO) Diagnosis and Rationale for Action against Cow's Milk Allergy (DRACMA) Guideline update - VII - Milk elimination and reintroduction in the diagnostic process of cow's milk allergy. World Allergy Organ J 2023; 16:100785. [PMID: 37546235 PMCID: PMC10401347 DOI: 10.1016/j.waojou.2023.100785] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 04/28/2023] [Accepted: 05/12/2023] [Indexed: 08/08/2023] Open
Abstract
The diagnosis of cow's milk allergy (CMA) in infants and young children remains a challenge because many of the presenting symptoms are similar to those experienced in other diagnoses. Both over- and under-diagnosis occur frequently. Misdiagnosis carries allergic and nutritional risks, including acute reactions, growth faltering, micronutrient deficiencies and a diminished quality of life for infants and caregivers. An inappropriate diagnosis may also add a financial burden on families and on the healthcare system. Elimination and reintroduction of cow's milk (CM) and its derivatives is essential for diagnosing CMA as well as inducing tolerance to CM. In non-IgE mediated CMA, the diagnostic elimination diet typically requires 2-4 weeks before reintroduction, while for IgE mediated allergy the time window may be shorter (1-2 weeks). An oral food challenge (OFC) under medical supervision remains the most reliable diagnostic method for IgE mediated and more severe types of non-IgE mediated CMA such as food protein induced enterocolitis syndrome (FPIES). Conversely, for other forms of non-IgE mediated CMA, reintroduction can be performed at home. The OFC cannot be replaced by the milk ladder after a diagnostic elimination diet. The duration of the therapeutic elimination diet, once a diagnosis was confirmed, can only be established through testing changes in sensitization status, OFCs or home reintroduction, which are directed by local protocols and services' availability. Prior non-evidence-based recommendations suggest that the first therapeutic elimination diet should last for at least 6 months or up to the age of 9-12 months, whichever is reached first. After a therapeutic elimination diet, a milk-ladder approach can be used for non-IgE mediated allergies to determine tolerance. Whilst some centers use the milk ladder also for IgE mediated allergies, there are concerns about the risk of having immediate-type reactions at home. Milk ladders have been adapted to local dietary habits, and typically start with small amounts of baked milk which then step up in the ladder to less heated and fermented foods, increasing the allergenicity. This publication aims to narratively review the risks associated with under- and over-diagnosis of CMA, therefore stressing the necessity of an appropriate diagnosis and management.
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Affiliation(s)
- Rosan Meyer
- Faculty Medicine, Imperial College London, Department Nutrition and Dietetics, Winchester University, UK and Faculty Medicine, KU Leuven, Belgium
| | - Carina Venter
- Children's Hospital Colorado, University of Colorado, Denver, CO, USA
| | - Antonio Bognanni
- Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Ontario, Canada
- Evidence in Allergy Group; Department of Medicine and Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Hania Szajewska
- Department of Paediatrics, The Medical University of Warsaw, Warsaw, Poland
| | - Raanan Shamir
- Institute of Gastroenterology, Nutrition and Liver Diseases, Schneider Children's Medical Center of Israel, Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Anna Nowak-Wegrzyn
- Hassenfeld Children's Hospital, Department of Pediatrics, NYU Grossman School of Medicine, New York, NY, USA
| | - Alessandro Fiocchi
- Allergy Unit - Area of Translational Research in Pediatric Specialities, Bambino Gesù Children's Hospital, Rome, Italy
| | - Yvan Vandenplas
- Vrije Universiteit Brussel, UZ Brussel, KidZ Health Castle, Brussels, Belgium
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23
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Meyer R, Vandenplas Y, Reese I, Vieira MC, Ortiz-Piedrahita C, Walsh J, Nowak-Wegrzyn A, Chebar Lozinsky A, Fox A, Chakravarti V, Netting M, Lange L, Venter C. The role of online symptom questionnaires to support the diagnosis of cow's milk allergy in children for healthcare professionals - A Delphi consensus study. Pediatr Allergy Immunol 2023; 34:e13975. [PMID: 37366210 DOI: 10.1111/pai.13975] [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: 01/30/2023] [Revised: 05/11/2023] [Accepted: 05/30/2023] [Indexed: 06/28/2023]
Abstract
BACKGROUND Cow's milk allergy (CMA) is one of the most common food allergies world-wide. The emergence of online CMA symptom questionnaires, aimed at parents and/or healthcare professionals (HCP), may raise awareness about the possible diagnosis of CMA, but also increases the risk for overdiagnosis leading to unnecessary dietary restriction impacting on growth and nutrition. This publication sets out to establish the availability of these CMA symptom questionnaires and critically assesses the development and validity. METHODS Thirteen HCP working in the field of CMA, from different countries, were recruited to participate. A combination of a Pubmed and CINAHL literature and online review using the Google search engine in English language was used. Symptoms in the questionnaires were assessed, using the European Academy for Allergy and Clinical Immunology guidelines for food allergy. Following the assessment of both the questionnaires and literature, the authors followed the modified Delphi approach to generate consensus statements. RESULTS Six hundred and fifty-one publications were identified, of which 29 were suitable for inclusion, with 26 being associated with the Cow's Milk-Related Symptoms Score. The online search yielded 10 available questionnaires: 7/10 were sponsored by formula milk companies and 7/10 were aimed at parents and three at HCP. Following the assessment of data, 19 statements were generated in two rounds of anonymous voting reaching 100% agreement. CONCLUSIONS Online CMA questionnaires, available to parents and HCP's, are varied in symptoms, and most were not validated. The overarching consensus generated from authors is that these questionnaires should not be used without the involvement of HCP.
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Affiliation(s)
- Rosan Meyer
- Department of Medicine, Imperial College London, London, UK
- Department of Nutrition and Dietetics, University of Winchester, Winchester, UK
- Department of Medicine, KU Leuven, Leuven, Belgium
| | - Yvan Vandenplas
- Vrije Universiteit Brussel (VUB), UZ Brussel, KidZ Health Castle, Brussels, Belgium
| | | | - Mario C Vieira
- Center for Paediatric Gastroenterology, Hospital Pequeno Príncipe, Curitiba, Brazil
| | | | | | - Anna Nowak-Wegrzyn
- Department of Pediatrics, NYU Grossman School of Medicine, Hassenfeld Children's Hospital, New York, New York, USA
- Department of Paediatrics, Gastroenterology and Nutrition, Collegium Medicum, University of Warmia and Mazury, Olsztyn, Poland
| | | | - Adam Fox
- Department of Paediatric Allergy, Evelina London Children's Hospital, London, UK
| | - Vijay Chakravarti
- Paediatrics & Allergy, Ramsay Rivers & Plymouth Nuffield Hospitals, Sawbridgeworth, UK
| | - Merryn Netting
- Discipline of Pediatrics, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
- SAHMRI Women and Kids Theme, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- Nutrition Department, Women's and Children's Health Network, Adelaide, South Australia, Australia
| | - Lars Lange
- Department of Pediatrics, GFO-Kliniken Bonn, St. Marien-Hospital, Bonn, Germany
| | - Carina Venter
- Section of Pediatric Allergy and Immunology, Children's Hospital Colorado, University of Colorado, Aurora, Colorado, USA
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24
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Gestels T, Vandenplas Y. Prenatal and Perinatal Antibiotic Exposure and Long-Term Outcome. Pediatr Gastroenterol Hepatol Nutr 2023; 26:135-145. [PMID: 37214166 PMCID: PMC10192590 DOI: 10.5223/pghn.2023.26.3.135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 03/22/2023] [Accepted: 04/12/2023] [Indexed: 05/24/2023] Open
Abstract
Antibiotics are frequently administered during pregnancy. Although necessary to address acute infections, their use facilitates antibiotic resistance. Other associations have also been found with the use of antibiotics, such as perturbations of gut bacteria, delays in microbial maturation, and increased risks of allergic and inflammatory diseases. Little is known about how the prenatal and perinatal administration of antibiotics to mothers affects the clinical outcomes of their offspring. A literature search was conducted of the Cochrane, Embase, and PubMed engines. The retrieved articles were reviewed by two authors and verified for relevance. The primary outcome was the effect of pre- and perinatal maternal antibiotic use on clinical outcomes. Thirty-one relevant studies were included in the meta-analysis. Various aspects are discussed, including infections, allergies, obesity, and psychosocial factors. In animal studies, antibiotic intake during pregnancy has been suggested to cause long-term alterations in immune regulation. In humans, associations have been found between antibiotic intake during pregnancy and different types of infections and an increased risk of pediatric infection-related hospitalization. A dose-dependent positive association between pre- and perinatal antibiotic use and asthma severity has been reported in animal and human studies, while positive associations with atopic dermatitis and eczema were reported by human studies. Multiple associations were identified between antibiotic intake and psychological problems in animal studies; however, relevant data from human studies are limited. However, one study reported a positive association with autism spectrum disorders. Multiple animal and human studies reported a positive association between pre- and perinatal antibiotic use by mothers and diseases in their offspring. Our findings have potentially significant clinical relevance, particularly considering the implications for health during infancy and later in life as well as the related economic burden.
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Affiliation(s)
- Thomas Gestels
- Department of Pediatrics, Antwerp University Hospital, Edegem, Belgium
| | - Yvan Vandenplas
- Department of KidZ Health Castle, Universitair Ziekenhuis Brussels, Brussels, Belgium
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25
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Cool R, Vandenplas Y. The Link between Different Types of Prebiotics in Infant Formula and Infection Rates: A Review. Nutrients 2023; 15:nu15081942. [PMID: 37111161 PMCID: PMC10140947 DOI: 10.3390/nu15081942] [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: 03/12/2023] [Revised: 04/08/2023] [Accepted: 04/13/2023] [Indexed: 04/29/2023] Open
Abstract
Breastfeeding plays a protective role against infections, partially through the prebiotic effect of human milk oligosaccharides (HMOs). Aiming to mimic these beneficial capacities, there is an ongoing search to make infant formula closer to human milk, including by adding oligosaccharides. Over the past two decades, multiple studies have been published on different types of prebiotics and their role in reducing infection rates in infants. This review aims to answer the question of whether there is evidence that the addition of oligosaccharides to infant formula decreases the prevalence of infection, and whether the effect is influenced by the kind of oligosaccharide added. The review of the literature reveals an important heterogeneity, including different types and dosages of prebiotics, different intervention periods and inclusion criteria, etc., making it impossible to formulate a consensus about the efficacy of adding prebiotics to infant formula. We would cautiously suggest that supplementation with galactooligosaccharides (GOSs)/fructooligosaccharides (FOSs) seems to have a beneficial effect on infection rates. For HMOs, more studies about the different types of HMOs are necessary to make any deductions. GOSs alone, inulin, and MOSs (bovine-milk-derived oligosaccharides) do not reduce the incidence of infections. The combination of GOSs and PDX (polydextrose) was found to play a protective role in one study. The evidence of the effect of prebiotics in reducing the use of antibiotics is low. The many lacunas in the direction of study uniformity offer many opportunities for further research.
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Affiliation(s)
- Roxane Cool
- Vrije Universiteit Brussel (VUB), UZ Brussel, KidZ Health Castle, 1090 Brussels, Belgium
| | - Yvan Vandenplas
- Vrije Universiteit Brussel (VUB), UZ Brussel, KidZ Health Castle, 1090 Brussels, Belgium
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26
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Xiao F, Wang Y, Ludwig T, Li X, Chen S, Sun N, Zheng Y, Huysentruyt K, Vandenplas Y, Zhang T. Generation and application of a convolutional neural networks algorithm in evaluating stool consistency in diapers. Acta Paediatr 2023; 112:1333-1340. [PMID: 36843346 DOI: 10.1111/apa.16731] [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: 11/11/2022] [Accepted: 02/24/2023] [Indexed: 02/28/2023]
Abstract
AIM The aim of the study was to develop a deep convolutional neural networks (CNNs) algorithm for automated assessment of stool consistency from diaper photographs and test its performance under real-world conditions. METHODS Diaper photographs were enrolled via a mobile phone application. The stool consistency was assessed independently according to the Brussels Infant and Toddler Stool Scale (BITSS) by paediatricians. These images were randomised into a training data set and a test data set. After training and testing, the new algorithm was used under real-world conditions by parents. RESULTS There was an overall agreement of 92.9% between paediatricians and the CNN-generated algorithm. Post hoc classification into the validated 4 categories of the BITSS yielded an agreement of 95.4%. Spearman correlation analysis across the ranking of 7 BITSS photographs and validated 4 categories showed a significant correlation of rho = 0.93 (95% CI, 0.92, 0.94; p < 0.001) and rho = 0.92 (95% CI, 0.90, 0.93; p < 0.001), respectively. The real-world application yielded further insights into changes in stool consistency between age categories and mode of feeding. CONCLUSION The new CNN-based algorithm is able to reliably identify stool consistency from diaper photographs and may support the communication between parents and paediatricians.
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Affiliation(s)
- Fangfei Xiao
- Department of Gastroenterology, Hepatology, and Nutrition, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yizhong Wang
- Department of Gastroenterology, Hepatology, and Nutrition, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,Institute of Pediatric Infection, Immunity and Critical Care Medicine, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Thomas Ludwig
- Danone Nutricia Research, Health & Science China, Utrecht, Netherlands
| | - Xiaolu Li
- Department of Gastroenterology, Hepatology, and Nutrition, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Sijia Chen
- Danone Open Science Research Center, Shanghai, China
| | - Nan Sun
- Danone Open Science Research Center, Shanghai, China
| | - Yixiao Zheng
- Danone Open Science Research Center, Shanghai, China
| | - Koen Huysentruyt
- Vrije Universiteit Brussel, KidZ Health Castle, Brussels, Belgium
| | - Yvan Vandenplas
- Vrije Universiteit Brussel, KidZ Health Castle, Brussels, Belgium
| | - Ting Zhang
- Department of Gastroenterology, Hepatology, and Nutrition, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,Institute of Pediatric Infection, Immunity and Critical Care Medicine, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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27
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Lavalle L, Sauvageot N, Cercamondi CI, Jankovic I, Egli D, Vandenplas Y. Limosilactobacillus reuteri DSM 17938-Containing Infant Formulas and the Associations with Gastrointestinal Tolerance: A Cross-Sectional Observational Study. Nutrients 2023; 15:530. [PMID: 36771237 PMCID: PMC9919438 DOI: 10.3390/nu15030530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 01/05/2023] [Accepted: 01/15/2023] [Indexed: 01/20/2023] Open
Abstract
Limosilactobacillus (L.; previously Lactobacillus) reuteri has been shown to influence gastrointestinal (GI) tolerance. This study was a secondary analysis of GI tolerance data from a multi-country, cross-sectional, observational study in healthy infants using the validated Infant Gastrointestinal Symptom Questionnaire (IGSQ) and a gut comfort questionnaire. Breastfed infants (BFI; n = 760) were compared to formula-fed infants receiving either L. reuteri-containing formula (FFI + LR; n = 470) or standard formula without any probiotic or prebiotic (FFI-Std; n = 501). The IGSQ composite scores (adjusted mean ± SE) in FFI + LR (22.17 ± 0.39) was significantly lower than in FFI-Std (23.41 ± 0.37) and similar to BFI (22.34 ± 0.30;), indicating better GI tolerance in FFI + LR than in FFI-Std. Compared with FFI-Std, FFI + LR had lower reports of difficulty in passing stools (11% vs. 22%; adjusted-odds ratio (OR) (95%CI) = 0.46 (0.31-0.68)), fewer hard stools (mean difference = -0.12 (-0.21, -0.02)) and less physician-confirmed colic (OR = 0.61 (0.45-0.82)), and similar to BFI. Parent-reported crying time (mean difference = -0.15 (-0.28, -0.01)), frequency of spitting-up/vomiting (mean difference = -0.18 (-0.34, -0.03)), volume of spit-up (mean difference = -0.20 (-0.32, -0.08)) and fussiness due to spitting-up/vomiting (mean difference = -0.17 (-0.29, -0.05)) were lower in FFI + LR versus FFI-Std and similar to BFI. In this study, L. reuteri-containing formula was associated with improved digestive tolerance and behavioral patterns.
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Affiliation(s)
| | - Luca Lavalle
- Biostatistics & Data, Nestlé Research, 1000 Lausanne, Switzerland
| | | | - Colin Ivano Cercamondi
- Nestlé Product Technology Center—Nutrition, Société des Produits Nestlé S.A., 1800 Vevey, Switzerland
| | - Ivana Jankovic
- Nestlé Product Technology Center—Nutrition, Société des Produits Nestlé S.A., 1800 Vevey, Switzerland
| | - Delphine Egli
- Nestlé Product Technology Center—Nutrition, Société des Produits Nestlé S.A., 1800 Vevey, Switzerland
| | - Yvan Vandenplas
- UZ Brussel, KidZ Health Castle, Vrije Universiteit Brussel (VUB), 1090 Brussels, Belgium
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28
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Lestari LA, Rizal AN, Damayanti W, Wibowo Y, Ming C, Vandenplas Y. Prevalence and Risk Factors of Functional Gastrointestinal Disorders in Infants in Indonesia. Pediatr Gastroenterol Hepatol Nutr 2023; 26:58-69. [PMID: 36816434 PMCID: PMC9911174 DOI: 10.5223/pghn.2023.26.1.58] [Citation(s) in RCA: 1] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Revised: 09/22/2022] [Accepted: 11/13/2022] [Indexed: 01/15/2023] Open
Abstract
PURPOSE Information regarding functional gastrointestinal disorders (FGIDs) in infants is currently lacking in Indonesia. This study aimed to describe the prevalence and risk factors of FGIDs in infants aged 6 weeks to 4 months in Indonesia. METHODS This cross-sectional study of 433 infants was conducted between September 2018 and February 2020. Information on FGIDs was collected using the Infant Gastrointestinal Symptom Questionnaire and the Feeding Practice and Gut Comfort Questionnaire. Adapted Rome IV criteria were used to define the FGIDs. RESULTS The prevalence of regurgitation was 26.3%; 16.8% of the infants presented crying-related symptoms and 5.5% exhibited constipation. The statistical analyses revealed that constipation was associated with sex (odds ratio [OR], 2.74; 95% confidence interval [CI], 1.07-7.71; p=0.043), employment of the father (OR, 0.3; 95% CI, 0.12-0.77; p=0.01), and education of the mother (OR, 1.92; 95% CI, 1.07-3.51; p=0.031). Length at birth (OR, 0.74; 95% CI, 0.55-0.99; p=0.042) was associated with constipation. Length at visit (OR, 0.83; 95% CI, 0.76-0.91; p<0.001) was associated with regurgitation, and the weight at visit (OR, 0.58; 95% CI, 0.35-0.96; p=0.038) was associated with crying and/or colic. A history of parental FGIDs was associated with crying-related symptoms (OR, 2.12; 95% CI, 1.23-3.68; p=0.007). CONCLUSION Regurgitation, crying, and constipation are common FGIDs in infants. Some parental and infant characteristics may be predictors for FGIDs. Further investigations are needed to evaluate the clinical relevance of our findings. Understanding the determinants of FGIDs will benefit healthcare professionals and parents to improve infant's quality of life and better manage these condition.
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Affiliation(s)
- Lily Arsanti Lestari
- Department of Nutrition and Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia.,Centre for Health and Human Nutrition, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Adhyatma Noor Rizal
- Centre for Health and Human Nutrition, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Wahyu Damayanti
- Department of Pediatrics, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Yulianti Wibowo
- Medical Nutrition Services, Nestle Indonesia, Jakarta, Indonesia
| | - Chang Ming
- Biostatistics & Data, Nestle Research, Lausanne, Switzerland
| | - Yvan Vandenplas
- Vrije Universiteit Brussel (VUB), UZ Burssel, KidZ Health Castle, Brussels, Belgium
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Hojsak I, Kolaček S, Mihatsch W, Mosca A, Shamir R, Szajewska H, Vandenplas Y. Synbiotics in the Management of Pediatric Gastrointestinal Disorders: Position Paper of the ESPGHAN Special Interest Group on Gut Microbiota and Modifications. J Pediatr Gastroenterol Nutr 2023; 76:102-108. [PMID: 35900172 DOI: 10.1097/mpg.0000000000003568] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Synbiotics are a mixture comprising of live microorganisms and substrate(s) selectively utilized by host microorganisms that confers a health benefit on the host. There is an increasing number of studies investigating their role in different diseases and disorders. AIM The purpose of this article is to provide recommendations for the use of synbiotics in the management of pediatric gastrointestinal disorders. The recommendations are developed by the ESPGHAN Special Interest Group on Gut Microbiota and Modifications. METHODS From existing literature databases, we searched and appraised all systematic reviews and/or meta-analyses, and subsequently published randomized controlled trials (RCTs) that compared the use of synbiotics, in all delivery vehicles and formulations, at any dose, compared to no synbiotics. Synbiotics which are part of infant formula were not assessed. The recommendations were formulated only if at least 2 RCTs that used a well-defined synbiotic were available. RESULTS Based on the currently available evidence, no recommendation can be formulated in favor or against the use of evaluated synbiotic combination in the treatment of acute gastroenteritis, prevention of necrotizing enterocolitis, Helicobacter pylori infection, inflammatory bowel disease, functional gastrointestinal disorders, and allergy in infants and children. CONCLUSIONS There is a need for more, well-designed RCTs on the role of synbiotics in gastrointestinal disorders with the same outcome measures to enable the inter-studies comparisons.
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Affiliation(s)
- Iva Hojsak
- From the Children's Hospital Zagreb, University of Zagreb School of Medicine, Zagreb, Croatia
| | - Sanja Kolaček
- From the Children's Hospital Zagreb, University of Zagreb School of Medicine, Zagreb, Croatia
| | - Walter Mihatsch
- the Department of Pediatrics Ulm University, Ulm, and Neu-Ulm University of Applied Sciences, Neu-Ulm, Germany
| | - Alexis Mosca
- the Hôpital Robert Debré, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Raanan Shamir
- the Institute for Gastroenterology, Nutrition and Liver Diseases, Schneider Children's, Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hania Szajewska
- the Department of Paediatrics, The Medical University of Warsaw, Warsaw, Poland
| | - Yvan Vandenplas
- the Vrije Universiteit Brussel (VUB), UZ Brussel, Kidz Health Castle, Brussels, Belgium
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30
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Abstract
Human milk oligosaccharides (HMOs) are the third most important solid component in human milk and act in tandem with other bioactive components. Individual HMO levels and distribution vary greatly between mothers by multiple variables, such as secretor status, race, geographic region, environmental conditions, season, maternal diet, and weight, gestational age and mode of delivery. HMOs improve the gastrointestinal barrier and also promote a bifidobacterium-rich gut microbiome, which protects against infection, strengthens the epithelial barrier, and creates immunomodulatory metabolites. HMOs fulfil a variety of physiologic functions including potential support to the immune system, brain development, and cognitive function. Supplementing infant formula with HMOs is safe and promotes a healthy development of the infant revealing benefits for microbiota composition and infection prevention. Because of limited data comparing the effect of non-human oligosaccharides to HMOs, it is not known if HMOs offer an additional clinical benefit over non-human oligosaccharides. Better knowledge of the factors influencing HMO composition and their functions will help to understand their short- and long-term benefits.
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Affiliation(s)
- Meltem Dinleyici
- Department of Social Pediatrics, Eskisehir Osmangazi University Faculty of Medicine, Eskisehir, Turkey
| | - Jana Barbieur
- UZ Brussel, KidZ Health Castle, Vrije Unversiteit Brussel, Brussels, Belgium
| | - Ener Cagri Dinleyici
- Department of Pediatrics, Eskisehir Osmangazi University Faculty of Medicine, Eskisehir, Turkey
| | - Yvan Vandenplas
- UZ Brussel, KidZ Health Castle, Vrije Unversiteit Brussel, Brussels, Belgium
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31
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Lavalle L, Sauvageot N, Cercamondi CI, Egli D, Jankovic I, Vandenplas Y, Juffrie M, Bardosono S, Galindez G, Waheed KAI, Gokhale P, Ibrahim MN, Asghar R, Shirazi H, Perez MLM, Kesavelu D, Edris A, Beleidy AE, Hodhod ME, Elzalabany M, Hussein H, Shaaban SY, Elmashad A, Abdelmoez A, El-Asheer OM, Vandenplas Y, Lavalle L, Sauvageot N, Cercamondi CI, Egli D, Jankovic I, Vandenplas Y. Infant feeding practice and gastrointestinal tolerance: a real-world, multi-country, cross-sectional observational study. BMC Pediatr 2022; 22:714. [PMID: 36514058 DOI: 10.1186/s12887-022-03763-8] [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: 03/25/2022] [Accepted: 11/21/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Signs of feeding intolerance, such as gastrointestinal (GI) symptoms, are frequently observed in otherwise healthy formula-fed infants in the first months of life. The primary objective of this observational study was to examine GI tolerance in formula-fed infants (FFI) vs. breastfed infants (BFI) in a real-world setting with a secondary objective being the comparison of infants fed formula with pre- and/or probiotics (FFI_PP) and those fed formula without any pre- and/or probiotics (FFI_noPP) as well as BFI. METHODS A six-country, cross-sectional study in full-term exclusively/predominantly FFI (n = 2036) and BFI (n = 760) aged 6-16 weeks was conducted using the validated Infant Gastrointestinal Symptom Questionnaire (IGSQ) and a Feeding Practice and Gut Comfort Questionnaire. RESULTS The IGSQ composite score in FFI was non-inferior compared to BFI (mean difference [95%CI]: 0.17 [-0.34, 0.67]; non-inferiority p-value < 0.0001) and scores for BFI and FFI were below the threshold of 23, indicating no GI discomfort. Adjusted mean IGSQ scores ± SE were similar in FFI_PP (22.1 ± 0.2) and BFI (22.3 ± 0.3) while FFI_noPP (23.4 ± 0.3) was significantly higher and above 23 indicating some GI discomfort (mean differences [95%CI] FFI_noPP minus FFI_PP and FFI_noPP minus BFI were 1.28 [0.57, 1.98] and 1.09 [0.38, 1.80], respectively; both p < 0.01). Hard stools and difficulty in passing stool were more common in FFI compared to BFI (p < 0.01) but were less common in FFI_PP compared to FFI_noPP (p < 0.01). FFI_PP showed significantly less crying than FFI_noPP and was similar to BFI. Significantly fewer physician-confirmed colic episodes (Rome IV criteria) were reported in FFI_PP compared with FFI_noPP or BFI. CONCLUSIONS In this real-world observational study, FFI had non-inferior overall GI tolerance compared to BFI. Within FFI, infants receiving formulas with pre- and/or probiotics had a better GI tolerance, improved stooling and less infantile colic compared to those receiving formula without any pre- and/or probiotics and were more similar to BFI. TRIAL REGISTRATION NCT03703583, 12/10/2018 ( https://clinicaltrials.gov/ct2/show/NCT03703583 ).
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Affiliation(s)
| | - Luca Lavalle
- Biostatistics & Data, Nestlé Research, Lausanne, Switzerland
| | | | - Colin Ivano Cercamondi
- Nestlé Product Technology Center - Nutrition, Société Des Produits Nestlé S.A., 1800, Vevey, Switzerland
| | - Delphine Egli
- Nestlé Product Technology Center - Nutrition, Société Des Produits Nestlé S.A., 1800, Vevey, Switzerland.
| | - Ivana Jankovic
- Nestlé Product Technology Center - Nutrition, Société Des Produits Nestlé S.A., 1800, Vevey, Switzerland
| | - Yvan Vandenplas
- Vrije Universiteit Brussel, UZ Brussels, KidZ Health Castle, Brussels, Belgium
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32
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D'Auria E, Acunzo M, Salvatore S, Grazi R, Agosti M, Vandenplas Y, Zuccotti G. Biotics in atopic diseases: state of the art and future perspectives. Minerva Pediatr (Torino) 2022; 74:688-702. [PMID: 36149096 DOI: 10.23736/s2724-5276.22.07010-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Prevalence of allergic diseases has growing in recent decades, being a significant burden for patients and their families. Different environmental factors, acting in early life, can significantly affect the timing and diversity of bacterial colonization and the immune system development. Growing evidence points to a correlation between early life microbial perturbation and development of allergic diseases. Besides, changes in the microbiota in one body site may influence other microbiota communities at distance by different mechanisms, including microbial-derived metabolites, mainly the short chain fatty acids (SCFA). Hence, there has been an increasing interest on the role of "biotics" (probiotics, prebiotics, symbiotics and postbiotics) in shaping dysbiosis and modulating allergic risk. Systemic type 2 inflammation is emerging as a common pathogenetic pathway of allergic diseases, intertwining communication with the gut mcirobiota. The aim of this review was to provide an update overview of the current knowledge of biotics in prevention and treatment of allergic diseases, also addressing research gaps which need to be filled.
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Affiliation(s)
- Enza D'Auria
- Department of Pediatrics, Vittore Buzzi Children's Hospital, University of Milan, Milan, Italy -
| | - Miriam Acunzo
- Department of Pediatrics, Vittore Buzzi Children's Hospital, University of Milan, Milan, Italy
| | - Silvia Salvatore
- Department of Pediatrics, University of Insubria, F. Del Ponte Hospital, Varese, Italy
| | - Roberta Grazi
- Department of Pediatrics, Vittore Buzzi Children's Hospital, University of Milan, Milan, Italy
| | - Massimo Agosti
- Department of Pediatrics, University of Insubria, F. Del Ponte Hospital, Varese, Italy
| | - Yvan Vandenplas
- KidZ Health Castle, Free University of Brussels, Brussels, Belgium
| | - Gianvincenzo Zuccotti
- Department of Pediatrics, Vittore Buzzi Children's Hospital, University of Milan, Milan, Italy
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33
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Dellon ES, Gonsalves N, Abonia JP, Alexander JA, Arva NC, Atkins D, Attwood SE, Auth MKH, Bailey DD, Biederman L, Blanchard C, Bonis PA, Bose P, Bredenoord AJ, Chang JW, Chehade M, Collins MH, Di Lorenzo C, Dias JA, Dohil R, Dupont C, Falk GW, Ferreira CT, Fox AT, Genta RM, Greuter T, Gupta SK, Hirano I, Hiremath GS, Horsley-Silva JL, Ishihara S, Ishimura N, Jensen ET, Gutiérrez-Junquera C, Katzka DA, Khoury P, Kinoshita Y, Kliewer KL, Koletzko S, Leung J, Liacouras CA, Lucendo AJ, Martin LJ, McGowan EC, Menard-Katcher C, Metz DC, Miller TL, Moawad FJ, Muir AB, Mukkada VA, Murch S, Nhu QM, Nomura I, Nurko S, Ohtsuka Y, Oliva S, Orel R, Papadopoulou A, Patel DA, Pesek RD, Peterson KA, Philpott H, Putnam PE, Richter JE, Rosen R, Ruffner MA, Safroneeva E, Schreiner P, Schoepfer A, Schroeder SR, Shah N, Souza RF, Spechler SJ, Spergel JM, Straumann A, Talley NJ, Thapar N, Vandenplas Y, Venkatesh RD, Vieira MC, von Arnim U, Walker MM, Wechsler JB, Wershil BK, Wright BL, Yamada Y, Yang GY, Zevit N, Rothenberg ME, Furuta GT, Aceves SS. International Consensus Recommendations for Eosinophilic Gastrointestinal Disease Nomenclature. Clin Gastroenterol Hepatol 2022; 20:2474-2484.e3. [PMID: 35181570 PMCID: PMC9378753 DOI: 10.1016/j.cgh.2022.02.017] [Citation(s) in RCA: 55] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 01/28/2022] [Accepted: 02/07/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Substantial heterogeneity in terminology used for eosinophilic gastrointestinal diseases (EGIDs), particularly the catchall term "eosinophilic gastroenteritis," limits clinical and research advances. We aimed to achieve an international consensus for standardized EGID nomenclature. METHODS This consensus process utilized Delphi methodology. An initial naming framework was proposed and refined in iterative fashion, then assessed in a first round of Delphi voting. Results were discussed in 2 consensus meetings, and the framework was updated and reassessed in a second Delphi vote, with a 70% threshold set for agreement. RESULTS Of 91 experts participating, 85 (93%) completed the first and 82 (90%) completed the second Delphi surveys. Consensus was reached on all but 2 statements. "EGID" was the preferred umbrella term for disorders of gastrointestinal (GI) tract eosinophilic inflammation in the absence of secondary causes (100% agreement). Involved GI tract segments will be named specifically and use an "Eo" abbreviation convention: eosinophilic gastritis (now abbreviated EoG), eosinophilic enteritis (EoN), and eosinophilic colitis (EoC). The term "eosinophilic gastroenteritis" is no longer preferred as the overall name (96% agreement). When >2 GI tract areas are involved, the name should reflect all of the involved areas. CONCLUSIONS This international process resulted in consensus for updated EGID nomenclature for both clinical and research use. EGID will be the umbrella term, rather than "eosinophilic gastroenteritis," and specific naming conventions by location of GI tract involvement are recommended. As more data are developed, this framework can be updated to reflect best practices and the underlying science.
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Affiliation(s)
- Evan S Dellon
- Center for Esophageal Diseases and Swallowing and Center for Gastrointestinal Biology and Disease, Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina.
| | - Nirmala Gonsalves
- Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - J Pablo Abonia
- Division of Allergy and Immunology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | | | - Nicoleta C Arva
- Department of Pathology, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Dan Atkins
- Section of Pediatric Allergy and Immunology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado
| | - Stephen E Attwood
- Department of Health Services Research, Durham University, Durham, United Kingdom
| | - Marcus K H Auth
- Department of Paediatric Gastroenterology, Hepatology and Nutrition, Alder Hey Children's NHS Foundation Trust and University of Liverpool, Liverpool, United Kingdom
| | - Dominique D Bailey
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Columbia University Irving Medical Center, New York, New York; Division of Digestive and Liver Disease, Department of Medicine, Columbia University Irving Medical Center, New York, New York; Columbia Center for Human Development, Columbia University Irving Medical Center, New York, New York
| | - Luc Biederman
- Department of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland
| | - Carine Blanchard
- Department of Gastro-Intestinal Health, Immunology group, Nestlé Institute of Health Sciences, Nestlé Research, Société des Produits Nestlé S.A., Lausanne, Switzerland
| | - Peter A Bonis
- Division of Gastroenterology, Tufts University School of Medicine, Boston, Massachusetts
| | - Paroma Bose
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Riley Hospital for Children and Community Health Network, Indiana University School of Medicine, Indianapolis, Indianapolis
| | - Albert J Bredenoord
- Department of Gastroenterology, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Joy W Chang
- Division of Gastroenterology, Department of Internal Medicine, University of Michigan, Ann Arbor, MichiganI
| | - Mirna Chehade
- Mount Sinai Center for Eosinophilic Disorders, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Margaret H Collins
- Division of Pathology and Laboratory Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Carlo Di Lorenzo
- Division of Gastroenterology, Hepatology and Nutrition, Nationwide Children's Hospital, Columbus, Ohio
| | | | - Ranjan Dohil
- Division on Pediatric Gastroenterology, Rady's Children's Hospital, University of California, San Diego, San Diego, California
| | - Christophe Dupont
- Ramsay Group, Marcel Sembat Clinic, Paris Descartes University, Paris, France
| | - Gary W Falk
- Division of Gastroenterology, Perelman School of Medicine, University of Pennsylvania Philadelphia, Pennsylvania
| | - Cristina T Ferreira
- Hospital Santo Antônio, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil
| | - Adam T Fox
- Paediatric Allergy, Guy's & St. Thomas' Hospitals NHS Foundation Trust, London, United Kingdom
| | - Robert M Genta
- Division of Gastroenterology, Department of Pathology and Medicine, Baylor College of Medicine, Houston, Texas; Inform Diagnostics, Irving, Texas
| | - Thomas Greuter
- Department of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland; Division of Gastroenterology and Hepatology, University Hospital Lausanne, Lausanne, Switzerland
| | - Sandeep K Gupta
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Riley Hospital for Children and Community Health Network, Indiana University School of Medicine, Indianapolis, Indianapolis
| | - Ikuo Hirano
- Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Girish S Hiremath
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Monroe Carell Jr. Children's Hospital at Vanderbilt, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Shunji Ishihara
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Shimane, Japan
| | - Norihisa Ishimura
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Shimane, Japan
| | - Elizabeth T Jensen
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Carolina Gutiérrez-Junquera
- Pediatric Gastroenterology Unit, University Hospital Puerta de Hierro Majadahonda, Autonomous University of Madrid, Majadahonda, Spain
| | - David A Katzka
- Division of Gastroenterology, Mayo Clinic Rochester, Minnesota
| | - Paneez Khoury
- Human Eosinophil Section, National Institute of Allergy and Infectious Diseases/National Institutes of Health, Bethesda, Maryland
| | | | - Kara L Kliewer
- Division of Allergy and Immunology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Sibylle Koletzko
- Department of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital, LMU Munich, Munich, Germany; Department of Pediatrics, Gastroenterology and Nutrition, School of Medicine Collegium Medicum University of Warmia and Mazury, Olsztyn, Poland
| | - John Leung
- Division of Gastroenterology, Tufts University School of Medicine, Boston, Massachusetts
| | - Chris A Liacouras
- Center for Pediatric Eosinophilic Disorders, Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Alfredo J Lucendo
- Department of Gastroenterology, Hospital General de Tomelloso, Instituto de Investigación Sanitaria Princesa, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Tomelloso, Spain
| | - Lisa J Martin
- Department of Pediatrics, Cincinnati Children's Hospital, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Emily C McGowan
- Division of Allergy and Immunology, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Calies Menard-Katcher
- Digestive Health Institute, Children's Hospital Colorado, Aurora, Colorado; Gastrointestinal Eosinophilic Diseases Program, University of Colorado School of Medicine, Aurora, Colorado
| | - David C Metz
- Division of Gastroenterology, Perelman School of Medicine, University of Pennsylvania Philadelphia, Pennsylvania
| | | | - Fouad J Moawad
- Division of Gastroenterology and Hepatology, Scripps Clinic, La Jolla, California
| | - Amanda B Muir
- Center for Pediatric Eosinophilic Disorders, Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Vincent A Mukkada
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Simon Murch
- Warwick University Medical School, Coventry, United Kingdom
| | - Quan M Nhu
- Division of Gastroenterology and Hepatology, Scripps Clinic, La Jolla, California; Department of Molecular Medicine, Scripps Research Institute, San Diego, California; Division of Allergy and Immunology, University of California, San Diego, La Jolla, California
| | - Ichiro Nomura
- Division of Eosinophilic Gastrointestinal Disorders, Allergy Center, National Center for Child Health and Development, Tokyo, Japan
| | - Samuel Nurko
- Center for Motility and Functional Gastrointestinal Disorders, Boston Children's Hospital, Boston, Massachusetts
| | - Yoshikazu Ohtsuka
- Department of Pediatrics and Adolescent Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Salvatore Oliva
- Pediatric Digestive Endoscopy, Pediatric Gastroenterology and Liver Unit, Maternal and Child Health Department, University Hospital, University of Rome, Rome, Italy
| | - Rok Orel
- University Children's Hospital Ljubljana, Faculty of Medicine, University of Ljubljana, Slovenia
| | - Alexandra Papadopoulou
- Division of Gastroenterology and Hepatology, Children's Hospital Agia Sofia, First Department of Pediatrics, University of Athens, Athens, Greece
| | - Dhyanesh A Patel
- Center for Esophageal Disorders, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Robert D Pesek
- Division of Allergy and Immunology, Department of Pediatrics, Arkansas Children's Hospital, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | | | - Hamish Philpott
- Department of Gastroenterology, Lyell McEwin Hospital, University of Adelaide, Adelaide, Australia
| | - Philip E Putnam
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Joel E Richter
- Morsani College of Medicine, University of South Florida, Tampa, Florida
| | - Rachel Rosen
- Aerodigestive Center, Boston Children's Hospital, Boston, Massachusetts
| | - Melanie A Ruffner
- Division of Allergy and Immunology, Children's Hospital of Philadelphia, Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ekaterina Safroneeva
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Philipp Schreiner
- Department of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland
| | - Alain Schoepfer
- Division of Gastroenterology and Hepatology, University Hospital Lausanne, Lausanne, Switzerland
| | - Shauna R Schroeder
- Division of Gastroenterology, Hepatology, and Nutrition, Phoenix Children's Hospital, Phoenix, Arizona
| | - Neil Shah
- Portland Hospital, London, United Kingdom; Reckitt Healthcare, Slough, United Kingdom
| | - Rhonda F Souza
- Division of Gastroenterology and Center for Esophageal Diseases, Baylor Scott & White Center for Esophageal Research, Baylor University Medical Center, Baylor Scott & White Research Institute, Dallas, Texas
| | - Stuart J Spechler
- Division of Gastroenterology and Center for Esophageal Diseases, Baylor Scott & White Center for Esophageal Research, Baylor University Medical Center, Baylor Scott & White Research Institute, Dallas, Texas
| | - Jonathan M Spergel
- Division of Allergy and Immunology, Children's Hospital of Philadelphia, Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Alex Straumann
- Department of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland
| | - Nicholas J Talley
- School of Medicine and Public Health, University of Newcastle, Newcastle, Australia; National Health and Medical Research Council Centre of Research Excellence on Digestive Health, Newcastle, Australia; Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Nikhil Thapar
- Department of Gastroenterology, Hepatology and Liver Transplant, Queensland Children's Hospital, School of Medicine, University of Queensland, Brisbane, Australia; Woolworths Centre for Child Nutrition Research, Queensland University of Technology, Brisbane, Australia
| | - Yvan Vandenplas
- KidZ Health Castle, Vrije Universiteit Brussel, Brussels, Belgium
| | - Rajitha D Venkatesh
- Division of Gastroenterology, Hepatology and Nutrition, Nationwide Children's Hospital, Columbus, Ohio
| | - Mario C Vieira
- Center for Pediatric Gastroenterology, Hospital Pequeno Príncipe, Curitiba, Brazil
| | - Ulrike von Arnim
- Department of Gastroenterology, Hepatology and Infectious Diseases, University Hospital Magdeburg, Magdeburg, Germany
| | - Marjorie M Walker
- Department of Pathology, College of Health, Medicine and Wellbeing, Faculty of Health and Medicine, University of Newcastle Callaghan, Australia
| | - Joshua B Wechsler
- Division of Gastroenterology, Hepatology, and Nutrition, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Barry K Wershil
- Division of Gastroenterology, Hepatology, and Nutrition, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Benjamin L Wright
- Division of Allergy, Asthma, and Clinical Immunology, Department of Medicine, Mayo Clinic Arizona, Scottsdale, Arizona; Section of Allergy and Immunology, Division of Pulmonology, Phoenix Children's Hospital, Phoenix, Arizona
| | - Yoshiyuki Yamada
- Department of Pediatrics, Tokai University School of Medicine, Kanagawa, Japan
| | - Guang-Yu Yang
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Noam Zevit
- Institute of Gastroenterology, Hepatology, and Nutrition, Schneider Children's Medical Center of Israel, Sackler Faculty of Medicine, Tel-Aviv University, Petah-Tikva, Israel
| | - Marc E Rothenberg
- Division of Allergy and Immunology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Glenn T Furuta
- Digestive Health Institute, Children's Hospital Colorado, Aurora, Colorado; Gastrointestinal Eosinophilic Diseases Program, University of Colorado School of Medicine, Aurora, Colorado
| | - Seema S Aceves
- Division of Allergy, Immunology, and Rheumatology, Departments of Pediatrics and Medicine, Rady Children's Hospital, University of California San Diego, San Diego, California
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Meyer R, Vandenplas Y, Lozinsky AC, Vieira MC, Canani RB, Dupont C, Uysal P, Cavkaytar O, Knibb R, Fleischer DM, Nowak-Wegrzyn A, Venter C. Diagnosis and management of food allergy-associated gastroesophageal reflux disease in young children-EAACI position paper. Pediatr Allergy Immunol 2022; 33:e13856. [PMID: 36282131 DOI: 10.1111/pai.13856] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 08/26/2022] [Accepted: 09/06/2022] [Indexed: 11/06/2022]
Abstract
Gastro-oesophageal reflux (GOR) and food allergy (FA) are common conditions, especially during the first 12 months of life. When GOR leads to troublesome symptoms, that affect the daily functioning of the infant and family, it is referred to as GOR disease (GORD). The role of food allergens as a cause of GORD remains controversial. This European Academy of Allergy and Clinical Immunology (EAACI) position paper aims to review the evidence for FA-associated GORD in young children and translate this into clinical practice that guides healthcare professionals through the diagnosis of suspected FA-associated GORD and medical and dietary management. The task force (TF) on non-IgE mediated allergy consists of EAACI experts in paediatric gastroenterology, allergy, dietetics and psychology from Europe, United Kingdom, United States, Turkey and Brazil. Six clinical questions were formulated, amended and approved by the TF to guide this publication. A systematic literature search using PubMed, Cochrane and EMBASE databases (until June 2021) using predefined inclusion criteria based on the 6 questions was used. The TF also gained access to the database from the European Society of Paediatric Gastroenterology and Hepatology working group, who published guidelines on GORD and ensured that all publications used within that position paper were included. For each of the 6 questions, practice points were formulated, followed by a modified Delphi method consisting of anonymous web-based voting that was repeated with modified practice points where required, until at least 80% consensus for each practice point was achieved. This TF position paper shares the process, the discussion and consensus on all practice points on FA-associated GORD.
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Affiliation(s)
- Rosan Meyer
- Faculty of Medicine, KU Leuven, Leuven, Belgium.,Department Nutrition and Dietetics, Winchester University, Winchester, London, UK.,Department Paediatrics, Imperial College, London, UK
| | - Yvan Vandenplas
- KidZ Health Castle, UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Adriana Chebar Lozinsky
- Department of Allergy and Immune Disorders, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Mario C Vieira
- Department of Paediatrics-Pontifical Catholic University of Paraná and Center for Pediatric Gastroenterology-Hospital Pequeno Príncipe, Curitiba, Brazil
| | - Roberto Berni Canani
- Department of Translational Medical Science and ImmunoNutritionLab at CEINGE-Advanced Biotechnologies Research Center, University of Naples "Federico II", Naples, Italy
| | - Christophe Dupont
- Department of Paediatric Gastroenterology, Necker University Children Hospital, Paris, France
| | - Pinar Uysal
- Department of Allergy and Clinical Immunology, Adnan Menderes University, Aydin, Turkey
| | - Ozlem Cavkaytar
- Department of Pediatric Allergy and Immunology, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | - Rebecca Knibb
- School of Psychology, Aston University, Birmingham, UK
| | - David M Fleischer
- University of Colorado Denver School of Medicine, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Anna Nowak-Wegrzyn
- Department of Pediatrics, NYU Grossman School of Medicine, New York City, New York, USA.,Department of Pediatrics, Gastroenterology and Nutrition, Collegium Medicum, University of Warmia and Mazury, Olsztyn, Poland
| | - Carina Venter
- University of Colorado Denver School of Medicine Children's Hospital Colorado, Aurora, Colorado, USA
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Barbieur J, Levy EI, Vandenplas Y. Efficacy and safety of medical and nutritional management of gastroesophageal reflux in formula-fed infants: a narrative review. Curr Opin Pediatr 2022; 34:503-509. [PMID: 35855545 DOI: 10.1097/mop.0000000000001147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The prescription of proton pump inhibitors has an increasing trend, despite that guidelines recommend nutritional management as first-line management. A thickened antiregurgitation formula is recommended in formula-fed infants. In this review we focus on the novel insights in management of formula-fed infants with gastroesophageal reflux disease (GERD). RECENT FINDINGS New data are limited. Concerning thickened antiregurgitation formula, locust bean gum has been the most studied and has limited adverse effects. However, positive results were also obtained with pectin. The effect of pro- and prebiotics on regurgitation is unclear. The overlap between cow's milk allergy and gastroesophageal reflux remains a challenge. SUMMARY Very limited new data were published during the last 18 months. Thickened antiregurgitation formula is the first-line approach in formula-fed infants with GERD. No specific thickening agent can be recommended because of lack of comparative trials. Proton pump inhibitors are over prescribed in infants.
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Affiliation(s)
- Jana Barbieur
- Vrije Universiteit Brussel, UZ Brussel, KidZ Health Castle
| | - Elvira Ingrid Levy
- Vrije Universiteit Brussel, UZ Brussel, KidZ Health Castle
- Department of Pediatrics, C.H.U. Saint-Pieter, Free University of Brussels, Brussels, Belgium
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Daelemans S, Deseck V, Levy EI, Vandenplas Y. Are pro- and/or synbiotics beneficial in Helicobacter pylori eradication therapy in children? A narrative review. Eur J Pediatr 2022; 181:3225-3234. [PMID: 35726032 DOI: 10.1007/s00431-022-04523-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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: 11/24/2021] [Revised: 06/03/2022] [Accepted: 06/03/2022] [Indexed: 11/03/2022]
Abstract
To assess the effect of pro- and synbiotics in the eradication therapy of Helicobacter pylori (Hp), as well as their effect on adverse effects and therapy compliance in children, a review was performed. We searched for relevant studies published in the English language in PubMed in the last 5 years. Articles were extracted using subject heading and keywords of interest to the topic. There is low-quality evidence that Lactobacillus casei, Bifidobacterium infantis, and Clostridium butyricum (only one RCT for all three) and Saccharomyces boulardii (more than 1 RCT) increase the eradication rate and decrease the adverse effects. Data with synbiotics report only a trend towards a better eradication. Heterogeneity in study designs and outcomes is a major limitation to propose evidence-based recommendations. A reduced incidence of antibiotic-associated diarrhoea is reported. Therapy compliance has been poorly studied. Conclusion: Due to study heterogeneity, there is very low evidence that some specific probiotics strains increase the eradication rate of Hp when added to standard eradication therapy in children. Whether this is related to immunological effects of the strain or a decrease of adverse effects is not known. More studies, especially comparative trials, are needed before the addition of pro- or synbiotics to Hp eradication treatment can be recommended in daily routine. What is Known: • Eradication treatment of Helicobacter pylori in children has a low success rate and induces frequently adverse effects. • The addition of probiotics might improve eradication and decrease adverse effects, but no paediatric guideline does recommend probiotics as part of the eradication treatment. What is New: • There is low-quality evidence that Lactobacillus casei, Bifidobacteria infantis, and Clostridium butyricum (only one randomized controlled trial (RCT) for all three) and Saccharomyces boulardii (more than 1 RCT) increase the eradication rate and decrease the adverse effects. • Data with synbiotics report only a trend towards a better eradication.
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Affiliation(s)
- Sari Daelemans
- Vrije Universiteit Brussel (VUB), UZ Brussel, KidZ Health Castle, Laarbeeklaan, 101, 1090, Brussels, Belgium
| | - Virginie Deseck
- Department of Pediatrics, C.H.U. Saint-Pierre, Free University of Brussels, Brussels, Belgium
| | - Elvira Ingrid Levy
- Vrije Universiteit Brussel (VUB), UZ Brussel, KidZ Health Castle, Laarbeeklaan, 101, 1090, Brussels, Belgium.,Department of Pediatrics, C.H.U. Saint-Pierre, Free University of Brussels, Brussels, Belgium
| | - Yvan Vandenplas
- Vrije Universiteit Brussel (VUB), UZ Brussel, KidZ Health Castle, Laarbeeklaan, 101, 1090, Brussels, Belgium.
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Pletincx M, Leuris J, Vandenplas Y. Empirical treatment of infant irritability as acid gastro-oesophageal reflux is not recommended. Acta Paediatr 2022; 111:2038-2039. [PMID: 35821654 DOI: 10.1111/apa.16485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 06/13/2022] [Accepted: 07/11/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Michel Pletincx
- CHIREC Sainte-Anne St-Remi Hospital, Paediatric Department, Brussels, Belgium
| | - Julie Leuris
- CHIREC Sainte-Anne St-Remi Hospital, Paediatric Department, Brussels, Belgium
| | - Yvan Vandenplas
- Vrije Universiteit Brussel (VUB), UZ Brussel, KidZ Health Castle, Brussels, Belgium
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Kilic Yildirim G, Dinleyici M, Vandenplas Y, Dinleyici EC. Effects of Multispecies Synbiotic Supplementation on Anthropometric Measurements, Glucose and Lipid Parameters in Children With Exogenous Obesity: A Randomized, Double Blind, Placebo-Controlled Clinical Trial (Probesity-2 Trial). Front Nutr 2022; 9:898037. [PMID: 35845797 PMCID: PMC9286749 DOI: 10.3389/fnut.2022.898037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 06/15/2022] [Indexed: 11/29/2022] Open
Abstract
Studies on the effects of synbiotics on obesity in children are limited. The objective of this randomized double-blind placebo-controlled trial was to test the effects of a multispecies synbiotic during 12 weeks on anthropometric measurements, glucose metabolism and lipid parameters in 61 children with exogenous obesity. All children were treated with a standard diet and increased physical activity and received once daily a synbiotic supplement (probiotic mixture including Lactobacillus acidophilus, Lacticaseibacillus rhamnosus, Bifidobacterium bifidum, Bifidobacterium longum, Enterococcus faecium and fructo-oligosaccharides) or daily placebo for 12 weeks. At baseline, no statistically significant differences existed in anthropometric measurements, glucose and lipid parameters between both groups. We observed changes for anthropometric measures (% reduction comparing to baseline) in both synbiotic and placebo groups. After 12 weeks; changes (% reduction comparing to baseline) in weight (p < 0.01), BMI (p < 0.05), waist circumference (p < 0.05) and waist circumference to height ratio (p < 0.05) were significantly higher in the children receiving the synbiotic supplement. There is no difference in glucose metabolism, lipid parameters, presence of non-alcoholic fatty liver disease between both groups after 12 weeks. The daily intake of a multispecies synbiotic in addition to diet and increased physical activity did improve anthropometric measurements: body weight, BMI, waist circumference and waist/height ratio. The supplementation of this synbiotic is an efficient weight-loss strategy above diet and exercise in pediatric obesity (Trial identifier: NCT05162209).
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Affiliation(s)
- Gonca Kilic Yildirim
- Department of Pediatrics, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey
- Pediatrics Nutrition and Metabolism Unit, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Meltem Dinleyici
- Department of Pediatrics, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey
- Department of Social Pediatrics, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Yvan Vandenplas
- UZ Brussel, KidZ Health Castle, Vrije Unversiteit Brussel, Brussels, Belgium
| | - Ener Cagri Dinleyici
- Department of Pediatrics, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey
- *Correspondence: Ener Cagri Dinleyici
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Vandenplas Y, Bajerova K, Dupont C, Eigenmann P, Kuitunen M, Meyer R, Ribes-Koninckx C, Salvatore S, Shamir R, Szajewska H. The Cow's Milk Related Symptom Score: The 2022 Update. Nutrients 2022; 14:nu14132682. [PMID: 35807862 PMCID: PMC9268587 DOI: 10.3390/nu14132682] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 06/22/2022] [Accepted: 06/25/2022] [Indexed: 02/07/2023] Open
Abstract
CoMiSS® was developed 7 years ago to increase the awareness of health care professionals towards the possibility that symptoms presented by infants could be related to cow’s milk. While CoMiSS was conceived mostly on theoretical concepts, data is now available from 25 clinical trials. Based on this extensive research using the tool since 2015, we aim to propose an updated CoMiSS. The evidence was reviewed, debated and discussed by 10 experts, of whom seven were part of the original group. The panel concluded that the cut-off previously proposed to indicate the likelihood that symptoms may be cow’s milk related should be lowered from ≥12 to ≥10. Data in healthy infants > 6 months are missing. Since the Brussels Infant and Toddlers Stool Scale (BITSS) was recently developed for non-toilet trained children, the Bristol Stool Scale was changed to the BITSS without changing the impact of stool characteristics on CoMiSS. Overall, CoMiSS raises awareness that symptoms might be cow’s milk related. New studies are needed to determine if the change in cut-off and other small adaptions improve its sensitivity and specificity. Data for CoMiSS is still needed in presumed healthy infants between 6 and 12 months old. There may also be regional differences in CoMiSS, in healthy infants as well as in those with cow’s milk allergy. Finally, we emphasize that CoMiSS is an awareness tool and not a diagnostic test.
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Affiliation(s)
- Yvan Vandenplas
- Vrije Universiteit Brussel (VUB), UZ Brussel, KidZ Health Castle, Laarbeeklaan 101, 1090 Brussels, Belgium
- Correspondence: ; Tel.: +32-475748794
| | - Katerina Bajerova
- Department of Pediatrics, University Hospital Brno and Masaryk’s University, 625 00 Brno, Czech Republic;
- Department of Internal Medicine, Geriatrics and Practical Medicine, University Hospital Brno and Masaryk´s University, 625 00 Brno, Czech Republic
| | - Christophe Dupont
- Ramsay Group, France et Clinique Marcel Sembat, Paris Descartes University, Boulogne-Billancourt, 75004 Paris, France;
| | - Philippe Eigenmann
- Pediatric Allergy Unit, University Hospitals of Geneva, 1205 Geneva, Switzerland;
| | - Mikael Kuitunen
- Children’s Hospital, University of Helsinki and Helsinki University Hospital, 00290 Helsinki, Finland;
| | - Rosan Meyer
- Department Paediatrics, Imperial College London, London SW7 2BX, UK;
- Department Dietetics, Winchester University, Winchester SO23 4NR, UK
- Department Medicine, KU Leuven, 3001 Leuven, Belgium
| | - Carmen Ribes-Koninckx
- Pediatric Gastroenterology, La Fe University Hospital, Instituto de Iinvestigacion Sanitaria La FE Valencia, 46026 Valencia, Spain;
| | - Silvia Salvatore
- Department of Paediatrics, University of Insubria, 21100 Varese, Italy;
| | - Raanan Shamir
- Institute of Gastroenterology, Nutrition and Liver Diseases, Schneider Children’s Medical Center, Lea and Arieh Pickel for Pediatric Research, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv 69978, Israel;
| | - Hania Szajewska
- Department of Paediatrics, The Medical University of Warsaw, 02-014 Warsaw, Poland;
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Vandenplas Y. Breastfeeding and its risk factors. J Pediatr (Rio J) 2022; 98:219-220. [PMID: 35120884 PMCID: PMC9432162 DOI: 10.1016/j.jped.2021.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 12/30/2021] [Indexed: 11/25/2022] Open
Affiliation(s)
- Yvan Vandenplas
- Vrije Universiteit Brussel (VUB), UZ Brussel, KidZ Health Castle, Belgium.
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Alshehri DB, Sindi HH, AlMusalami IM, Rozi IH, Shagrani M, Kamal NM, Alahmadi NS, Alfuraikh SS, Vandenplas Y. Saudi Experts Consensus on Diagnosis and Management of Pediatric Functional Constipation. Pediatr Gastroenterol Hepatol Nutr 2022; 25:163-179. [PMID: 35611377 PMCID: PMC9110844 DOI: 10.5223/pghn.2022.25.3.163] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 01/02/2022] [Accepted: 03/07/2022] [Indexed: 11/14/2022] Open
Abstract
Although functional gastrointestinal disorders (FGIDs) are very common in pediatric patients, there is a scarcity of published epidemiologic data, characteristics, and management patterns from Saudi Arabia, which is the 2nd largest Arabic country in terms of area and the 6th largest Arabic country in terms of population, with 10% of its population aged <5 years. Functional constipation (FC) is an FGID that has shown a rising prevalence among Saudi infants and children in the last few years, which urges us to update our clinical practices. Nine pediatric consultants attended two advisory board meetings to discuss and address current challenges, provide solutions, and reach a Saudi national consensus for the management of pediatric constipation. The pediatric consultants agreed that pediatricians should pay attention to any alarming signs (red flags) found during history taking or physical examinations. They also agreed that the Rome IV criteria are the gold standard for the diagnosis of pediatric FC. Different therapeutic options are available for pediatric patients with FC. Dietary treatment is recommended for infants with constipation for up to six months of age. When non-pharmacological interventions fail to improve FC symptoms, pharmacological treatment with laxatives is indicated. First, the treatment is aimed at disimpaction to remove fecal masses. This is achieved by administering a high dose of oral polyethylene glycol (PEG) or lactulose for a few days. Subsequently, maintenance therapy with PEG should be initiated to prevent the re-accumulation of feces. In addition to PEG, several other options may be used, such as Mg-rich formulas or stimulant laxatives. However, rectal enemas and suppositories are usually reserved for cases that require acute pain relief. In contrast, infant formulas that contain prebiotics or probiotics have not been shown to be effective in infant constipation, while the use of partially hydrolyzed formula is inconclusive. These clinical practice recommendations are intended to be adopted by pediatricians and primary care physicians across Saudi Arabia.
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Affiliation(s)
- Dhafer B Alshehri
- Department of Pediatrics, Faculty of Medicine, Najran University, Najran, Saudi Arabia
| | | | | | | | - Mohamed Shagrani
- King Faisal Specialist Hospital and Research Centre, Pediatric Gastroenterology, Riyadh, Saudi Arabia
| | - Naglaa M Kamal
- Pediatric Department, Kasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt.,Pediatric Hepatology, Gastroenterology and Nutrition, Alhada Armed Forces Hospital, Taif, Saudi Arabia
| | - Najat Saeid Alahmadi
- Pediatric Department, King Salman Medical City, Ministry of Health, Almadinah Almonawarah, Saudi Arabia
| | - Samia Saud Alfuraikh
- King Abdul Aziz Hospital, Ministry of National Guard Health Affairs, Eastern Region, Saudi Arabia
| | - Yvan Vandenplas
- Vrije Universiteit Brussel, UZ Brussel, KidZ Health Castle, Brussels, Belgium
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Vandenplas Y, Ksiażyk J, Luna MS, Migacheva N, Picaud JC, Ramenghi LA, Singhal A, Wabitsch M. Partial Hydrolyzed Protein as a Protein Source for Infant Feeding: Do or Don't? Nutrients 2022; 14:nu14091720. [PMID: 35565688 PMCID: PMC9103110 DOI: 10.3390/nu14091720] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 03/25/2022] [Accepted: 04/18/2022] [Indexed: 11/16/2022] Open
Abstract
Exclusive breastfeeding until the age of six months is the recommended feeding method for all infants. However, this is not possible for every infant. Therefore, a second choice of feeding, as close as possible to the gold standard, is needed. For historical reasons, this has been cow’s-milk-based feeding. This paper discusses if this second-choice feeding method should contain intact protein or partially hydrolyzed proteins. The limited data available indicates that mother’s milk is relatively rich in bioactive peptides. Whether partially hydrolyzed protein might be a protein source closer to human milk protein content than intact cow’s milk needs further research. However, more research on protein and bioactive peptides in mother’s milk should be a priority for future scientific development in this field. Results of such research will also provide an answer to the question of which option would be the best second choice for infant feeding if sufficient breast milk is not available.
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Affiliation(s)
- Yvan Vandenplas
- KidZ Health Castle, Vrije Universiteit Brussel (VUB), 1090 Brussel, Belgium
- Correspondence: ; Tel.: +32-475748794
| | - Janusz Ksiażyk
- Department of Pediatrics, Nutrition, and Metabolic Diseases, The Children’s Memorial Health Institute, 04-730 Warsaw, Poland;
| | - Manuel Sanchez Luna
- Neonatology Division and NICU, Hospital General Universitario “Gregorio Marañón”, Complutense University of Madrid, 28009 Madrid, Spain;
| | - Natalia Migacheva
- Department of Pediatrics, Samara State Medical University, 443084 Samara, Russia;
| | - Jean-Charles Picaud
- Department of Neonatology, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, F69677 Lyon, France;
- CarMen Laboratory, INSERM, INRA, Claude Bernard University Lyon1, F69310 Pierre-Benite, France
| | - Luca A. Ramenghi
- Department of Neuroscience, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, 16147 Genoa, Italy;
| | - Atul Singhal
- Childhood Nutrition Research Centre, PPP Department, UCL GOS Institute of Child Health, London WC1N 1EH, UK;
| | - Martin Wabitsch
- Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics and Adolescent Medicine, University of Ulm, 89075 Ulm, Germany;
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Lievens L, Vandenplas Y, Vanlaethem S, Van Ginderdeuren F. The effects of assisted autogenic drainage, combined or not with bouncing on gastroesophageal reflux in infants. Acta Paediatr 2022; 111:866-872. [PMID: 34923656 DOI: 10.1111/apa.16224] [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: 09/07/2021] [Revised: 11/11/2021] [Accepted: 12/16/2021] [Indexed: 11/29/2022]
Abstract
AIM This study aimed to determine the effect of assisted autogenic drainage (AAD) with or without bouncing (BAAD) on both acid and non-acid gastroesophageal reflux (GER) in infants <1 year. METHODS During a 24-h multichannel intraluminal impedance-pH monitoring (MII-pH), infants were treated with a 20-min intervention of AAD (in supine position) or BAAD (in upright position), 2 h postprandial. In this controlled trial with intra-subject design, the number of reflux episodes (REs) was the primary outcome measure. The results during AAD and BAAD were compared to a baseline period before intervention and 20 min after intervention. RESULTS Overall, 50 infants were included in both groups. During AAD a significant decrease of RE's was found compared to baseline (p = 0.001). No significant differences were found in the BAAD group compared to baseline (p = 0.125). CONCLUSION AAD and BAAD do not cause or increase GER in infants under the age of 1 year.
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Affiliation(s)
- Laure Lievens
- Rehabilitation Research Department of Physiotherapy Human Physiology and Anatomy Faculty of Physical Education and Physiotherapy Vrije Universiteit Brussel Brussels Belgium
| | - Yvan Vandenplas
- Vrije Universiteit Brussel UZ Brussel KidZ Health Castle Brussels Belgium
| | | | - Filip Van Ginderdeuren
- Rehabilitation Research Department of Physiotherapy Human Physiology and Anatomy Faculty of Physical Education and Physiotherapy Vrije Universiteit Brussel Brussels Belgium
- Vrije Universiteit Brussel UZ Brussel KidZ Health Castle Brussels Belgium
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Bahbah WA, ElHodhod M, Salah M, AlRefaee F, AlTuraiki M, Mousa S, Al Mehaidib A, Ayesh WH, El-Bazzar AN, El Haddad J, El Khashab HY, El Zawahry A, Hasosah M, Shaaban SY, Vandenplas Y. A Survey to Identify the Current Management of Cow’s Milk Disorders and the Role of Goat Milk-Based Formulas in the Middle East and North Africa Region. Nutrients 2022; 14:nu14051067. [PMID: 35268042 PMCID: PMC8912394 DOI: 10.3390/nu14051067] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 01/18/2022] [Accepted: 01/20/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Cow’s milk allergy (CMA) and cow’s milk intolerance (CMI) are the major cow’s milk disorders observed in infants and young children. This study investigates, for the first time, physician knowledge regarding CMA and CMI prevalence, diagnosis, and management in the Middle East and North Africa (MENA) region. In addition, we explore the role of goat milk-based formula as an alternative in infants suffering from CMI. Method: This cross-sectional survey was conducted from December 2020 to February 2021. A convenience sample of 2500 MENA-based physicians received the questionnaire, developed by a working group of pediatric experts. Results: 1868 physicians completed the questionnaire, including pediatric specialists (80.8%), training physicians (0.2%), dermatologists (0.1%), family/general physicians (12.9%), neonatologists (3.6%), neurosurgeons (0.2%), allergy nurse specialists (0.3%), pharmacists (2.1%), and public health workers (0.1%). Differentiation between CMA and CMI was recognized by the majority of respondents (80.7%), for which the majority of respondents (35.4%) identified that the elimination and challenge test was the best test to differentiate CMA from CMI, whereas 30.7% and 5.4% preferred the immunoglobulin E (IgE) test and skin prick test, respectively. In addition, 28.5% of respondents reported that there is no confirmatory test to differentiate CMA from CMI. The majority of respondents (47.3%) reported that amino acid-based formula (AAF)/ extensively hydrolyzed formula (EHF) is the cornerstone for the management of CMA. However, most respondents (33.7%) reported that lactose avoidance was best for the management of CMI. Overall, 65% of the respondents were aware of nutritionally adapted goat’s milk formula as an alternative to cow’s milk products and 37% would recommend its routine use in infants (≤2 years of age). Conclusion: The results of this survey demonstrate that the majority of physicians are aware of the underlying pathophysiology and management of CMA and CMI. However, a significant proportion of physicians do not follow the clinical guidelines concerning CMA/CMI diagnosis and management. Notably, this survey identified that goat’s milk formulas may offer a suitable alternative to AAF/EHF in infants with CMI as they contain β-casein protein which is easily digestible. In addition, goat’s milk formulas contain higher levels of oligosaccharides and medium-chained fatty acids compared with standard cow’s milk formulas, yet further clinical trials are warranted to support the inclusion of goat’s milk formulas in clinical guidelines.
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Affiliation(s)
- Wael A. Bahbah
- Department of Pediatrics, Faculty of Medicine, Menoufia University, Shebin El-Kom 32511, Egypt;
| | - Mostafa ElHodhod
- Faculty of Medicine, Ain Shams University, Cairo 11566, Egypt;
- Faculty of Medicine, October 6 University, Giza 12511, Egypt
| | | | - Fawaz AlRefaee
- Department of Pediatrics, Al Adan Hospital, Ministry of Health, Kuwait City P.O. Box 46969, Kuwait;
| | - Muath AlTuraiki
- Department of Pediatrics, King Salman Hospital, Riyadh 12769, Saudi Arabia;
| | - Samira Mousa
- Medical Department, Faculty of Veterinary Medicine, Benha University, Benha 13518, Egypt;
| | - Ali Al Mehaidib
- Department of Pediatrics, King Faisal Specialist Hospital & Research Center, Riyadh 11211, Saudi Arabia;
| | - Wafaa Helmi Ayesh
- Department of Clinical Nutrition, Dubai Health Authority, Dubai P.O. Box 4545, United Arab Emirates;
| | - Ahmed N. El-Bazzar
- Department of Pediatrics, Ministry of Health Hospitals, Cairo 12613, Egypt;
| | - Joseph El Haddad
- Department of Pediatrics and Neonatology, Saint George University Hospital, Beirut 1100, Lebanon;
| | - Heba Y. El Khashab
- Department of Pediatrics, Sulaiman Al Habib Medical Group, Riyadh 12214, Saudi Arabia;
- Department of Pediatrics, Ain Shams University, Cairo 11566, Egypt
| | - Amr El Zawahry
- Pediatrics Department, King’s College Hospital London, Dubai P.O. Box 340901, United Arab Emirates;
- Department of Pediatrics, Sharjah University, Sharjah P.O. Box 27272, United Arab Emirates
| | - Mohammed Hasosah
- King Abdullah International Medical Research Center, Pediatric Gastroenterology Department, National Guard Hospital, King Saud Bin Abdulaziz University for Health Sciences, Jeddah 21482, Saudi Arabia;
| | - Sanaa Youssef Shaaban
- Department of Pediatrics, Faculty of Medicine, Ain Shams University, Cairo 11566, Egypt;
| | - Yvan Vandenplas
- KidZ Health Castle, UZ Brussel, Vrije Universiteit Brussel, 1090 Brussels, Belgium
- Correspondence:
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Kołodziej M, Gieruszczak‐Białek D, Pieścik‐Lech M, Skórka A, Vandenplas Y, Szajewska H. Overuse continues despite no new evidence on the efficacy of proton pump inhibitors for crying and irritability in infants. Acta Paediatr 2022; 111:682-683. [PMID: 34837407 DOI: 10.1111/apa.16201] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 11/24/2021] [Accepted: 11/25/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Maciej Kołodziej
- Department of Paediatrics The Medical University of Warsaw Warsaw Poland
| | | | | | - Agata Skórka
- Department of Paediatrics The Medical University of Warsaw Warsaw Poland
| | - Yvan Vandenplas
- Vrije Universiteit BrusselUZ BrusselKidZ Health Castle Brussels Belgium
| | - Hania Szajewska
- Department of Paediatrics The Medical University of Warsaw Warsaw Poland
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Hofman D, Kudla U, Miqdady M, Nguyen TVH, Morán-Ramos S, Vandenplas Y. Faecal Microbiota in Infants and Young Children with Functional Gastrointestinal Disorders: A Systematic Review. Nutrients 2022; 14:nu14050974. [PMID: 35267949 PMCID: PMC8912645 DOI: 10.3390/nu14050974] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 02/15/2022] [Accepted: 02/22/2022] [Indexed: 01/27/2023] Open
Abstract
Functional gastrointestinal disorders (FGIDs) refer to gastrointestinal tract issues that lack clear structural or biochemical causes. Their pathophysiology is still unclear, but gut microbiota alterations are thought to play an important role. This systematic review aimed to provide a comprehensive overview of the faecal microbiota of infants and young children with FGIDs compared to healthy controls. A systematic search and screening of the literature resulted in the inclusion of thirteen full texts. Most papers reported on infantile colic, only one studied functional constipation. Despite methodological limitations, data show alterations in microbial diversity, stability, and colonisation patterns in colicky infants compared to healthy controls. Several studies (eight) reported increases in species of (pathogenic) Proteobacteria, and some studies (six) reported a decrease in (beneficial) bacteria such as Lactobacilli and Bifidobacteria. In addition, accumulation of related metabolites, as well as low-grade inflammation, might play a role in the pathophysiology of infantile colic. Infants and toddlers with functional constipation had significantly lower levels of Lactobacilli in their stools compared to controls. Microbial dysbiosis and related changes in metabolites may be inherent to FGIDs. There is a need for more standardised methods within research of faecal microbiota in FGIDs to obtain a more comprehensive picture and understanding of infant and childhood FGIDs.
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Affiliation(s)
- Denise Hofman
- FrieslandCampina, Stationsplein 1, 3818 LE Amersfoort, The Netherlands;
- Correspondence:
| | - Urszula Kudla
- FrieslandCampina, Stationsplein 1, 3818 LE Amersfoort, The Netherlands;
| | - Mohamad Miqdady
- Ped. GI, Hepatology & Nutrition Division, Sheikh Khalifa Medical City, P.O. Box 51900, Abu Dhabi 51133, United Arab Emirates;
| | - Thi Viet Ha Nguyen
- Department of Pediatrics, Hanoi Medical University, Hanoi 116001, Vietnam;
| | - Sofía Morán-Ramos
- Unidad de Genomica de Poblaciones, Instituto Nacional de Medicina Genomica, Mexico City 14610, Mexico;
| | - Yvan Vandenplas
- Paediatric Gastro-Enterology and Nutrition, Vrije Universiteit Brussel, UZ Brussel, KidZ Health Castle, 1050 Brussels, Belgium;
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Alliet P, Vandenplas Y, Roggero P, Jespers SNJ, Peeters S, Stalens JP, Kortman GAM, Amico M, Berger B, Sprenger N, Cercamondi CI, Corsello G. Safety and efficacy of a probiotic-containing infant formula supplemented with 2'-fucosyllactose: a double-blind randomized controlled trial. Nutr J 2022; 21:11. [PMID: 35193609 PMCID: PMC8862345 DOI: 10.1186/s12937-022-00764-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 02/08/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Human milk oligosaccharides (HMOs) have important and diverse biological functions in early life. This study tested the safety and efficacy of a starter infant formula containing Limosilactobacillus (L.) reuteri DSM 17938 and supplemented with 2'-fucosyllactose (2'FL). METHODS Healthy infants < 14 days old (n = 289) were randomly assigned to a bovine milk-based formula containing L. reuteri DSM 17938 at 1 × 107 CFU/g (control group; CG) or the same formula with added 1.0 g/L 2'FL (experimental group; EG) until 6 months of age. A non-randomized breastfed group served as reference (BF; n = 60). The primary endpoint was weight gain through 4 months of age in the formula-fed infants. Secondary endpoints included additional anthropometric measures, gastrointestinal tolerance, stooling characteristics, adverse events (AEs), fecal microbiota and metabolism, and gut immunity and health biomarkers in all feeding groups. RESULTS Weight gain in EG was non-inferior to CG as shown by a mean difference [95% CI] of 0.26 [-1.26, 1.79] g/day with the lower bound of the 95% CI above the non-inferiority margin (-3 g/day). Anthropometric Z-scores, parent-reported stooling characteristics, gastrointestinal symptoms and associated behaviors, and AEs were comparable between formula groups. Redundancy analysis indicated that the microbiota composition in EG was different from CG at age 2 (p = 0.050) and 3 months (p = 0.052), approaching BF. Similarly, between sample phylogenetic distance (weighted UniFrac) for BF vs EG was smaller than for BF vs CG at 3-month age (p = 0.045). At age 1 month, Clostridioides difficile counts were significantly lower in EG than CG. Bifidobacterium relative abundance in EG tracked towards that in BF. Fecal biomarkers and metabolic profile were comparable between CG and EG. CONCLUSION L. reuteri-containing infant formula with 2'FL supports age-appropriate growth, is well-tolerated and may play a role in shifting the gut microbial pattern towards that of breastfed infants. TRIAL REGISTRATION The trial was registered on ClinicalTrials.gov ( NCT03090360 ) on 24/03/2017.
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Affiliation(s)
| | - Yvan Vandenplas
- KidZ Health Castle, Vrije Universiteit Brussel, UZ Brussel, Brussels, Belgium
| | - Paola Roggero
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | | | | | | | | | - Mailis Amico
- Biostatistics & Data, Nestlé Research, Société des Produits Nestlé S.A., Lausanne, Switzerland
| | - Bernard Berger
- Nestlé Institute of Health Sciences, Nestlé Research, Société des Produits Nestlé S.A., Lausanne, Switzerland
| | - Norbert Sprenger
- Nestlé Institute of Health Sciences, Nestlé Research, Société des Produits Nestlé S.A., Lausanne, Switzerland
| | - Colin I Cercamondi
- Nestlé Product Technology Center - Nutrition, Société des Produits Nestlé S.A., Vevey, Switzerland.
| | - Giovanni Corsello
- Department of Health Promotion Sciences Maternal and Infant Care, University of Palermo, Palermo, Italy
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Vandenplas Y, Zhao ZY, Mukherjee R, Dupont C, Eigenmann P, Kuitunen M, Ribes Koninckx C, Szajewska H, von Berg A, Bajerová K, Meyer R, Salvatore S, Shamir R, Järvi A, Heine RG. Assessment of the Cow's Milk-related Symptom Score (CoMiSS) as a diagnostic tool for cow's milk protein allergy: a prospective, multicentre study in China (MOSAIC study). BMJ Open 2022; 12:e056641. [PMID: 35177461 PMCID: PMC8860045 DOI: 10.1136/bmjopen-2021-056641] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES The MOSAIC study aimed to evaluate if the Cow's Milk-related Symptom Score (CoMiSS) can be used as a stand-alone diagnostic tool for cow's milk protein allergy (CMPA). DESIGN Single-blinded, prospective, multicentre diagnostic accuracy study. SETTING 10 paediatric centres in China. PARTICIPANTS 300 non-breastfed infants (median age 16.1 weeks) with suspected CMPA. INTERVENTIONS After performing the baseline CoMiSS, infants commenced a cow's milk protein elimination diet with amino acid-based formula for 14 days. CoMiSS was repeated at the end of the elimination trial. Infants then underwent an open oral food challenge (OFC) with cow's milk-based formula (CMF) in hospital. Infants who did not react during the OFC also completed a 14-day home challenge with CMF. A diagnosis of CMPA was made if acute or delayed reactions were reported. PRIMARY OUTCOME MEASURES A logistic regression model for CoMiSS to predict CMPA was fitted and a receiver-operator characteristic (ROC) curve generated. An area under the curve (AUC) of ≥0.75 was deemed adequate to validate CoMiSS as a diagnostic tool (target sensitivity 80%-90% and specificity 60%-70%). RESULTS Of 254 infants who commenced the OFC, 250 completed both challenges, and a diagnosis of CMPA made in 217 (85.4%). The median baseline CoMiSS in this group fell from 8 (IQR 5-10) to 5 (IQR 3-7) at visit 2 (p<0.000000001), with a median change of -3 (IQR -6 to -1). A baseline CoMiSS of ≥12 had a low sensitivity (20.3%), but high specificity (87.9%) and high positive predictive value (91.7%) for CMPA. The ROC analysis with an AUC of 0.67 fell short of the predefined primary endpoint. CONCLUSIONS The present study did not support the use of CoMiSS as a stand-alone diagnostic tool for CMPA. Nevertheless, CoMiSS remains a clinically useful awareness tool to help identify infants with cow's milk-related symptoms. TRIAL REGISTRATION NUMBER NCT03004729; Pre-results.
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Affiliation(s)
- Yvan Vandenplas
- Vrije Universiteit Brussel, UZ Brussel, KidZ Health Castle, Brussels, Belgium
| | - Zheng-Yan Zhao
- Children's Hospital Zhejiang, University School of Medicine, Zhejiang University, Hangzhou, China
| | | | - Christophe Dupont
- Department of Paediatrics, Hôpital Necker-Enfants Malades, Paris, France
| | - Philippe Eigenmann
- Department of Infants and Adolescents, University Hospitals Geneva, Geneva, Switzerland
| | - Mikael Kuitunen
- New Children's Hospital, Helsinki University Central Hospital, Helsinki, Finland
| | - Carmen Ribes Koninckx
- Paediatric Gastroenterology, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Hania Szajewska
- Department of Paediatrics, Medical University of Warsaw, Warszawa, Poland
| | - Andrea von Berg
- Research Institute, Department of Paediatrics, Marien-Hospital Wesel, Wesel, Germany
| | - Kateřina Bajerová
- Research Institute, Department of Paediatrics, Marien-Hospital Wesel, Wesel, Germany
| | - Rosan Meyer
- Department of Paediatrics, Imperial College London, London, UK
| | - Silvia Salvatore
- Department of Paediatrics, Hospital 'F. Del Ponte', University of Insubria, Varese, Italy
| | - Raanan Shamir
- Institute for Gastroenterology, Nutrition and Liver Disease, Schneider Children's Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Vandenplas Y, Depoorter L. Reply to von Bünau et al. Comment on "Depoorter, L.; Vandenplas, Y. Probiotics in Pediatrics. A Review and Practical Guide. Nutrients 2021, 13, 2176". Nutrients 2022; 14:725. [PMID: 35215375 PMCID: PMC8880261 DOI: 10.3390/nu14040725] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 01/11/2022] [Indexed: 02/01/2023] Open
Abstract
We agree with Prof. Stange and Erhardt for their comment on our paper on Probiotics in Pediatrics [...].
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Affiliation(s)
- Yvan Vandenplas
- KidZ Health Castle, UZ Brussel, Vrije Universiteit Brussel, 1090 Brussels, Belgium;
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50
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Abstract
Much evidence has been accumulated over recent years on the importance of the first 1000 days of a child's life, starting from conception to the postnatal age of two years, with regard to the risk of developing allergic disease [...].
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Affiliation(s)
- Yvan Vandenplas
- KidZ Health Castle, UZ Brussel, Vrije Universiteit Brussel, 1090 Brussels, Belgium
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