Probiotics are live microorganisms that confer health benefits to the host when administered in adequate amounts. Although recommendations for probiotic use should be strain-specific, many systematic ...reviews, including recommendations from different societies, recommend probiotic use in general, providing no relevant information for healthcare professionals regarding which probiotic to recommend for which clinical indication, at what dose, and for how long. This narrative review aimed to present the available evidence on the use of probiotics in the prevention and treatment of common gastrointestinal diseases in children, considering the strain and dose used. Furthermore, this study summarizes the evidence on the possible side effects and quality of products containing probiotics.
A positive correlation between malnutrition and length of hospital stay has been shown previously. However, the impact of malnutrition on an incidence of nosocomial infections and their effect on the ...duration of hospitalization has not been established among paediatric patients in developed countries. We investigated the correlation between malnutrition, nosocomial infections and LOS in hospitalized children in our University Children's Hospital.
We conducted prospective longitudinal cohort study during the period of 1 year. Nutritional status (body weight and length/height, body mass index) was measured on hospital admission and the existence and type of nosocomial infections were monitored and evaluated during hospital stay of all recruited children.
367 paediatric patients were included into the study (girls 184, 50.1%; mean age 7.3 years (IQR: 1 month - 18 years). On hospital admission overall 47 patients (12.8%) were malnourished; moderate malnutrition (BMI −2 to −3 SDS) was present in 8.7% patients, severe malnutrition (BMI <−3 SDS) in 4.1%, and 29 (7.9%) patients were stunted ((body length) BL/(body height) BH < −2 SDS). Altogether 21 children (5.7%) experienced nosocomial infection. Malnourished patients acquired nosocomial infections significantly more often in comparison to well-nourished patients (11/47 (23.4%) vs. 11/318 (3.5%), respectively; p < 0.001). The LOS was significantly longer in children who were malnourished (12.3 vs. 7.3 days, respectively; p = 0.004), and by an identical number of days, the hospitalization was prolonged also in children who developed nosocomial infection (12.3 vs. 7.3 days, respectively; p = 0.004). Binary logistic regression showed that odds of acquiring nosocomial infections were 5 times higher (RR 5.1 (95% CI 2.276–11.485)) in children who were malnourished, and the risk increased with prolonged hospital stay.
Malnutrition is an important risk factor for developing nosocomial infection, and they both independently increase LOS. However, what is the cause and what is the consequence in the vicious circle of malnutrition, nosocomial infection and LOS remains questionable. Nevertheless, the timely addressed malnutrition could prevent longer hospital stay and higher incidence of nosocomial infection.
Background and aims: From the patients’ perspective, diet has a relevant role in triggering symptoms of inflammatory bowel disease (IBD). There is a lack of prospective studies regarding the diet of ...children with IBD. The aim of this study was to assess the frequency and impact of self-imposed elimination diets on the nutritional status and clinical course of disease in the pediatric population. Methods: This was a prospective case-control study that included newly diagnosed patients with IBD and healthy controls (age/sex-matched peers and siblings) over a one-year period. The participants were examined in three categories: (1) anthropometric data and nutritional status; (2) dietary intake, as obtained by a Food Frequency Questionnaire (FFQ); and (3) dietary beliefs and elimination diets, as obtained by a structured questionnaire. Results: Overall, one-hundred and thirty-seven participants were included (twenty-eight with Crohn’s disease, sixteen with ulcerative colitis, three with IBD-unclassified, and seventy healthy controls). Only 15% of patients followed the self-imposed elimination diet upon the diagnosis, which increased to 47.6% by the end of the follow-up. The elimination diet did not influence the nutritional status and quality of the diet. Self-imposed elimination diets were not a risk factor for disease relapse. Most of the patients received nutritional counseling during the follow-up. Conclusions: The number of patients following self-imposed elimination diets had increased during the disease course but with no influence on nutritional status or relapse risk.
Fat overload syndrome is a well-known complication of intravenous lipid emulsion therapy. It is characterized by headaches, fever, jaundice, hepatosplenomegaly, respiratory distress, and spontaneous ...hemorrhage. Other symptoms include anemia, leukopenia, thrombocytopenia, low fibrinogen levels, and coagulopathy. Several reports in the literature describe fat overload syndrome caused by rapid infusion of lipid emulsions, all with soybean-based lipid emulsions. We report fat overload syndrome in a 2-year-old girl with short bowel syndrome on home parenteral nutrition. Fat overload syndrome occurred as a result of accidental, very rapid infusion of a 20% soy oil, medium-chain triglyceride, olive and fish oil–based lipid emulsion (SMOFlipid) that showed the same complications seen with an earlier lipid emulsion (Intralipid). The patient was successfully treated with supportive care combining fluid infusion, transfusion of platelets, and substitution of serum albumin (0.5 g/kg/d) and fresh-frozen plasma (10 mL/kg). In the next couple of days, she received extra platelets, erythrocyte transfusion, and filgrastim (Neupogen; 5 µg/kg/d) due to a very low leukocyte count. To the best of our knowledge, this is the first case of fat overload syndrome caused by SMOFlipid emulsion described in the literature.
In this trial involving infants at high risk for celiac disease, the introduction of gluten at 4 months of age, as compared with delayed exposure to gluten until 6 months of age, did not reduce the ...risk of celiac disease at 3 years of age.
Celiac disease, an immune-mediated systemic disorder elicited by gluten in genetically susceptible persons, is characterized by anti–transglutaminase type 2 antibodies (TG2A) and enteropathy.
1
The prevalence of celiac disease is 1 to 3% in the general population and approximately 10% among first-degree family members of patients with celiac disease.
2
–
10
Celiac disease is treated with a gluten-free diet. More than 95% of patients have the HLA-DQ2 heterodimer, either in the
cis
or
trans
configuration. Most of the remaining patients have the HLA-DQ8 heterodimer or half of the HLA-DQ2 heterodimer (DQB1*02).
1
,
8
,
11
–
14
However, more than 25% of the general population . . .
Possible therapeutic effect of Lactobacillus (L.) reuteri DSM 17938 has been reported in children with functional abdominal pain (FAP) but data are inconclusive.
This is a randomized double-blinded ...controlled trial (RCT) which assessed effect of L. reuteri DSM 17938 (dose 108 CFU/day) in children (age 4–18 years) on FAP during an intervention period of 12 weeks and follow-up of 4 weeks. This study was performed after the interim analysis and had different labeling of products and a new randomization. Data presented here are results of this RCT and pooled data from both RCTs (before and after interim analysis).
This RCT included 46 children (median age 10.1 vs 10.6 years; 11 vs 13 girls). Abdominal pain was less severe in intervention group during the 4th month of the study and there was significant increase in the number of days without pain. Pooled data from both parts of the study included 101 children. Number of days without pain was significantly higher in the L. reuteri group (mean difference 26.42 days, 95% CI 22.47–30.17). Significant difference in the pain intensity was found after 2nd, 3rd and 4th month of the intervention. There was no difference between groups in the number of children in whom symptoms completely ceased (Risk Ratio 1.09, 95% CI 0.75–1.58).
Administration of L. reuteri DSM 17938 was associated with the reduction in the intensity of pain and with significantly increase in pain-free days in children with FAP.
Background
Data on the efficacy of the newly established dietetic treatment of Crohn's disease (CD), the CD exclusion diet (CDED), are scarce. The aim of this study was to provide real‐world data on ...the efficacy of CDED in comparison with exclusive enteral nutrition (EEN) for remission induction.
Methods
A retrospective analysis of children diagnosed with CD who were treated with CDED + partial EN (PEN) or with EEN was performed. Eighty percent of the children assigned to CDED + PEN underwent 1–2 weeks of EEN prior to CDED + PEN. For all children, data from the medical charts were extracted before the introduction of diet therapy and at the end of EEN or CDED + PEN phase 1.
Results
A total of 61 patients (49.2% females; median age, 14.4 years minimum: 6.7, maximum: 17.9) were included in the study; 42 children (68.9%) achieved remission, 27 of 41 (65.9%) received EEN and 15 of 20 (75.0%) received CDED + PEN. There was no significant difference in the failure of nutrition therapy between the two groups (P = .469). Patients receiving CDED + PEN had significantly higher weight gain (P = .002) and increases in body mass index z‐score (P = .001) compared with patients who received EEN alone.
Conclusion
Treatment with CDED + PEN (with prior 1–2 weeks of EEN) has comparable efficacy to EEN therapy alone in inducing remission in children with CD, and it leads to better weight gain. Further studies are needed to confirm these results.
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